HomeMy WebLinkAboutPermit Building 1991-2-16
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NOTlflED F;A'C.d~1__
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INSPECTION LINE
726.3169
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INfORMATION LINE
726-3753
Job Address
2373 Centennlal Blvd
TL 6005, Map 17 03 25 43
I ~~::GtW'fEX'1 s tl ng)
uect
I Water Heater
Ran~e
Value of Work
00
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legal Description
Owner
Nnrm~n J-1;n't
2373 Centennlal Blvd
Sprlngfleld, Oregon
Phone
746-0721
BUilding Permit Info DescrJbe Work (I e, BUild Single
Famllv ResIdence With Attached Gerace)
Convert oaraoe to utllltv room
Address
Construction lender
Address
Phone
DESIGN TEAM
(nome)
Owner
(address)
Prlmory
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
General
Owner
Plumbmg
OwnAY'
Electncal
n,,,no.Y'O
Mechanical
Owner
PLUMBING
ELECTRICAL
NO
FEE CHARGE NO
3
Re$\dence 0'
5.0[ 15 00
~q ft
New cirCUits, alterations
or eKtenslons
Each slrIgle flx~ure
Relocated budding
(new fix addItional)
S F ReSidence
{1 bath}
2+
SERVICES
Duplex (1 bath) each
Temporary Construction
Addlhonal bath
Amps
Water service
Sewer
Storm Sewer
FEEDERS
Amps
TOTAL CHARGES
15.00 TOTAl CHARGES
5760 90
Sq Ftg Main
Sq Ftg Access
Sq Ffg ~her
~_New_Add_Alter _Rep
_Fence_Demo_Change/ U$e
_Other
(lIC$ no)
(e~plre$)
(phone no)
(lICS no 1
(expires)
(phone no )
MECHANICAL
FEE CHARGE NO FEE I CHARGE
furnace/burner to I
R.TU's
Appliance vent I
15.00 separate
Stationary evap I
cooler
2 Vent fan With 3 0016.00
s,"~le duct
Vent system apart from I
heatln~ or A C
Mechamcal exhaust
hood and duct
Wood stove/heater
I Heat Pumr;l
I Air handler to
10000 CFM
I Air handler over
10000 CFM
I
I 1
I I
I ISSUANCE OF PERMIT 10 00
15 00 16.00
I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the ElectrICal work be done by the ElectFlcal Contractor, the electrICal portion of thiS perm\1 shaU not he valid until a
lobel hos b~n Signed by an Electncal Contractor and attached to the electncot pane'
I HAVE CAREFUllY EXAMINED the completed applu:atlon for permit, and do hereby certify that all mfarmatlon hereon IS true and correct, and I further
certrfy that any and 011 work performed shall be done IrI accordance With the Ordinances of the City of Sprmgfleld and the lows of the State of Oregon
pertaining to the work descrIbed herm and that NO OCCUPANCY wdl be mode of any structure WIthout the permiSSion of the BUlldmg DIVISIon I further
<<'rtHy that my reglstTafLan 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 Will be used on;]IS prolect
~ BaSIS fOf BUilder's Board exemption '- d U /
NAME (ploa.o P"ntIVRMA.&L)J--,:" -JL.'j ;fJ;;f'LSlGNATU~~ ~ =- ~ATE.,7-/j-8' /
V FOR OFFICE USE ONLY
K-l
V-N
Type/ Canst
Bedrooms
<:tone.
!'Inlts
Occy lood
Occy Group
Zone
Fire Zon-
Flood Plaln---1JO
R-1
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 50
Demo
elECTRICAL PERMIT 15 00
Charges and SIdewalk
Surcharges 60
AI C Paving
MECHANICAL PERMIT
Charges and 16.00 Curb Cut
Surcharges --------
64
Sq Ftg M,:un
<:;q Ftg Access
Sq Ftg Other
x
Value
Valul
Value
x
x
~,/5U 90
TOTAL VALUATION
Systems Development
Charae (1 5%)
10 80 PD 2-4-81
REC #55750
I Total Comb Permit
I EP Label
I
I
1 TO~A~_
85 28
20
85.48
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COMBINATION APPLICATION/PERMIT (CAP)
I Applicant to furnISh
A Job Address
B Legal Descrlphon
1 example-tax lot 100, Lane County Map Reference 17 03 43
2 example-Lot 1 Block 3, 2nd Addition to SpringfIeld Estates
Name, etc of owner and construction lender
Energy Sources
1 example-heat/electrical ceiling/or forced air gas
2 example-water heater / electrlcal/ or solar
Square footage or valuation, etc
1 example-1250 sq foot house, 500 sq foat garag.
2 example~lf new prolect, check new-If addition, ch
add, etc
Budding permit Information
1 example-construct single family house With an atl
garage
2 example-remodel eXisting garage Into family roo I (
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
DESIGN TEAM AND CONTRACTORS
To avoid deSign or construction delays, Building DIV1'
Staff must be able to contact appropriate persons re~ dlr
deSign information or lob site correctIons, etc
C
D
E
F
H
II AbbrevIated Plumbing, Mechanical & Electrical Schedule
A Except where blank spaces occur In the deSCription pc
of the Mechanical and ElectrICal Schedules, the appllc
need fill-in only the No Boxes adlacent to the approF
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 schedule
have been abbreViated
2 If the Item(s) to be Installed are not covered on the
ated schedules you should consult the full schedule
C BUILDING DIVISION STAFF WILL Fill OUT All FEES At
CHARGES ON THE SCHEDULES
III Applicant to Sign and date
Whenever pOSSible, the Initial application will be used as
worksheet only Where poSSible, Budding DIVISion Staff w
prepare a typewritten copy and return It to the applicant
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 OF
and no plans wdl be processed untd these fees are paId J l
other fees and charges are due and payable when the pe
IS ISSUed +-
V FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Additional Project Information
PLANS REVIEWED BY
PERMIT VALIDATION
CITY
OF
SPRINGFIELD
City Hall
SpringfIeld. Oregan
Department of Public Works
OFFICIAL RECEIPT
(
55819(
No. B
Datel- \'2.. 19Cbl
Rec'd From f\.1.0VI'Y'Ol\ Hoy+,
Address 141,~ ( fJU~Q{)
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Received
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Amount Recelv~-:;-~5_A y; ( /L
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Permit Cler~
.
DAN SMITH
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datp
2-6-81
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