HomeMy WebLinkAboutPermit Building 1980-10-30 ,.. .. -'~ '"Ri(j \r~:.i::;.J~i'.;,l~'~:;-",,"~~lii.. . ~--'~'I''''':<:'~II'~~~~ ~M.'I.:~!!.;:d4.!j~:.t~~~~:~~.._..~:!::..'-~~~"';!II.:~,~u..o.;i.~ ~ (;;'-I!Il 1'IJ / / - -...: ~...._~ -~'~'I':>'-.or.n.._r" ."'-_v....-_ ._...........~..'-~.~":""1:~ INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY .sQUR~h C Heat t I ec INFORMATION LINE 726-3753 ~uu Sq, Ftg, Main Sq, Ftg. Access, Water Heater _ Sq. Ftg, Other Range _New_Add_Alter_Rep. Value of Work: _Fence_Demo_Chonge/Use Sidniy--Thwing, Edward Wood, -Bernie Hiat1 $3,500.00 ,_Other Building Permit Info: Describe Work (i.e" Build Single Gene Hiatt 663 Centennial Phane 741-1420 Family Residence With Attached Garage) Oregon 97477 Eugene Job Addreu 525 West Centennial Blvd Legal Description TI S10D~ 27 43 Owner Address Springfield, PFF, t~sP SpnCP for nttorney See also Job # 800525 Construction lender Address Phone DESIGN TEAM (no"';') (address) Primary Hiatt Brothers Soriqfield Structural Electrical Mechanical Ha rvev &. Pri r.e CONTRACTORS (name) (address) General Hi a tt Brothers Sorinqfield Plumbing T IA'; n R; \/(:>, V'c: F'llgpnp Sorinqfield Electrical Pen s e 1 in Mechanical PLUMBING ElECTR ICAl NO. I 3 I I I I FEE I CHARGE NO. 15.00115.00 sq, ft, New circuits, alterations or extensions Residence of I FEE I I I I I I I I 'I I I I I I Each single fixture Relacated building (new fix. additianal) S,F. Residence (1 bath) SERVICES Duplex (1 bath) each Temporary Canstructian Additional both 1 Amps. 100 Water service Sewer Storm Sewer FEEDERS Amps. TOT Al CHARGES 1 !:) _ n( I TOTAL CHARGES WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panfil. (lics, nd',) (expires) 00 o I-> o +:> ..... (phone no,) 741-1420 746-1621 (phone no.) 741-1420 683-1414 741-1186 FEE CHARGE (Iics. no.) (expires) 3.00 r I I I 16.00 12.00 10.00 ?l:innl I HA VE CAREFUllY EXAMINED the completed application far permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State af Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division. I further;' certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis far exemption is nated~ heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project, Basis for Builder's Board exemption: MECHANICAL CHARGE I I furnace/burner to I\TU's I Appliance vent separate I Stationary evap. cooler I Vent fan with single duct I Vent system apart from heating or A,C. I Mechanical exhaust hood and duct I Wood stove/ heater I Heat Pump I Air handler to 10,000 CFM I Air handler over 10,000 CFM I I I NO, I I 115.00 I I I I I I I 2 I I I I I I I I I 1 ISSUANCE OF PERMIT 11:i _ nn I TOTAL CHARGES NAME (please print) .J//~./ /0,/'/ ") ~L4t/t:/( SIGNATUR~--L-- h/ ~ ~ ~~j~r.. FOR OFFICE USE ONLY Zone Fire Zone Flood Plain r-=.? NU !j-~ ~--:' Ftg. Main ~q. Ftg. Access Sq, Ftg. Other V.=1J 1 Type/ Canst. Bedrooms c:.toriFU Units nccy load nccy Group BUilDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldq Per Fee 28.00 ------1~12 18.20 PLUMBING PERMIT Charges and Surcharges 15.00 Fence _ nO 'Demo _____ ,!:) no I Sidewalk .60 I A/C Pavin<:! 25.00 I Curb Cut ------C 00-' elECTRICAL PERMIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges '( Value Value Value t>oo x x TOTAL VALUATION Systems Development Charqe (1.5%) Plan Check Total Comb. Permit TOTAL DATE/0 -?cJ ..y-e I 3.500.00 18.20 86.32 104.52 ~~ '~~'~";";':;''''''' ':;',' ,\~',":" .( PERMIT V ALJDA nON COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or vC,lluation, etc. 1. example-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, che<:k add, etc. ;' F. Building permit information: 1. example-construct single family house with an.attached garage 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. . DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Me<:hanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will . prepare a typewritten copy and return it to the applicant at the t.me the actual permit is issued for his signature. IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. .- V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I , t Additional Project Information: ..... ,~'~ 1 :1 ITY OF SPRINGFIELD ~ ; -.-! . City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B 5 5 0 6 5 ~ \()- ~0,190.0 '),.1 i- . ~ Fro~\ \0 ->-.-A_) . '"\() !ss "-O~O~ ~\\ThJ\f\k~l~_, ,ed Fo' b \c1 f\ ,,')Ie) ,cO fJ(JJ(J \ 1 \L- ill~rY\ '() - u \.c;) (X) \- 4S~J, (00 .OJ \ 1 ~ ~ r--:r \ P) ,L'O .49-, ,(rO~ \I'\\~ t'M ~ d~ ~. ,~\( Y0 I, o~<< ~ {'tt) ,~.'2D ([ . '~.' t~ () ([ \TT.I . - :2- Int Received ,\ \.../"\ .5 ~t~ AUTHORIZEd SIGNATURE SHELTON-TURNBULL PfUNTEIil5 . t:UGE"'IE Olil g7..01 ~8~11'6 (lJ( ( ( ( Permit Clerk ...,___...._J ~'" r.;t-\I t:'nninpt>rino Division PLANS REVIEWED BY: /1 / . /) , /' i~/~' ,.j I J~' I;U-t~~ ~.4~' ./ . name nAN SMiTH signature date 10-21-80