HomeMy WebLinkAboutPermit Building 1981-9-26
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SEP 11 ':;31
INSPECTION LINE
726-3769
CITY OF SPR!NGFlElD'
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
F.NERGY SOURCES:
Sq. Ftg. Main
Sq. Ftg. Access.
Sq. Ftg. Other
___NewX-_ Add_Alter_Rep.
_Fence __Demo_Change/ Use
__Other
co
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O"l
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Jab Address
l1JfLCentenni aJ...Bl V..dL_____ __ ____ Hear
17~~3-26-~;4~_LL_ 10700-------1 ~:::: ::~ter-=___=__---'--
Value of Work:
Legal Description
--------,-
Owner Ca 1 va rv TemQJ p
Address 1116 Centennia 1
Soringfield~ O~~41J
Phone
74W-12-5
_ ___tL2DO--,,-OO
Building Permit Info: Describe Work (i.e., Build Single
Family Residence With Attached Garage)
I Install rooLb.etwe.er nlcLarLd npw hIJild-
I'i ~-o
I
Comtruction Lender
Address
Phone
DESIGN TEAM
(name)
(address)
(lies. no.)
(expires)
(phone no.)
Primary Co 1 umbi a Emoi re Enoi neeri no
- -
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(expires)
(phone no.)
General n,,/no!"
Plumbing
Electrical
Mechanical
PLUMillNG
ELECTRICAL
MECHANICAL
Residence of
furnace / burner to
~TU's
Appliance vent
se po ra te
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
FEE I CHARGE
I
I
I
I
I
/
NO.
FEE
CHARGE NO. I
FEE
CHARGE NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
sq. ft.
New circuits, alterations
or extensions
SERVICES
Duplex (1 bath) each
Temporary Construction
Additional both
Amps.
Water service
Sewer
Wood stove/ heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
TOT AL CHARGES
TOTAL CHARGES
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 for permit, and do hereby certify that all information hereon is true and correct, and I further
certify that any and 011 work performed shall be done in accordance with the Ord:nances of the City of Springfield and the Laws of the State of Oregan
pertaining to the work described herin, and that NO OCCUPANCY will be ma de of any structure without the permission of the Building Division. I further
certlfy 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 wi,th ORS 701.055 will be used an this project.
NAME (please print)
E. a ~- I K. .1> ,) .t..(~ e;
<;IGNATURE
)i 1 I
tfc( k. ~xJuj1.uz-
DATE 9- :16. v?
Basis for Builder's Board exemption:
fOR OFFICE USE ONLY
Zone -R....l rllp
Type/ Const. V - N
Bedrooms
<;'tori"u
'Inits
0ccy Load -
0ccy Group--B.?
~q. Ftg. Moin
~q. Ftg. Access
Sq. Ftg. Other
'(
'(
Value
Value
Value
$2.400.00
Fire Zone
Flood Plain
x
TOTAL V ALUA nON
BUILDING PERMIT
Charges and
Surcharges
___24~on
.qfj
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per Fee
15.60 PD q-1-Al
#57220
Systems Development
Charqe (1.5%)
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
I Total Comb. Permit
I
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
A/ C Pavinq
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
rOT A~~_
$24.96
/
. /
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COMBINATION APPLICATION IPERMIT (CAP)
PERMIT V ALIDA liON
1. Applicant to furnish
A. Job Address
B. legal Description
1. example-tax lot 100, lane County Map Reference 17 03 .4~
2. example-lot 1. Block 3, 2nd Addition to Sprin!;' " C , T Y
c. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air g
2. example-water heater lelectrical/ or solar
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot gara
2. example-if new project, check new-if addition, I (Po.
add, etc.
F. Building permit information:
1. example-construct single family house with an a
garage
2. example-remodel existing garage into family rot
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 Divh
Staff must be able to contact appropriate persons reg
design information or job site corrections, etc.
.Q2te
OF SPRINGFIELD
City Hall
Springtie\d, Oregon
t of Public Works
Departmen P T
OffICIAL RECEI ,--"1'150
No. B .J;:..J, '
q--d:i198/. ,
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Rec'd From t ..t _:L.:. J' '
/' IJ"{' /) (!t?: /1'Z,:'D/Jt.,j'L/t~../
Address LI '- j. . - -= -
Received For:
bn
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11. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description po
of the Mechanical and Electrical Schedules, the applic(
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 schedules
have been abbreviated
2. If the item(s) to be installed are not covered on the a
ated schedules you should consult the full schedules
C. BUilDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
~
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IV.
III. Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, Building Division Staff will
prepare a typewritten copy and return it to the applicant at
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 appli(
and no plans will be processed until these fees are paid. All t-
other fees and charges are due and payable when the permit
is issued.
Amount Received
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AU,HOR\"Z.€.O SIGNATU:RE 97401 !>6'S1\.6
SMELTON.TURN8Ul..L PRINTERS - EUGENE
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
)
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Additional Project Information:
name
Dan_ Smit_h ___
signature
~ ....
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""C.- . ( " -
-late
9-4-81
PLANS REVIEWED BY: