HomeMy WebLinkAboutPermit Building 1980-11-6
. -u
I HlSPECTlOll LlIlE
726-3769
Job Address "2004 Donnelly
Legal De$Criot;on Lochaven Subdivision
CITY OF SPRI;lGFIELD-- .
COIIBIlIATI ON 'APPLI CAT ION/PERMIT
E!IERGY ...5OURCES: .
Heat t;lec tr~c
-
Lb t '34 evLlG 3
Owner Gene & Bernard Hiatt & Robert
~- .,.
Address 663 W, Centenni~r~'''~~''
'Springfield
COI1f1. II NO, FEEDERS
Install/alter/relocate
di<;trih. feeders
I Of amps.
I
I
I ISSUANCr cF PFR!IIT
TOTAL CHARGES I TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'I.J REQUIRES that tile Electrical \'Iork b~ done by an Electrical Contractor. the electrical portion of this perr.lit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Construction lender
Address
U!:.:;)lliH Tcl\i1
lname)
Primary
'S::"~.:c.:::.:-!~
Ele':trlcal
:.~!-::;~-:
--...-~----
.. ,.-.-.. .".;
Generil,l
Hiatt Bros,
". I ~~~:l r:c:
:::~<:::""i.:!: Penselin Electric
.O:.:_!__ ::
?L!.:~~S!:;~
;.::':';;~
f~xt;;re
C::;'- I (!-lARGE
I
!
;~elocateo J~ildino
i (new fix. additional)
17 iF ba ~~) i dence
Duplex (1 bath) each
Additional bath
l~!dter service
I Sewer
!Storm Sewer
I
~'!ater Hea ter
lNFORt1ATION UNc.
72E-3753
Sq"Ftq,I,lain
:q. ftg. Access.
So, Ft9, Other
Ilew Add A lter ~ep,
--Fence Demo Change/Use
Other =- -
~
I~
7lf'lQ420
I Ranqe
I
I
I
I
I
I
ValuE of Hork:
28,200
Builriina Permit Info: Describe Work(i.e.. Build Single
Fal:'lil v l1.es idence l'li th /I.ttached flaraae)
Mobile home set UP with
Phone
(address I
improvements
Ooubtt. W'lcto)
(l ics. no.)
(OhOM no.l
(exoires)
{: ic<;_ ~.J.:
:~~ni"e!=i
(ohon~ no. )
Springfield
741-1420
Springfield
20-48C
741-1186
:~~:':T~!C':'L
~ECHt.:,~ICAL
~ln _ I
IResidence of 5Q. il.
I'New circu~ts alts.
or extenslons
ISERVICES
p~'C j r'!-J!lQr,~ 1:0_ I
I furnace/burner to
I 6TU's
I Floor furnace
and vent
Recessed wall
Snaee hpater arn vpnt
fHARr.F ,
I FFF
I
I
Temporary Construction
Change in existing
res i dp.nee.
multifamily, comm. or
Tnduc;tr;;l1
Appliance vent
c;p.oarate
Stationarv evar:.
cooler ~ .
I Vent fan with
sinale duct I
I Ven t sys tem apa rt from
heatina or A.C.
I ~lechanical exhaust
hood and durt
Of
amps,
Wood stove/heater
I HAVE c/\REFULLY EXN"1WED the completed aprlication for permit. and do hereby certify that all infonnation 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 Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that IlQ OCCUPAHCY \'1i11 ,be made
of any s:ruCture without the oermission of the Building Division. I further certify that my registration with the Builderls
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 emnloyees who are in com~liance with OP.S 701.055 will be used on this project.
IWIE(please print) D.J2."'.... lu, 't/ C-o....-A SIr,HATURE jQ~,--,!f.,V ~I VV L. DATE fJ. ? ~t()
FO~ OFFIr.~ IJSE O"LY
Zone HH~ Type/Const. l'-\ +I Units Sq. Ftg. l1ain
Fire Zone Bedroems Dccy Load Sq, Ftl]. Access
Flood Plain Stories Occy Group r&,'<., Sq, Ft9, Other
BUILDIIIG PERI,IIT
Charges ane
Surcharges
'4000 '
___c..;________
PLUI1BING PERMIT
Charoes and
Surcharges
__L~_OQ___
ion
IO,CO
------------
40
ELECTRIC;,L PERI:IT
. Charoes and
Surcharges
t1ECHAII I CAL PERI1IT
Charges and
Surcharges
Value
Value
V3lue
x
,
x
TOTAL VALUATlDrI
Plan Ck,
65VBldo
Plan Ck.
