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Home My WebLink AboutPermit Building 1981-2-6 I INSPECTION LINE 726-3769 I Job Address I Legal DeSCription .. NOTifiED -.IU ~ ~ .~ 'CITY OF ff'RINGFIELD "_ ~ COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 Owner Nnrm;m H;:n't 2373 Centennlal Blvd Sprlngfleld, Oregon 5760 90 Sq Ftg Mam Sq Ftg Access 5q Ftg Qther _New-.LAdd_Alter_Rep _Fence_Demo_Change! Use _Dthe' 00 >--' o o " N 2373 Centennlal Blvd TL 6005, Map 17 03 25 43 ENERGUP,-\"EX'1 s t 1 ng) Heat - t Ieee Water Heater Ronqe Value of Work Address phone 746-0721 BUilding Permit Info Oescnbe Work (I e , BUild Smgle Fornll" Residence With Attoched Garage) Convert oaraoe to utllltv room Construction lender Address Phone DESIGN TEAM (name) OWner (address) (lIes no) (expires) (phone no) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lIes no) (expires) (phone no ) General Owner PlumbmQ ('IlAtnAV' Electncal 0wM~ Owner Mechanical PLUMBING ELECTRICAL MECHANICAL NO FEE CHARGE NO FEE CHARGE NO I FEE CHARGE I Duplex (1 bath) each Temporary Construction 2 furnace/burner to ~TU'5 ApplIance vent separate Stationary evap cooler Vent fan With 51ngle duct Vent system apart from heating or A C Mechanical exhaust hood and duct 3 00 6. 00 ResIdence 0& 3 Each sm!:jle fixture Relocated buddIng (new fiX additional) S F Residence (1 bath) 5 Ol15 00 sq ft New CIrCUits, alterations or extenSions ]5 00 2+ SERVICES Additional bath 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 I I 10 00 TOTAL CHARGES 15.00 TOTAL CHARGES 15 00 TOTAL CHARGES 16.fJO WHERE STATE LAW REQUIRES that the ElectrIcal work be done by the Eledrlcal Contractor, the electrICal porllon 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 oppllcation for permit, and do hereby cerhfy 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 Ordmances of the City of Spnngfleld and the Laws of the State of Oregon pertolnlng to the work descnbed henn, and that NO OCCUPANCY will be mode of ony structure Without the permiSSion of the BUIlding DIVISion I further cert1fy that my registration WIth the Budder'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 WII.! be used on:JS prolect I BaSIS for BUIlder's Boord exemption ~ /:1 P / NAME (pI,a"pnn,>.t.-d(hUJ./) .'~J":5jL'I jJJlf'J SIGNATU~~ ~?" ~ATEC7-/7-fl/ t V FOR OFFICE USE ONLY NO Type/ Canst Bedroom- Stona. V-N x K-1 R-1 Ilolts nccy load f'lccy Group Sq fig Sq Ftg Sq Ftg Main Access Other Value Value Value TOTAL VALUATION ~,/bU 9U Zone FIre Zone Flood Plain x BUILDING PERMIT 36 00 Plan Ck Comm/lnd Charges and 65%/ Bldq Per Fee Surcharges 1 44 Plan Ck Res 30%/ Bldg Per Fee PLUMBING PERMIT 15.00 Charges and Fence Surcharges bU Demo ELECTRICAL PERMIT 15 00 Charges and Sidewalk Surcharges 60 Alc PaVLna MECHANICAL PERMIT Charges and 16 00 Curb Cut Surcharges -------- 64 Systems Development Chorae (t 5%) 10 80 PO 2-4-81 REC #55750 EP Label 85 28 20 Total Comb Permit 85 48 TOTAL COMBINATION APPlICA TlON/P~~~p).' ,jlJ~ "...a 1... r, Applicant to furnish A Job Address B legal DescriptIon 1 exomole-tox 101 1 DO, lone County Mop Reference 17 03 43 2 example-Lot 1 Block 3, 2nd AddItIon to SpringfIeld Estates C Name, ete of owner and construction lender o Energy Sources 1 example-heat/electrical ceiling/or forced air gas 2 example.water heater/electrical/or solar E Square footage or valuation, ete 1 example-1250 sq foot house, 500 sq foot garage 2 example-If new prolect, check new-If addition, check add, ete F Budding 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 TEAM AND CONTRACTORS To avoid deSign or construction delays, Budding DIvISion Staff must be able to contact appropriate persons regarding deSign information or lob 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 opphcant need fdl~1n only the No Boxes adlacent to the appropnate ltem(s) to be ,nstalled B Full Plumbing, Mechanical, and Electrical Schedules are available at the Budding 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 abbreVI- ated sohedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FilL OUT ALL FEES AND CHARGES ON THE SCHEDULES III ApplICant to SIgn and dote Whenever pOSSible, the Initial application will be used as a worksheet only Where pOSSIble, Budding D,vISIon Staff Will prepare a typewritten 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 apphcotton, and no plans wdl be processed untd these fees are pOld 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 Prolect Information PLANS REVIEWED BY "'ERMIT VALIDATION c9-ld-gl Permit Clery DAN SMITH ".,gnotur~ kutl ~/ fin . . / / nam.-:> " , , ," -0 /0 c---p ...I'Jt-:- 5S g 1C4 2-6-81