HomeMy WebLinkAboutPermit Building 1981-5-20
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CITY OF SPRINGFIElCJ ) - . INFORMATION LINE
COM81NATION APPllCArIO~EIlMIT 726-3753
INSPECTION LINE
726-3769
Job Address 488 Wes t., C_enj:ennjAl_BJ vd
legal Description lL03_2Z_ 44~_TL3900
ENERGY SE~R~~l
f1cat ______________.
\'Iater Heater _ n_E 1 ect
Runge ~u-=c~ ---EJ.eC_t_.
V"lue of Work:
1001.00
Owner
John Koellinq
1968 W 34th Street
Eugene, Oregon 97401
Phone
484-f;?RR
8uilding Permit Info: Describe Work (i.e., B"ild Single
Family Residence With Allached Garage)
Address
Sq. Ftg. Moin
Sq. Ftg. Access.
Sq. Ftg. Other X
_ New, .._Add.. _~Alter _Rep,
nFencen. Demo_Change/ Use
_.Other
co
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Con3truction lender
Repairing apartment damage caused
by vehicle impact
Address
Phone
DESIGN TEAM
(name)
(address)
(lies. no.)
Primary
Ownf'r
Structural
Electrical
Mechanical
CONTRACTORS
(name)
Owner
Owner
(address)
(lies. no.)
General
Plumbing
Electrical
C & SElectric
2140 CentenniaLB.lJJrI
Mechanical
PLUMalNG
ELECTRICAL
NO.
FEE I CHARGE NO.
15.00
FEE I CHARGE NO.
I
I
~5.00
Residence of
1 Each single fixture
Relocated building
(new fix. additional)
S.F, Residence
(1 bath)
2
sq. ft.
New circuits, alterations
or extensions
SERVICES
Duplex (1 bath) each
Temporary Construction
Additional bath
Amps:
Water service
Sewer
Storm Sewer
FEEDERS
Amps.
TOTAL CHARGES
5.00
15-.-00
WHERE STATE LAW REQUIRES tho' the Electrical work be done by the EI~ctricol Contrac'or, the electricol por'ion of this permit shall not be valid un,i1 a
label has been signed by an Ele<trical Contractor and attached '0 the electrical panel,
TOT AL CHARGES
(expires)
(phone no,)
(expires)
(ohane no.)
344-2236
MECHANICAL
FEE
CHARGE
furnace/burner to
P,TU's
Appliance vent
sepa ra te
Stationory evap.
cooler
Vent fan with
single duct
Vent system apart from
heatil"g or A,C.
Mechanical exhaust
hood and duct
Woad stave/ healer
Heat Pump
Air hondler to
10,000 CFM
Air handler over
10,000 CFM
~
ISSUANCE OF PERMIT
TOTAL CHARGES
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify tho' all information hereon is true and correct, and I further
certify that any and all work performed shall be done in accordance with the Ord:nances 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
certlfy tho' 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 on this project.
Basis for Builder's Board exemRtian:
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NAME (please print) n
'IGNATU~
I
FOR OFFICE USE ONh
~~.
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.A::~/t'l1 C/
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Zone
R-1
Sq, Ftg, M"in
Sq. Ftg. Access
Sq, Ftg, Other
Type/Const'4N
Bedrooms
2
Units 1
Occy Load
Occy Group_R-l
Fire Zon~
Flood Plain
Storipc
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65}~/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per Fee
11.00
-------.44
DATE's- ~A/
./ /
" Value
x Value
'( Value
TOTAL VALUATION 1001.0a
Systems Development
Charge (1.5%)
PLUMBING PERMIT
Charges and
Surcharges
5.00
--------;-20
7.15 PO 5-20-811
Ktlii oooc:C$ 12
copies
I Total Comb. Permit
Fence
Demo
elECTRICAL PERMIT
Charges and
Surcharges
15.00
-----~OO
Sidewalk
AI C Pavina
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.50
32.74
I TO' .L
i
32.74
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I. Applicant to furnish
A. Job Address
B. legal 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 attach
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 Divisior
Staff must be able to contact appropriate persons regar
design information or job site corrections, etc.
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COMBINATION APPLICATION/PERMIT (CAP)
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II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description porti
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 c
ated schedules you should consult the full schedules
C. BUilDING DIVISION STAFF Will Fill OUT All FEES ANI
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used as c
worksheet only. Where possible, Building Division Staff wi
prepare a typewritten copy and return it to the applicant c
the time the actual permit is issued for his signature.
Fees and Charges
Plan check fees are due and payable at the time of the ap
and no plans will be processed until these fees are paid. ~
other fees and charges are due and payable when the pel
is issued.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
namf"
Tor~ SHEIRBON
_,;gnatu,e_1 fY1
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PERMIT VALIDATION
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CITY OF
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SPRINGfiELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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Date \\\C\ L'1\ c0CJ19 ~ . .
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AUTHORIZED SIGNATURE
SHELTON-TURNBULL PRINTERS. EUGENE OR ~7401
Amount Received
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