HomeMy WebLinkAboutPermit Building 1980-12-16
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Job A.....o.. 2026 Donn\.' 111
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Lot 33, Block 3
Owne, RObert--Co.c~r~,~Ge~e !. Bem.ar"t Ht"atC",- -"
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Add,... 663 We'st tentennt'al Blvd
Sori nqfie 1 dL_Or_ego"__R477.
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Can'truc:tion L..nd.,'
Sf ng I e ,C~r;>ort ~n<l AltJcned S tor~Qe Shed
~~bile Home,Plumb~~9_~ E~ectrlcjl ser~iSE
Add,,"
Pharw
DESIGN TEAM
(nom.)
Primory
Garret Maupin. P,O. Box 846. Sorinafield
(add..",
(Iiu.roo.)
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746.:85H
Structural
Elec.trical
M.chanical
General
CONTRACTORS (nom.)
Hiatt Brothers Construction,
(addreu)
663 West Centennial
(lies. no.)
(.xaire,)
'"hone no.)
Boulevard, Springfield
741-1420
PlumbinQ
Electrical
M.chanical
PLUMBING ELECTRICAL MECI-JANICAl
NO, fEE CHARGE NO, FEE I CHARGE ' NO. I FEE ICHARCE
Residence of I furnace I burner to
Each sinRle fixture SQ. ft. I\TU's
R.lacat.d building New circuits, alterations I I Appliance ....nt
(new fix. oddition~1) or extensions Mparate
I S.F. Residence I I I Stationary .Yap.
(1 bath) SERVICES coal.r
I I I I Vent fan with I
Duplex (l bath) .ach T.mparary Construction sinRI. duct
I I I I Vent system apart from I
Additional bath Amps. h.atinq or A.C.
I I I I I Mechanical e.houst I
Water service hood and duct
I Sewer I I I I Wood sta...e/heoter I
I Storm Sewer I FEEDERS I I I Heat ;umo I
1 I Mobil e Home I I I I I Air hondler 10 I
Amos. 10.000 CFM
I Servi ce 115.001 1 Mobile Home I I I I Air hondl.r o...er I
10.000 CfM
1 I 1 Service I 110.001 'I I
I I I I I I I I
I I 1 I I I I I
I I I I I I ISSUANCE OF PERMIT
TOTAL CHARGES 15.001 TOTAL CHARGES 10, 00 I TOT A' CHARGES
WHERE STATE LAW REQUIRES Ihat Ih. Electrical work be done by the Electrical Contrador, the electrical po!tion of Ihis p.rmit "'011 nol b. volid until a
lobol has hHn sisned by an Electrical Contrador and attached 10 the el.ctrical panel.
I HAVE CAREFULLY EXAMINED the completed application for p.rmit, and do hereby certify that all information .h.r.on is true and corr.ct, and I furth.r
certify that any and all work performed shall be don. in accordance with the Ordinances of the Cit)- of Springfield and the Laws of the State of Or.gon
pertaining to the work described h.rin, and .that NO OCCUPANCY will b. mod. of any structur. without the permission of the B~'ilding Di...ision. I further
cortrfy that my registration with the Build.r's Board is in full force and eff.ct as r.quir.d by ORS 701.055, that if exempt the basis for exomptian is noted
heron, and that only subcontractors and .mplay..s who are in compliance with ORS 7.01.055 will bet used on this project.
Basis for Builder's"Board ex.mption-
NAME (pl.ase print) Dr.. 0'......
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"GNATURE /QVA _ ifdAP J
_ DATE/l-lt, )j 0
fOR OffiCE USE ONLY
I'IM':) Type/Canst V-I~ Inits Sq. Fig. Main 240 5.10 Volu. J22A..J)D
Zon" .
Fir. Zone Bedrooms ,,",ccy Load Sq. Fig. Access 1'2. . 9.50 Valu. ---6.8..4 . 00
Flood Plain c.tari.. "ccy Group_ M-l Sq. Ftg. Oth.~ Value
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.- TOTAL VALUATION
BUILDING PERMIT 20.00, Plan ell:. Comm/lnd I Systems De....lapm.nt I
Chorg.s and -------- 65%' BldQ P.r F.e CharAIl n.5%'
SurcharGlls .80 Plan Ck. Rlls I t!ome Setup Permi s
30'" BldQ P.r f.. 6.00
PLUMBING PERMIT 1 I
Charglls and 15.00 f.nce
Surcharg.s .60 I Totol Comb. Permit I 69:60
Dem.
ELECTRICAL PERMIT 10.00 I Sid.walk fiR I I I
Charg.s and F. Rn
Surcharges .40 lAIC Pa...ina I I
MECHANICAL PERMIT I Curb Cut I
Charges and --------- 1 In...Dn 69.60
Surcharg.s I I TOTAL
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I. Applicanl10 furnish -.;-',.~ i-~., -:','":... ... ..... ,_'. _:i
A. Job Address .:'" 'V ,-.-...- ,.'",<
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8: legal Description '''.,... ".:- ~... .-~; .. w. ~j ..- .~.; p '..,~, .. - ~ -
1. example-tax lot 100, lane County Map,ReferencE','''' n., ,II., , ;. ,-
2, example-Lot 1. Block 3'l'l~;!,ddition,t?,\Springfiel,-"(,,,,,- C I T y.~- 0 F'~:SP RING FIE L D
,_'_' C. Name, etc. of owner and construction lender :
O. Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. example-water heater/electrical/or solar
E. Square footage or valuation. etc. .
1, example-1250 sq, foot house, 500 sq, foot garage
2. example-if new project, che"ck n-ew.=i{ addition, ch.
add, etc.
F. Building permit information:
1. example-construct single family house with an att
garage . 1'".
2. example-remodel existing garage into family roor
3. example-convert single family residence into
restaurant (change of use)
G, Value of work os defined in Section 303 (0) of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS (
To ovoid design or construction delays, Building Divi!
Staff must be able to contact appropriate persons res;;
design information or job site corrections, etc.
COMBINA nON APPLICATION/PERMIT (CARt
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II. Abbreviated Plumbing, Mechanical & Electrical Schedule
A. Except where blank spaces occur in the description pc
of the Mechanicol and Electrical Schedules, the applil
need fill.in only the No. Boxes adjacent to the appro,
Item(s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedules
ore. available at the Building Division .~
1. To conserve space on the permit form the schedult
have been abbreviated
2. If the item{s) to be installed are not covered on thl
ated schedules you should consult the full schedult
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
III. Applicant to sign and dote
Whenever possible, the initial application will be used 0:
worksheet only. Where possible, Building Division Staff ,
prepare a typewritten copy and return it to the applican'
the time the actual permit is issued for his signature.
IV,
Fees and Charges {
Plan check fees ore due and payable at the time of the 0 ..,;,
and no plans will be processed until these fees ore paid.~..
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:
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City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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Received For:
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- A~RrtED 5IGNATUIIII:
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Permit Clerk
5 feet \oIi~~ <etback sidewalk to hp ~~s":""rl with C'+~, :tilR~ard ;;:;rl;:::1;
Additional .Project Information:
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PLANS REVIEWED BY:
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nom"'"
Lorne PleQer
"ignatur'"
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~ate
12-11-BO