The URL can be used to link to this page

Home My WebLink AboutPermit Building 1981-6-5 INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD -..s COMBINATION APPLlCA nON I PERMIT .4f INFORMATION LINE 726-3753 J00 ' Sq. Ftg. Main Sq, Ftg. Access, Sq. Ftg. Other ___Newd _Add ~Alter _Pep, . .Fence .._Demo_Change! U,e _.Other o<J o (}J E;- Job Address l I D "~n "7 03- /'>"7 d3" ~a escrlptl~_"- _ _ ._^ L:L . 5'25 W. CentenniC!l 81\'J. 1'- 5800 ENERGY W-VRCES: I,\c(.\.t. f:, ....'r' Heat .t.lectrlc Water Heater Elect;ri~_ v'\. j 0... Ronge Value of Work: Owner Hiatt, Hiatt, Wood & Thwing 663 W. Centennial PhUtl-1420 Springfield. Or. $1,500 Address I Building Permit Info: De,cribe Work (i.e.. Build Single Familv Re'iiJence With Attached Gora_ge) addition to existing law office Construction Lender P::l ("; of; (" 1<';_rst Federal Address Eugene Phone DESIGN TEAM (nome) (address) (lie,. no.) (expire,) , (phone no,) Primary Hiatt Bros. Investments Springfield " 741-1420 St(ucturol ~12ctricaf j,\echaniccl CONTRACTORS (nome) (address) (lie" no,) (expire,) (phone no,) Plumbing Hiatt Bros. Investments Twin Rivers Plumbing Penselin Electric Harvey & Price Springfield Eugene Springfield Springfield 20-96 20-48C 741-1420 683-1414 741-1186 746-1621 General Electricai Mechanical PLUMBING elECTRICAL MECHANICAL NO. I I i Each ,ingle fixture Relocored building (new fix, additional) S,F, Re,idence (1 both) FEE i CHARGE! NO, I I FEE I CHARGE I NO. FEE 'CHARGE Residence of furnace/ burner to BTU', .:2- er~. ft. New circuits, alterations or extensions SERVICES I/-sco I Appliance vent separate Stationary evop. cooler I Vent fan with , single duct Vent system apart from heating or A,C. Mechanical exhaust hood and duct 'j Duplex (1 both) each Temporary Construction Additional both Amps. Water service Sewer 'Wood stave/ heater Storm Sewer FEEDERS Heat Pump I' Air handler to 10,000 CFM Air handler over 10,000 CFM I I ~S"Q Amps, , ,., /VrfJ I eXTJ:.AI'D S'iS. I I I r I TOTAL CHARGES TOTAL CHARGES ISSUANCE OF PERMIT IS: CO I TOTAL CHARGES ID.tl{J I~.j-n WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shoil not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREFULLY EXAMINED the completed applieotion for permit, and do hereby certify that oil information hereon i, true and correct, and I further certify that any and 011 work perrormed sholl be done in accordance with the Ordinance, of the City of Springfield and the low, of the Stat" of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be mode of any ,tructure without the permission of the Building Div;,;on. I further certify that my registration with the Builder's Board is in full force and effect 0 s required by ORS 701.055, that if exempt the bo,is for exemption i, noted h"ron, and that only subcontractors and employee, who ore in compliance with ORS 701.055 will be u,ed on this project. NAME (plea,e print) /)E- jJ iV, S a-~,c/ p7( "lGNATURE~V~~~O( FOR OffiCE USE ONLY &-f-7;' DATE Bo,i, for Builder', Boord exemption: Zone d. -~ Typel Const. 'f/. - / )../ ~ } Unit. ()ccy load . r"lccy Group-B- 2.. "q. Ftg. Main "q, Ftg. Access Sq. Ftg, Other '( Value Value Fire Zone Flood Plain Bedrooms ~torip~ x x Value CJZJ TOTAL VALUATION ---i-500 BUILDING PERMIT Charge, and Surcharge, /s,oo , Ido Plan Ck. Comm/lnd 65%1 Bldg Per Fee Plan Ck, Res 30%1 Bid,! Per Fee 9, 7.s- System, Development Charge (1.5%) d:2. SO PLUMBING PERMIT Charge, and Surcharge, Fence P L, C I::. ~ I'll ~ q.7S' ~&,. ~,( Demo I Total Comb. Permit elECTRICAL PERMIT Charge, and Surcharge, / S. 00 Sidewalk ,~O AI C PovinQ ____J!i~~o CIJrb Cut ,s'iS I TOTAL ~7 iS3 MECHANICAL PERMIT Charge, and Surcharge, Ill. 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 time the actual permit is issued for his signature. IV. Fees and Charges t- 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. /' COMBINA nON APPlICA T10N/~~ " .IT (CAP) I. Applicant ~ furnish A. Job Address B. legal Description 1. example-tax lot 100, lane County Map Reference 2. example-lot 1. Block 3, 2nd Addition to Springfield 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 valuation, etc. 1. example-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check ~-if addition, chec add, etc. F. Building permit information: 1. example-construct single family house with an attae 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 c\ooid design or construction delays, Building Divisio Staff must be able to contact appropriate persons regal design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description port of the Mechanical and Electrical Schedules, the applicar need fill-in only the No. Boxes adjacent to the appropri. item(s) to be installed B. Full Plumbing, Mechanical, 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 a ated schedules you should consult the full schedules C. BUilDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: AdditionQI Project Information: PLANS REVIEWED BY: namp c,ignature ~ PERMIT VALIDATION (0: CITY Of SPRINGFIELD City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT .. . t::: No. B 56 6 7 6 "I Date' L'-\\.-L ~ 19'6 \ Rec'd From ~\crtt \ &.N ') .. . I Address U\D6 cU. ~~$~\r\)DJ -1 , 1 Received For: \~.c0 ~\\t,~_ J . . -~ 4J}(j .tCO {g ill 0 f'r \~,J:D f 4-0 .1.If:) ( "\'\\ ~~~~\ ll\ :so L\9r-, ,5~ ( ~~b q .IS n(). so ( Amount , BY t '\ Received (11;_ S3 ~\DeL; .8'''.. ( (~iD r I. AUTHORIZED SIGNATURE SHElTON.TUF'lNBl,JlL PRINTERS. EUGENE OR 97.01 ;, Permit CierI<- ).c~ G:,-/-11 ..fate t .