HomeMy WebLinkAboutPermit Building 1981-2-17
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INSPECTION LINE'
726-3769
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CITY OF SPRINGFIELD
COMBINAt:ION APPLICATION/PERMIT
.,
INFORMATION LINE
726-3753
Job Address 724 Centenni a 1 Bl vd.
Legal Description 17-03-26-43. Tax Lot # 8200
ENER~bt~CES:
Heat ,
Water Heater
Ra nge
Value of Work:
Sq. Ftg, Main
Sq. Ftg, Access.
Sq. Ftg. Other APPROX 300 I
_New_Add_Alter_Rep,
_Fence_Dema_Change/ Use
_Other
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Owner
Frank S. Copperfield
724 Centennial Blvd.
Springfield.Oreqon
Phone 726-6636
2,201.00
Building Permit Infa: Describe Work (i.e., Build Single
Family Residence With Attached Garage)
Address
Solar Greenhouse
Constructian Lender
Address
Phone
DESIGN TEAM
(name)
(address)
(lics. no.)
(expires)
(phone na.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lics. no.)
(expires)
(phone no.)
General
Ted Cantrell
724Centenn i a 1 Blvd. ~ Spil cL
7?6-6636
Plumbing
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE NO.
FEE CHARGE NO.
FEE I CHARGE
Each single fixture
Relacated building
(new fix. additional)
S.F. Residence
(1 bath)
." ft.
New circuits, alterations
or extensions
l)
furnace/burner to
BTU's
Appliance vent
separate
Stationary evap.
caoler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
haod and duct
Residence of
SERVICES
Duplex (1 bath) each
'Temporary Canstructian
Additional bath
Amps,
Water service
Sewer
Wood stave/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
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 panel.
I HA VE CAREFULLY EXAMINED the 'completed application for permit, and da 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 a s required by ORS 701.055, that if exempt the basis for exemption is noted
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:
SIGNATURE~/~f~
FOR OFFICE USE ONLY
DATE
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NAME (please print) 1=1\1.'1-1//1:' S ClJfJJ?EfE/ELb
~q. Ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
'( Value
x Value
Value
TOTAL VALUATION 2,201 .00
Systems Development
Charge (1.5%)
7.20 PD.. 2-11)-81. 55789
Total Comb. Permit
TOTAL
24.96
, COMBINATION APPlICA T10N/PERIllltAP)
;
";< I. Applicant to furnish
'.;:'~- A.' -Job Address
..
': '-,. B. Leg~1 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 valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot garage
2. example-if new project, check new-if addition, check
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 (0) 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.
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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, 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 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 time 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:
AdditionClI Project Information:
PLANS REVIEWED BY:
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