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HomeMy WebLinkAboutPermit Building 1980-7-2 . . legal Oe<cription TL 2601 MAP1? 03 22 2 CITY OF SPRlilGFIElO CDr1BliIATION APPLlCATION/PERMrT EilERGY SOURCES: Heat Electric Heat Hater Heater Elect Ranqe 'INFORllATION LINe 726-3753 Sq. Ftg. 1.lain Ptmp.:q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - CX> o o V1 CX> ...., I IrISPECTION L1IIE 726-l769 Job Address 1045 Gateway Loop lsn N~~+h h~n S~rppt Springfield, 'Oregon 97477 Phone Valu€.1)f Hork: ,,000,00 Built;ino Permit Info: Describe \'Jork{i-,e.. Family l1esidence I'lith j'l,ttached Garaqe) Build Single Owner AOL Address i?~!'v!_ ~es Inc 746-4311 Add Petitions and Restrooms to Existing Building-:. Construction lender Address UeSIGil lEAn (name) Primary John Amundson Structural Electrical f1echanical CONTRACTORS (name) Genera 1 R. Milho11en Plumbino Hunley Plumbinp; Electrical 3-Way Electric Phone (address) (lics.no.) (eXf);res) {chone no.', (address) f1 ics. no.' (pxnirpc;) (ohMP nn ~lechan; ca 1 PlUllBIrlG ELECTRICAL MECHANICAL 110.1 ~IEach single fixture I'Relocated building (new fix. additional) Is.F. Residence (1 bath) louplex (1 bath) each IAdditional bath I ~Ia ter servi ce I Sewer Istorm Sewer FFf I CHARGE j,OO 110.00 I .Jl(l FCC CHARliE. -1!lL..-1 FFLJ:IlAB.IiE. SQ. FT. furnace/burner to BTlI's Residence of New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~rp hp~tpr rinrl vpnt 1 Temporary Construction Change in existing rpc:, i Qf'nrp. multifamily, com. or TnrltJc;.tr;ril 10f amps.1 I com'I.1I NO. FEEDERS IInstall/alter/relocate rlic;trib. feerlers IOf 200 amps. 1 I I I I 1 I I I 15.0q 1 Apoliance vent SPDilriltp Stationarv evao. cooler ~ . I Vent fan wi th sinale duct 1 Vent syster.l apart heatino or A.C. IMechanical exhaust hood ilnd durt . 1 Hood stove/heater 3.00 from Install ductwork for existing hea1 r'1.U11.fJ 4,50 10.00 17.50 I ISSUANCE OF PFR'HT TOTAL CilARGES 10,00 I TOTAL CilARGES 15. O~ TOTAL CHARGES WHERE STATE l1W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this shall not be valii until the labe~ has been signed by an Electrical Supervisor and returned to the Building oivisi?n I HAVE CAREFUllY EXM1INEo the completed aprlication 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 ac~ordance with the Ordinances of the City of Springfield and the laws of the State of Oregon oertaining to the work described herein, and that fIC OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify 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 exemntion is noted hereon, and that only subcontractors and employees "ho ~re i~ comaliance with or.s. 7(11.055. \'1i~1 ~ us on this prO.ject. J' 7 ,_) A,O,L, SerVlces.' Inc, V. r /",-''} );!'....... HAt.1E(please print) SU-;iIATURFf." _ L.1:.....-.:'-L.~A""7'J:L~-'I DP.' - - -~,.... FOP. OFFICE USE orllY r}/;---" c-4 i-I HR If Zone Type/Const. Uni~s Sq. Ftg. Hain x . Value Fire Zone11 Bedrooms Occy load Sq. Ft9. Access x Value .l.. Jj-c cUL+U ) , uuu. uu Flood Plain Stories Occy Group Sq. Ftg. Other x Value perr.lit TOTAL V AlUA TI 011 BUILDING PERI.IIT Charges anc Surcharges , Plan Ck. Comm/lnd 32.00 65%/Bl do Per Fee ----l..:~S-----Pian Ck. Res lO%/Blde Per Fee 10.00 Fence ------:110----1 Demo _ ___15-" QQ.._ __J Sidewalk ,60 I A/C Paving L___L7_SQ_ I Curb Cut I ,70 ---,...