HomeMy WebLinkAboutPermit Building 1981-3-12
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INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
Owner
Centennial Medical Associates
1621 Centennial Blvd Phone
$36,000
Sq. Ftg, Main '~
Sq. Ftg. Access.
Sq. Ftg. Other
_New _Add_Alter )(.Rep.
_Fence_Demo_Ch~nge/ Use
_Other
co
.......
o
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Job Addrf!SS
1621 Centennial Boulevard
ENERGY S~CES:
Heot
Water Heater
Range
Value of Work:
Legal Description TL 4500. Map 17 03 25 34
Address
Building Permit Info: Describe Work (i.e., Build Single
Familv Residence With Attached Garoqe)
~rentennial Medic~' CLini~
Construction Lender
Address
Phone
DESIGN TEAM
(name)
(oddress)
(lies. no.)
(expires)
(phone no.)
Primary
Westover Construction Co: 4034 Main Street
1441
,limp 1 qR1
747-9971
Structural
Electrical
Mechanical
CONTRACTORS (name)
Westover Construction Co
General
(address)
4034 Main Street
(lies. no.)
3441
(expires)
June 1981
(ohone no.)
747-9971
Plumbinq
Electrical Bills Electric 3170 West 11th Street, Eugene 20-84C June 1981
MechonicalLarry Kelson H&P Mechanical
687-1851
PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO,
FEE CHARGE NO.
FEE I CHARGE j
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
x
.n. ft.
New circuits, alterations
or extensions
15.00
furnace / burner to
I\TU's
Appliance vent
seporote
Stotionary evap.
cooler
Vent fan with
si ng Ie duct
Vent system apart from
heating or A.C.
Mechanical exhoust
hood and duct
Residence of
SERVICES
Duple" (1 bath) eoch
...,....
Temporary Construction
Additional bath
Amps.
Water service
Sewer
Wood stove/ heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10.,000 CFM
Air hondler over
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOT AL CHARGES
WHERE STATE LAW REQUIRES that the Electricol 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.
r
I HAVE CAREFULLY EXAMINED the completed opplicotion for 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 Ordinances of the City of Springfield and the Laws of the Stat.. 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 ...Hect 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: /J -'/J C. , ;J-- 0
NAME {please print~. .~t I~ ,j ~L~{t{A-'-"V <;IGNATUREf\ ~~ dCv- ir{J~Uu.1
ME/-..I./ / rJ J..' /.AJEr;T(/vrC~R OFFICE USE ONLY
V~
_I ~ ~2--/.? I
DA~ /1
ZonD
C-2
Type/ Const.
Bedrooms
~tories
Units
<;'1. Ftg. Main
<;'1. Ftg. Acces'
Sq. Ftg. Other
1405
x Value
x Value
'( Value
TOTAL VALUATION
1fi,oon
Fire Zone
Flood PI"in
1
('lecy Load
Occy Group _g 'J
BUILDING PERMIT
Charges and
Surcharges
145.00
o.~o
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per Fee
94 25 PD 3 2 81Systems Development
. - - Charqe (1.5%1
REC 55952
36.000
}01,00
5:40.00.
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
Total Comb. Permit
166.40
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
I A/ C Paving
I Curb Cut
---------,
15.00
.60
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
2LlJ.rlOJ
~O
~~
,
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COMBINA nON APPlICA nON/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Leg;:ZYDescription , .
1. exbmple-tax lot 100, Lane County Map Referenc
2. example-Lot 1. Block 3, 2nd Addition to Springfie
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-h. eat/electrical ceili?g;,o}:.w~!;ed_air,gqs
2. 'example-water heater/electrlcalf~QJar;...l..b...""'{'\,
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot garag'
2. example-if new project, check new-if addition, d'
add, etc.
,F. Building permit information:
1. example-construct single family house with an at
garage
2. example-remodel existing garage into family roc
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 Div
Staff must be able to contact appropriate persons re
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedul,
A. Except where blank spaces occur in the description F
of the Mechanical and Electrical Schedules, the app!:
need fill-in only the No. Boxes adjacent to the apprc
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 schedul
have been abbreviated
2. If the item(s) to be installed are not covered on tf-
ated schedules you should consult the full schedu
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES)
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used c
worksheet only. Where possible, Building Division Staff
prepare a typewritten copy and return it to the applicar
the time the actual permit is issued for his signature.
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PERMIT VALIDATION
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CITY OF SPRINGFIELD
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City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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( No. B S 6 0 2 7 C
Date 3- 12 19~ I
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Received For:
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BY
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SHELTO.....TURNBULl. PRINTERS. EUGENE. OR 97401
IV. Fees and Charges ~
Plan check fees are due and payable at the time of the -k,:.,.....--..-..,
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:
Additional Project Information:
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Y.g..~~EWED BY:
-- I ORNE PLEGER
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~j.,
Permit Clerk-
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,;gnatu,uPr-ne '-!?[QCAI'-
date
3-11-81