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Home My WebLink AboutPermit Building 1981-2-17 (2) ~7"'~., "1 I " / !yuy .:....--.;~,,, '<i __wa.:....-~_ J.. 1l.;.'Ii~J~UI 11",~ A.'i~'f""i'io'.\\, """"~:;'"'''''~~blii:l>''-_'''104~ ~y"""",,....1I:l' '.!-;;:tl'....."~h......;.,.~...;..;;. ;;U..J'~.'~ _....,'!!>' - ...~ ~,:; "" -. .~..41~;~,.'9'~-,.~ INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 Job Address 724 Centenni a 1 Bl vd. legal Description 17-03-26-43. TaLiQt #8~QD I ENER~bt1t~CES: Heat Water Heater Range Yalue of Work: Sq, Ftg, Main Sq. Ftg, Access Sq, Ftg, Other APPROX 1()~ _New _Add.___Alter _Rep. __Fence_Demo_Change/ Use _0'ther m o @ .-:J Owner Frank S. Coooerfield 724 Centennial Blvd. Springfield. Oreqon Phone 726-6636 ::>,201.00 Building Permit Info: Describe Work (i.e" Build Single Family Residence With Attoched Goroge) Address Solar Greenhouse Construction lender Address Phone DESIGN TEAM (name) (address) (Iics. no,) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (Iics. no.) (expires) (phone no,) General Ted Cantrell 724 Centennial Blvd.. Snild, 7?fi-fifiiFi Plumbing Electrical Mechanical PLUMBING elECTRICAL MECHANICAL N0', FEE CHARGE N0', FEE CHARGE N0', FEE I CHARGE Residence of furnace/ burner to BTU's Appliance vent separate Stationary evap. cooler Yent fan with single duct Yent system apart from heating or A.C. Mechanical exhaust hood and duct Each single fixture Relocated building (new fix, additional) S.F, Residence (1 bath) sq, ft. New circuits, alterations or extensions SERYICES Duplex (1 bath) each Temporary Construction Additional bath Amps, Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air hondler to 10,000 CFM Air handler OVer 10,000 CFM Amp.. ISSUANCE 0'F PERMIT T0'T Al CHARGES T0'T Al 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 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 0'rdinances of the City of Springfield and the Laws of the State of 0'regon pertaining to the work described herin, and that N0' 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 0'RS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with 0'RS 701.055 will be used on this project. Basis for Builder's Board exemption: SIGNATURE~I C,~~fL/// DATE ~ -/'?-rl NAME (please print) ,ql.'ltY~.s ~"P~fr/ELb FOR 0'FFICE USE ONLY Zone R-l Type/ Const.--'iN Units Fire Zone Bedrooms ('lecy Load Flood Plain "torio, I")ccy Group M BUILDING PERMIT 24.00 Plan Ck. Comm/lnd Charges and 65%/ Bldg Per Fee Surcharges .96 Plan Ck, Res 30%/ Bldg Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and Sidewalk Surcharges AI C Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharges ------~-- "q, Ftg. Main "q. Ftg, Access Sq. Ftg. Other x Value x Value Value TOTAL YALUATlON 2,201 . on Systems Development Charge (1.5%) 7.20 PD.. 2-1u-81. 55789 Total Comb, Permit TOTAL I~: . COMBINA TlON APPLICATION/PERMIT (CAP) : l. Applicant to furnish ~::.:.-: A. Job Address - B. legal Description 1. example-tax lot 1 DO, 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 I 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 attachec 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 regardi design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portio of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the approprial 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 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 al 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 apF and no plans will be processed until these fees are paid. AI other fees and charges are due and payable when the perl is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: ~, ...... PERMIT VALIDATION ( CITY OF SPRINGFIELD City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT ( No. B S 5 8 4 j Date.-,~'.(J \, J9~\ ( .e"dtomhcu(\( (;'\l~n\-~Q~ Address \ ~"4- ~~ f\ -\ LA.~ ~ ( Received For: ( c \c)\ 'l\X\ -C) ;'V\ CO nN-. Wn - .q{-, ~ ( ( ( ( ^ /, Received(--\)L} C{ Lo dJ.L{~J SHELTON-TURNBULL PRINTERS - EUGENE, OR 97401 Amount ,4t. I..-. BY ( ~ -l- DAN SIil ITH ,;gnatu'e~f!JrfiI ) datf' 2-16-81 name