HomeMy WebLinkAboutPermit Building 1980-12-11
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cln OF S'RINGfIELD
COMIUNATlON ""'l!CATlON/PERMIT
INFCIRMATION LINE
726-.:1753
I INSPECTION LINE
726-3769
I Job Addre"
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'f0'f
20.94 D9-'1IlelJy_.
l.gol O...,'otio. .' o.chaven .Mobile ,Home Subd i v j sian ...
_I nt14...J31ocL4
Ow.., Robert Cochra, Gene &Berna.r:d_~iaJ;J_
ENERGY SOURCES: . I Sq. Ftg. Moin
H.ol Sq. FIg. Access.
'Nt'J"-' Heo,..' __._~~ -,-". .----~_I S.C}' FIg. Other
lo~ _.-._ ~~____'_ ___ I ^ New ~_ Add .._Alter _Rep.
'Yal_ of ....;~~:.... .hnce _Oem,)_Chonge/Use
, ., 4598.00 __O,h"
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W,
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Add,... 66J WPS t rpntp'mi ~ 1
Spri ngfield,_0~egon_-97_477
8u.ldi~ -P",mit I"fo: o.w,b; W~;k- (i.e.. Build Single'
.fom~1 R.,id.'He Wirh "ltoth"d.....9..~9!1
Double garage, mobile home plumbing &
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Electrical ~~rvic~
'''no
7_41::.1420_.
Construction lend.,
Addre"
Phone
DESIGN TEAM
(nomel
(oddr.nl
Primary
Garret Maupin. ~ 0 Box R46, Springfipl~
Structural
Electrical
Mechanical
t:t]NT~~~T0RS
lnome\
laddre,,}
l:iia..tt R...nih'''^< fl)nstrllrtion 1i1i1 WP<t fpntpnni.l 1l1"d, Spril1gfiel,l
741-1420
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WHERE STATE LAW REQUIRES that th. Electrical work be done by the Electrical Contractor, ~he electrical portion of this permit ,~oll not be valid until a I'
I label has been signed by an Electrical Contractor and alta'ched to the electrical panel.
Gener~1
Plumbin".
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1
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1 1
1
Electrical
Mechanical
PLUMBING
ELECTRICAL
No,l
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FEE CHARGE NO.
Residence of
Each sinqle fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
,q. ft.
New circuits, alterations
or extensions
SERVICES
Duplex (I both) each
Temporary Construction
Additional both
Amps.
W".ter service
Sewer
Storm Sewer
FEEDERS
Mobil e Home
Service
Amps.
TOTAL CHARGES
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1
15.001
TOTAL CHARGES
(lies. no.)
(exoires)
(phone no.)
_741i-R5l4
(lies. no.l
(phone no.l
(expires)
MECH.t,NICAl
FEE CHARGE NO, FEE CHARGE
furnace/burner to I
I\TU's
Appliance .....nt I
separate
Stationary evap.
cooler
Vent fan with
sinQle duct
Vent system aport from
heatinQ or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Heat Puma
Air handler to
10.000 CFM
Air handler o.....r
10,000 CFM
10.00
ISSUANCE OF PERMIT
10.00
TOTAL CHARGES
I HAVE CAREFULLY EXAMINED 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 performed sholl b. done in accordonce with the Ordinances of the City of Springfield and the Lows of the State of Orogon
pertaining to the work described herin, and that NO OCCUPANCY will be- made of any structure without the permission of the Bdlding .Division. 1 further
certlfy 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 exemption is noted
heron, and that ~nly subcontractors and employees who ore in complionce with ORS 101.055 will be used on this project.
Basis for Builder's Board exemption-
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SIGNATURE ~ ~
fOR OffiCE USE ONLY
NAME (please print)
p~
ITIn.)
V-N
Sq. Ftg. Main
Sq. Fig. Access
Sq. Ftg. Other
Type/Canst.