- . ?o.Ro 'Syster.1s Development I Charae (1.5.,) PlUI.IBING PERMIT Charges and Surcha rges ElECTRIU.l PERI~IT Charges and Surcharges Plan CheCK Fee Due. 20,80 77,48 Total Comb. Permit 11ECHAfll CAl PERI1 IT Cha rges and Surcharges I I 1 TOTAL 98,28 . COMBINATION APPLlCATION/PERNIT (CAP) ! . I. Appl icant to furnish A. Job Address B. legal Description ( 1. exa~ple- Tax Lot 100. lane County Map Ref ~, II 03 43 2. examole- Lot 1. Block 3, 2nd Addition to Sprtngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examo] e- hea t/ e 1 ectri Cd 1 eei 1 i ng/or force 2. examole- waterheater/electrlcal/or solar ( E. Square rootage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foe 2. example- if new project, check-new - if ( check add. ete. F. Building permit information: 1. example - construct single family house ~ attached garage 2. examole - remodel existing garage into fc 3. examole - convert single family residencE restaurant (change of use) G. Value of work as defined in Section 303 (a) e Structural Specialty Code H. DES I GN TEAl-I ArID CONTRACTORS To avoid design or construction delays, Buile Division Staff must be able to contact apprOf persons regarding design information or job ~ ( corrections. etc. II. Abbreviated Plu~bing. Mechanical. & Electrical S( A. Except \'/here blank spaces occur in the descr' portion of the Mechanical and Electrical Sch( the applicant need fill-in only the No. Boxe~ 4J~ to the appropriate item(s) to be installed B. Full Plumbing, Nechanical, and Electrical ScI are available at the Building Division r 1. To conserve space on the permit form the \ec have been abbreviated 2. If the item(s) to be installed are not CI the abbreviated schedules you should con! full SChedules (, C. BUILDI1:G DIVISION STAFF WILL FILL OUT ALL FEI CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be deliv! electrical contractor for signature by his e' supervisor. The general contractor is not at to sign the electrical label. Applicant to sign and date Whenever possible. the initial application will f a \'lOrksheet only. Where possible, Building Oivi~ wi 11 prepare, a type written copy and return it tr applicant at the time the actual permit is issuel signature. ( IV. Fees and Charges ~ Plan check fees are due and payable at the time th- ~"_' application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable ~/hen the permit is issued. CITY ( . PERMIT VALIDATIDN OF SPRINGFIELD (~ City Hall Springfield, Oregan Department of Public Work. OFFICIAL RECEIPT For: L!"O} /'i \ '3Qq 'L LlCl0 4G} () ( OmVfi {ri - rOJe Amount Rec.eived --I (j f ( Received Pf> (. Date r;- Z jcPr1o. B 53890C ( Rec'd f,o",Bc:c.5CU\JJ:lto_6...:dU'lC C (irAddres~n ~I U~r~. t5S _ c .' Ill. V. FOR OFFICE USE Q;ILY ~1{) C2.V ~lP FCf ::>'2 00 Ci.o) (-, 1,7 9., ;-,O,CO ltC) I~DU t,.;7n t7 . c:r""') ,() 2D. 9, () (-. ( c c c co-- C~__ ( I;"~ '~ o. . -e"o",,,o "G"',"", ( '''IUO''.TU.''"ULL ~''''.H.S, IUGE"[ 0.1"01 s..",. .... ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: II' . Permit Clerk \ .J ~ . j 'j Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: " r PLANS REVIEWED BY: name LOHNE W. PLEGER signature ~02<<0 C::V'~~a.--- F '''' . ~ . date 6-30-80