HomeMy WebLinkAboutPermit Building 1980-8-13 (2)
CITY OF SPRINGFIELD
Cm1BINATION APPLICATION/PERMIT
E1lERGY p-p~~S Sa se boa rd
Heat
Hater Heater
Range
Va 1 Uf of I-Iork:
25,168.00
BU1IMnq Permit Info: Descnbe Hork( i.e.. Build Single
Family Residence With Attached Garage)
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'INSPECTION LINE
726-3769
Job Address 5293 Cynthia Court
Legal Description Lot 8, Danielle Park
Owner C.M.Beagley
Address 5293 Cynthia Court
Springfield,Oregon 97477
Phone
746-4336
Construction Lender
Address
DESIGN TEAt.1
(name)
Phone
(address)
.
Primary
Structural
---- .-
Electrical
f1echani ca 1
CONTRACTORS
Genera 1
(name)
Owner
(address)
Plumbinq
Electrical
~1echani ca 1
PLU11BING
ELECTRICAL
NO. .
-
FEE CHARGE NO. I FFF
Residence of
Each single fixture
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
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I SERVICES
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ITempOrary Construction
IChange in existing
residence
ImultifamilY, comm. or
Industrial
1 10f ?nn amps.1
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders
10f amp~1
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Hater service
Sewer
Storm Sewer
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\\1 REQUIRES that the Electrical work be done by an Electrical
shall not be valiJ until the label has been signed by an Electrical Supervisor
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INFORllATlON mil: '
726-3753
Sq. Ftg. t.lain
:g. Ftg. Access. 880
Sq. Ftg. Other
--11ew__Add__Alter~~ep.
__Fence__Demo__Change/Use
Other
co
o
o
-...J
-...J
N
(lics. no.)
(exoires)
([lhQo*: no I
NAME(please print)
r..M. Beaalev
L5~DI\TEg:-I.?~Ju
""'" -
Addition to mobile home
.(]ics. no.)
(exoires)
(ohone no. 1
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125.001
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25.001 TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Divi~ion
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MECHANICAL
r.HARGF NO.
furnace/burner to
BTU's
Floor fu rnace
and vent
Recessed wa 11
Soace heater and vent
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
I Vent system apart from 1
heating or A.C.
I Mechanical exhaust
hood and duct
I l'lood stove/heater
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ISSUANCE OF PFRrlIT
~.
FFF
r.HAR.r;F .
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I HAVE CAREFULLY EXA~lINED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAI1CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with t~e Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 701.055 will be used on this project.
Zone R-1
Fire Zone
Flood Plain
Tyoe/Const. V-N
Bedrooms
Units
Occy Load
Occy Group
So. Ftc).
Sq. Ftg.
Sq. Ftg.
NO
1
R-J
Stori es
BUILDING PERt'lIT
Charges and
Surcha rges
Plan Ck. Comm/Ind
65%/Bldq Per Fpp-
Plan Ck. Res
30%/Bldq Per Fee
_ _ _lJ.?.:.QO_ _ _ __
4.60
rlain
Access 880
Other
x
x L8. bU
Value
Value Lt> ,1bH. UU
x
value-L5 168.00
TOTAL VALUATION '
ISystems Development '
Charge (1.5%)
PLW~BING PERMIT
Charges and
Surcha rges
\
Fence
I D~R10
I Sidewalk .
I A/C Pavi ng
I Curb Cut
I
34.50 PD 8-12-~0
REC#54285 I
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ITotal Comb. rermit
I TOTAL
ELECTRICt,L PERr~1T
Cha rges and
SurCharges
MECHANICAL PERMIT
Charges and
Surcharges
25.00
------------
1. 00
145.60
145.60
1111 I,
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,
. COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp I e- Tax Lot 100, Lane County t1ap Refel. (
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examp1e- heat/electrical cei1inq/or forced
2. example- waterheater/electrica1/or solar
E. Square footage or valuation, etc.
1. examo1e- 1250 sq. foot house, 500 sq. foot ~g
2. example- if new project, check new - if adc
check add, etc.
F. Building permit information:
1. example - construct single family house wit 0
a ttached garage
2. example - remodel existing garage into fami
3. examole - convert single family residence i r'
restaurant (change of use) ~
G. Value of work as defined in Section 303 (a) of
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bui1din ~
Division Staff must be able to contact appropri
persons regarding design information or job sit
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Sche ~s
A. Except where blank spaces occur in the descript
portion of the Mechanical and Electrical Schedu
the applicant need fill-in only the No. Boxes a
to the appropriate item(s) to be installed ('
B. Full Plumbing, Mechanical, and Electrical Sched
are available at the Building Division
1. To conserve space on the permit form the sc
have been abbreviated (.
2. If the item(s) to be installed are not cove
the abbreviated schedules you should consul
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I (.
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be de1iverel
electrical contractor for signature by his e1ec'
supervi sor. The genera 1 contractor is .not auth( leL
to sign the electrical label. - '.
Applicant to sign and date
Whenever possible, the initial application will be I
a worksheet only. Where possible, Building Divisior
will prepare a type written copy and return it to tt
applicant at the time the actual permit is issued f(
signa ture.
Fees and Charges. . (
Plan check fees are due and payable at the time of 1 ~
application, and no plans will be processed until tt+-
fees are paid. All other fees and charges are due and
payable when the permit is issued.
4 C I TV' 0 F : S P.R I N G.f'l E L D
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No. B S 4 3 0 2 t.
Date R- (?J 19'60
Rec'd From~hl..{ &flai()) ~,
Address !5Zq:) (T!)",n t t1 JO' /(f
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City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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Received For:
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\ \ 5 ,00
q.<CO
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1.06
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III.
Amount
Received l4r) (DO
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f
~ . "' (I
Op ^O'"O""," "0""0",
SHEL.TON-TURNBUlL PRINTERS' EUGENE. OR 87.01
BaSII-e
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applican,t exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
name
DAN SM ITH
signa ture
date
8-13-80