30%lB1 do
Conro/ I nd
Ppr F~e
Res
Per Fee
'Syste~s Development
Cha rue (\. 5~)
I ?\':?_~.on
i
I
I
I
I
Fence
Df-mo
'Sidewa 1 k
I A/C PdV; ng
Curb Cut
Total Comb. Permit
"
.
TOTAL
.,
COMBINATION APPLICATION/PERMIT (CAP)
I.
I
t
I
I
J
;
Applicant to furnish
A, Job Address
B. Legal Description
1. examole- Tax Lot 100, Lane County Map Reference
11 03 43
2, examole- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. ~lame. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinQ/or forced
2. exam~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1, examole- 1250 sq, foot house. 500 sq, foot og'
2. examole- if new proj~ct. check-new - if add
check add, etc.
F. 8:.Jildinc periodt information:
.- -:::.:;::::;e - CO:'lS!rt:c: single family house wit: ~
dttached Qar"'ce
-. -?x.:!:::le -' re::-:oael existing garage into rami'
.- ~xa~;je - c~nvert single family residence 11
=-~S:=:"::-~!1t (char:::e of use) ./-.
u. ;c:!.:e of ...;ori< as deflr.ed in Section j03 (a) of:
Structural Specialty Code
H. :::':S; ;:; T::':':.; MiD CO::TRACTORS
;c ~void design o~ construction delays, Buildinf C-
Division Staff must be able to contact approDri,
persons reg~rjing design information or job sitf
corrections. etc.
':'::.!"en~:e: ?h::::bing. ~.!echanical, & Electrical Schec (S
.:. :..'(:e::: ~.:he~e ~lank s~aces occur in the descriDt~
::r:~c~ of :;:e :.~echa:dcal and Electrical Schedul
:;:e ='Joiicant need fill-in only the "10. Boxes ac
:~ tne aaorooriate item(s) to be installed (
8. f'Jll Plu:::oing. t~echanical. and Electrical Schedl "
~!"2 ~v~i:able at the Suilding ~ivision
1. :0 c~nserve space on the permit form the scr
hav~ been abbreviated
2. !f ~he item(s) to be installed are not cover
the aObreviated scnedules you should consult
fu il scnedu 1 es
C, BUILDING DIVISIOII STAFF \,ILL FILL OUT ALL FEES A
CHARGES ml THE SCHEDULES
O. As noted on the CAP, the label must be delivered
electrical contractor for Signature by his elect
supervisor. The general contractor is .not autho ~o
to siQn the electrical label. - "-
Applicant-to sign and date
Whenever possible, the initial application will be u
a worksneet only. Where possible, Building ~ivision
will pre~are a type written copy and return it to th
applicant at the time the actual permit is issued fa
signature.
Fees and Cnd rges /,.'.
Plan check rees are due and payable at the time of t: \
application. and no plans will be processed until thl
fees are paid. All other fees and charges .are due al
payable when the permit is issued.
I I!.
IV,
V, FOR OFFICE USE ONLY '-
g
.
PERMIT VALIDATION
~,
CITY
,&
OF
SPRINGFIELD
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
Dote
1(-(0
,6
B 55105~
No.
ISO
Reed From t-4l0-tt brOI~ (J..lA..U
Address ~i():: f ;;~ ( ()0~.;J{ I ) ('.P Iff-
.-,^-.~/, 8.]..... - ......... J .
'--"'-''-../, 'I " 1'C- L L VI
Received For: (
nf)L \---In 4()UU
f
~
"
P-P 15,00
L-\Oj (j In()
G(-,P iO,[;O
4010 ~o
srx./ 4-2..'3 ,CD
G
6
G
4
-(J
~h~qu {t l' >
(' -1f)
(
fr
Amount Received.
(
=
AutHORIZED SlGNATUIU:
..s".s (~.
S"[lTO".TU~".Ull ....'..T[~. . e:uoe:,.e:, O~ .7"01
, '
(.
(
, I '
~,
. ___ .n'.. . 0....... _ .., . ".
j PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
;
!
~
,
J
i
~
,
!
I
I
I
l
I
I
J
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
"
date
I
""
'..'.."'. .. .,.... '''.....OJ