The URL can be used to link to this page

Home My WebLink AboutPermit Building 1982-10-1 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ErlERGY SOURCES: 'Heat !'Ja ter Hea ter 1 INSPECTION LINE. , 726-3769 Job Address 1116 Centennial Blvd. Legal Description 17-03-26-'44 ,. , ,10700 INFORI1ATION UNt 726-3753 Sq. F tg. r.1a i n ~q. ~tg. Access. Sq. Ftg. Other Ne\1 Add Alter P.ep. --Fence Demo Change/Use --Other -- -- 00 I:\j f-' m f-' W Owner 747-712E Ranqe ValuE of ~Iork: $2,000.00 \ Builtiinq PermH Info: Describe \oJork(i.e., Build Single Family nesidence With Attached Garaqe) Calvarv Temole 1110 Centennial Address Phone Spri'ngfield, Oregon 97477 i Construction I i Address , DESIGN TEAr1 Lender Construct Sloped Roof over Existing Flat Roof (name) Rev. Earl Dukes Phone (address) (lics. no.) 1116 Centennial Blvd. 747-7125 I I I I J TOTAL CHARGES 'Electrical Contractor, the electrical portion of this Supervisor and returned to the Building Division Primary Structural Electrical , 11echani ca 1 : CONTRACTORS : Genera 1 (name) Calvary Temple (address) Plumbinq - Electrical ; ~'echanical PLur1BI NG ELECTR ICAL NO.1 Each single fixture FEE I CHARGE NO, Residence of SQ. FT. Relocated building (new fix. additional) New circuits alts. or extensions IS.F. Residence (1 bath) IDuPlex (l bath) IAdditional bath IHater service 1 Sewer I I I I I 'I I I I I 1 1 each ISERVICES 1 ITemporary Construction I'change in existing residence Imultifamily, comm. or Industrial 10f ICOMM./IND. FEEDERS 1 Install/alter/relocate distrib. fpedprs 10f amp~1 I I I I amps.1 I I Storm Sewer . TOTAL CHARGES TOTAL: CHARGES WHERE STATE L,'I,\1 REQUIRES that the Electrical work be done by an shall not be val icJ until the label has been signed by an Electrical (exnires) (phone no.') (1 i CS. no.) (expires) (phone no.) MECHANICAL FFF r.HARGF NO. - r.HARGF FFF furnace/burner to BTlI's Floor furnace and vent Recessed wall Space heater and vent I I I 1 I I 1 I I I I I App 1 i ance vent separate . 1 Stationary evap. cooler I Vent fan with sinale duct I Vent system apart heating or A.C. I Mechanical.exhaust . hood and duct I I-Jood stove/heater I , I I from I I' ISSUANCE OF PFf\r11T permit I HAVE CAREFULLY EXA111NED the completed application 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 State of Oregon pertaining to the work described herein~ and that NO OCCUPANCY will be made' , of any structure without the permission of the Building Division. I further certify thct my registration with the Builder's Boa rd is in fu 11 force a nd effect as. requi red by ORS 701. 055, tha t if exempt the ba s5s for exempt i on is noted hereon, and tha t only subcontractors and employees who are incompliance with ORS 701.055 will, be used on this project. rW1E(please print)Y 12a. .'oJ' \/ \ -/ , I SIGiUITUREY FOR OFFICE USE 6~LY EI/1A PV'Y I 5~N Units Occy Load 1 Occy Group A- 3 Sq. Ftg. Sq. Ftg. Sq. Ftg. Zone RL- CUP Fire Zone Flood Plain Type/Const. Bedrooms Stori es BUILDING PER~lIT Charges and Surcharges Plan Ck. Comm/lnd 65%/Bldo Per Fee Plan Ck. Res 30%/Bldq Per Fee Fence .~, ,'~?JAMx~ . 11a in' x 0 DATrJ 10;/ /8>"2_ Access Other1224 sf. Value x Value ~eroof Value 2.000.00 TOTAL VALUATION 2,000.00 20.00 ------------ .80 $'13.00 . d Systems Development pal Charge 0.5%) . PLUl1B ING PERMIT Charges and. Surcharges Demo ELECTRIC/l,L PERr~IT Charges and Surcharges MECHANICAL PERMiT Cha rges and Surcharges Sidewalk - --- - - --- --:'::1 A/C Paving I Curb Cut I, I 1 I ITotal Comb. Permit I TOTAl $20.80 i i t t COMBINATION APPLICATION/PERMIT (CAP) . PERMIT VALIDATION 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 Springf~eld Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air gas' 2. example- waterheater/electricalior 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 attached 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 'TEAMAND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate 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 abbreviated schedules you should consult the full schedules . C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES.ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is .not authorized to sign the electrical label. III. Applicant to sign and date Whenever possible, the initial application will be used as ,a work~heet only. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at 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 application, 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. Receipt 6..q /0 building 4% $20.00 .80 $20.80 ~ ~'; ,) . V. FOR OFFICE USE ONLY Permit Clerk .. (U li1cti0 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ,;" ....~ " \, li:~' Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name (' ,I I rl "'Yi f' 'l ~ J'q signature:,' '(JrA'{/,u) _lL: . '~"::':',:~:-'::::::.~:--::'",,7_':'::,:~:' ::,':~:;:',,";. :,:~ ,;',".';;.C::: ',::-,';::,",:c. ::;:' .::,~:cx;:,:'-':;;'~~:'?'f'Atf!):j'E,fT:J2:~:-1~~1i.;:/d~:'=:Cl:;;:;r;=.~::i:::!r:., ~_..,..._7;;-_::;:~;:;: :,,";:;.,.; \.. / \..... ~'. Larne Pleger da te Sept. 30, 1982: ....-.-~~.-.. ..-..._'.....~ - .' <..;.-'" ,;., :,:..~ -.-..- .~-,-- ."'.. ," "-."-