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HomeMy WebLinkAboutPermit Building 1981-2-17 ~/ INSPECTION LINE' 726-3769 .~ 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 m - o @ -.:) 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 ~ -/7-P/ -, I ,~ 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. ~ 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: ""lIllIII taRMIT VALIDATION \1B1 . 'C l. . ~cJ QA 55~L\' Permit Clery DAN SiiHTH ,;gna,u,.-CYVI1_ )f!ljrd-j_) namp rJ;1 JJll ) , \ c- r1atf' 2-16-81