Bedrooms
C-tori"'"
Uriits
n....., Lood
l"'lccy Group M_ 1
Zon"
Fire Zone
Flood Plain
BUilDING PERMIT
Charges and
Surchorges
plan Ck. Comm/lnd
65%/ Bld~ Per Fee
Plan Ck. Res
30%/ 81d~ Per Fee
9.60
32.00
1.2B
PLUMBING PERMIT
Charges and
Surcharges
15.00
.60
10.00
.40
Fence
Demo
ELECTRICAL PERMIT
Charges and
Surcharges
158'
15.80
Sidewalk
A/C Povina
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
1
10.00
1<./ .J/~
"ATE~/-1~ I,.
484
.
. 9.50
'{alue
-'olu. ---A5.9B....oD-
x '{olue
TOTAL VAlUA'II0N '1:>Ytl. UU I
IPaid with MObilJ
IHome Setup Permit:
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Systems Development
Charae 11..5%\
Totol Comb. Permit
94.68
TOTAL
94.68
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COMBINATION APPLICATION/PERMIT (CAP),,;;, ,}t, PERMIT YALlDATION' ,-"'
I. Applicant to furnish 'f'-' ..., .~ -.~I~.;.-_~ . ~ ;'.c~. ~ _' - - ..
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A. Job Address ....;,....' .r t .~_;~ r '" .l'~ ,.' -..... ':.....~ , ""~"f:.-.....
B. legal Description .': _:. ,,;,,t!..~.:'" ...ti '\.;-,- ""...~. .),;:~' \. ~!___.:.. i .~<t>f' ..
1. example.tax lot 100, Lane County Map Reference 17'.03 43 "., ',' , ' ..
2, example.Lot 1. Block 3, 2~;J,~~~!tio~,toSR'ingli;. .' (I T Y , 0 F ' S P R IN G F IEl D
C. Nome, etc. of owner and construction lender I
0, Energy Sources
1. example-heat/electrical ceilinq.' or forced oir ga~
2. example-water heaterielectri~al:'or solar
E. Square footage or valuation, etc. -
1, example-1250 sq, foot house, 500 sq, foot gora~
2. example-if new proiect, check ne'!.Y-if\..apdl_tl?,r1' cI :1'".
odd, etc. . . 4..
F. Building permit information:
1. example.construCt single family house with an a
(,_, Rec'd
garage . 7"
2. example-remodel existing'gorag'e i!:lto family rOt ~.
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
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Div (n
Staff must be able to contact appropriate persons rE
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedul ('
A. Except where blank spaces occur in the description r
of the Mechanical and Electrical Schedules, the appl
need fill.in only the No, Boxes adjacent to the appre (at
item(s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division 1
1. To conserve space on the permit form-the schedu \.
have been abbreviated
2. ~ If the item(s} to be installed are not covered on d
ated schedules you should consult the full schedu (
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I
CHARGES ON THE SCHEDULES
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Date"/2 ~}5 19)5A9..,.,B_..5538Q~ "
From4-\,(n1t r fJV1~! ' r
Address ~O {,CXQY:\-klfLllLJ]~
City Hall
Springfield, Oregon
Department of Public Works
, OFFICIAL RECEIPT
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Received For:
R-p . 57 DC)
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III. Applicant to sign and date
Whenever possible, the initial application will be used c
worksheet only, Where possible, Building Division Staff
prepare a typewritten copy and return it to the applicar ~
the ~ime the actual permit is issued for his signature.
IV, Fees and Charges
Plan check fees are due and payable at the time of the,
and no plans will be processed until these fees are paid,
other fees and charges are due and payable when the permit
is issued.
Amount Receive~l Lr ,(ov
dL--
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- THORIZIi:D SIGN...TURI:
$H.~TON.TUIU..U ~ ~~I..T.~!1 . 'lUG.N.. O~ !I..Ql
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V, FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
5 foot wide s_etbilc~ sidewalk to'~ installed with ritv ~bndilrd cllrhrllT
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Additional Project Information:
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PLANS REVIEWED BY:
nam~
Lorne Pleger
",ignatur,..
7~~:-'
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"'ate 12 .11.80
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