HomeMy WebLinkAboutPermit Building 1981-5-27
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INSPECTION LINE
726-3769
CITY Of SPRINGfiELD
COMBINATION APPLICATION/PERMIT
i ENERGY ..sOU RC,ES: .
Hoot t I ~~!lC
Water ,!;laGler ~El ectric___
Range ~lZZa .Q1"I~n.:__~~s
Value of Work:
INfORMATION LINE
726-3753
Sq, Ftg. Main ---3-.2.85_
Sq, Ftg, Access.
Sq, fig, Other
-X New ___, Add_Alter _Rep,
___Fence__, Demo_Chonge/Use
___Other
Job Addres~ 601 W. Cen.~!Jn i a 1 _______
~_'_"Yescriptio-"-JZ-03_:27 -43 ~ Part _ofJ....L_5800 _
Owner
CerrtenniaL,Cen ter
Thw_iIl9,_ WOQdLlii att
663 w. r.aoten~j_aJ
<3 pd n g f-i e 1 d ,---Or-e gon
----.ROUND_IABLLllZZA PARLOUR
(RESTAURANT)
$137,970
&_Hiatt___
Phone UU ::.L42 n
9?-47-7--
Address
Budding Permit info: Desc.-ibe Work (i.e., B~ild Single
Family Residence V-lith Attoched Goroqe)
Construction lender
Address
Phone
DESIGN TEAM
52 6--N~t=.si'Wfn€'hester-~ics, no)
Roseburq. OreQQn gZ41~
(expires)
(nome)
Primary
Kruse-Fitch-Bea1s. A.I.A.
Structurol
C:~"1~
Electricol
same
same
Mechonicol
CONTRACTORS
(name)
(oddress)
(lies. no.)
(expires)
Ge~rol HiAtt Rrnc:_ Tnvpc:tmpntc:
Plumbing Twin Rivers Pl umbing
Electrical Pense1 in F1ectric
Mechanical Harvev & Price
Euqene
S . n-F;a1rl
PL-11l~
SpringfieJJj
20-96
?n-4Hr
PLUMBING
ELECTRICAL
MECHANICAL
NO. I
fEE I CHARGE NO.
i
5. 001 00. 00
NO, I
I Furnace/ burner to
1 HlCl ;:.QD(l-BTU' s
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
1 CLJ)D ~. single duct
I Vent system Gpart from
35. 00 heatirg or A.C.
Mechanical exhaust
hood and duct
fEE
[CHARGE
I
Residence of
20 Each single Fixture
Relocated building
(new fix. additional)
S.f. Residence
(1 bath)
<q. ft.
New circuits, alterations
or extensions
SERVICES
Duplex (1 bath) each
1
1
Amps. 225
Temporary Construction
Additionol bath
Water service
Sewer
Wood stove/heater
Storm Sewer
fEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CfM
1 Amps. 1 00
1 O. 00
I
I
I
I
I
ISSUANCE Of PERMIT
TOTAL CHARGES
I j
$1 00 . 001
TOTAL CHARGES
$55.00, TOTAL CHARGES
CXl
.....
o
N
<.n
.....
(phone no,)
1171-7411
(phone no,)
]1I1-H20
683-1414
7111_11Ah
7411-111?1
fEE CHARGE
7 5Cl
I
~,t)n 4, t)(;
11....0.0- 11 nc
1.50 4.50
10.00
$32.50
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel,
I HAVE CAREFUllY EXAMINED the completed application Far permit, and do hereby certify that all information hereon is true and correct, and I Further
certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building .Division. I Further
certiFy that my registration with. the Builder's Board is in Full force and effect as required by ORS 701,055, that iF exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used an this project.
Basis Far Builder's Boord exemption:
CL/J c/ t~/~ "IGNATU(/\a.4lA-v;;' //L~
,.-.>r ''/ - -
NAME (please print)
b/~}/lvlC;
FOR OffiCE USE ONLY
Zonp C-2
Fire Zone
flood Plain--1lO
3285
(key load l1A_
Occy Group~.n- ~
x
3285
Type/ Canst
Bedrooms
"tarie.
"q. ftg. Main
Sq, ftg. Access
Sq, ftg, Other
'(
Value
Value
Value
'Inils
x
BUILDING PERMIT Plan Ck. Camm/lnd fa.bJ
Charges and 344.00 65%/ Bldg Per fee 50.00
----~-----
Surcharges 13.76 I Plan Ck, Res F2.63
30%/ Bldg Per fee
PLUMBING PERMIT 1 00. 00 I I
Charges and fence
Surcharges I
4.00 Demo I
I elECTRICAL PERMIT 55.00
Charges and Sidewalk
Surcharges 2.20
A/ C Pavinq
MECHANICAL PERMIT 32.50
Charges and Curb Cut
Surcharges ---------
1.30
TOTAL VALUATION
paid 4-IU-~1
'd t . ~~tems Developm,t::?-tC
Qal 0 SItW,qk~tl3;~W ~u -
si~e revirw not necessary
pe.~d by-H;tatt---B-ro:. I:1v. I
Receipt #56278
1
I
Totol Comb, Permit
! TOTAL
i
,,$ -1-7.5/ \
1 3L.3J o. niL
IJ/,Y/U.UU
2,069.55
552.76
$2,622.31
~ .
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I. Applicant to furnish
A. Job Address
B. legal Description
1. example-tax lot 100, lane County Map Reference'''' ,,'> A~
2. example-Lot 1. Block 3, 2nd Addition to Springfield C
'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, chee
add, etc.
F.Building permit information:
1. example-construct single family house with an atta ,,.0
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 Divisi
Staff must be able to contact appropriate persons reg(
design information or iob site corrections, etc.
COMBINATION APPLICATION/PERMIT (CAP)
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description po
of the Mechanical and Electrical Schedules, the applicl
need fill-in only the No. Boxes adjacent to the approp
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 schedule
. have been abbreviated
2. If the item(s) to be installed are not covered on the
ated schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At
CHARGES ON THE SCHEDULES
-III. Applicant to sign and date
Whenever possible, the initial application will be used as
worksheet only. Where possible, Building Division Staff v (
prepare a typewritten copy and return it to the applicant
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 a
and no plans will be processed until these fees are paid. kll
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:
1. Fire Department Final Approval Required
AdditionQI Project Information:
PLANS REVIEWED BY:
PERMIT VALIDATION
CITY
OF
SPRINGFIELD
'I
(
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
r]
(
Date 5, r:J '7 -
Rec'd From 1-1 i a}-{
Address I~ (lI 3 W.
<"'!-.I:cJ
-'''; "
Received For:
bo
f
No. B 5 6 5 9 8 J
19r5 I
8-~ffi 1,- ~ XI V{ ,:) kords:"1
Q.Q.;n1Ln nl (j j)
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Ci j'\ fT1- , I
4/6
.~44.({)
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inn .no
4.{)D
55.CO
,!) . /lO
,~~ ,50 (I
1.30
,-J ()ll'lq,..C)~"f
- .,-
47(1
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L/?11
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Jbi ,<; QG
Lf70
Amount Received
;) l[l ,':J d. ?\ \ cC (I
c:Ut~ (I
BY
AUTHORIZED SIGNATURE {
SHEl TON-TURNBULL PRINTERS. EUGENE. OR 97401 5851'-8 \
\"
(I
Permit Clerk
'- Lorne W. Pleger
namf'
,;gnat~_O_ ~! f7p
date 6,,4 -8 {