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HomeMy WebLinkAboutPermit Building 1981-5-20 ,/ , .. ///...... . ~Jj'';'~;'~V~;;~~~.'!~~~;'~l!W.!..~,~JU,,~i!oWg..;.~i.if}!il<~mJ.l!'I\i.~.~S,1)~~;1;t7,~~~~,;~~," "~" . J" 7If/tLtud/ 5- 2()-P! -.. - 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 ....... o w ~ '-l 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: ..../ C,' ;; NAME (please print) n 'IGNATU~ I FOR OFFICE USE ONh ~~. J I .A::~/t'l1 C/ I .J 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 /~ J!{~_~~~.fI.~~~/i'L~~l~~!~:~J,\~'.\'{~~~>'~A~""-"'~~~l~'~~~~;~':~~~~?J]:~ -__~~'''''r_._'__ 1". ,,-,......,._~... -,,;'l." ;.:;:- I ~. I 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. ,'. J ~;,,\'" ...i COMBINATION APPLICATION/PERMIT (CAP) (\ 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 /1./1 ,I I !--, //l /'~/1 If) 0 - / '.- d 5-20-81 atf" l ~ \ PERMIT VALIDATION ,\ +-\ ( CITY OF ( SPRINGfiELD City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT ,( ( ~o. B S 65 4 6 ,- Date \\\C\ L'1\ c0CJ19 ~ . . Re,' d Fmm (:\1'3\,,:(\ \< elf . \ \ \ <\q; . ( Address \, \ lo~ ~O 3~ \1\ Received For: D\C\i\' \ \ .00 , . \jalo .l~ Lj ~\ \\\\.) ~ ,00 L\Gff) , {)() ~\e('+- {~;OO ( I rL~ " 0 ("l ,'-\7n (I') ( \ D\J\e~ · 'd> ( ( ( ( ( ( f (\J~ q \ ~ ) f !!I851l-e \ ~ d I ( ....... W:ILf ~\'C"t) AUTHORIZED SIGNATURE SHELTON-TURNBULL PRINTERS. EUGENE OR ~7401 Amount Received ~at BY ( I, I 'i