HomeMy WebLinkAboutPermit Building 1980-12-16
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I INSPECTION LINE
726-3769
I Job Addreu
I Legol DeJ'ription
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<;n...i 'lgf.ie.l d ,_Oregon_--97_417
I Conltruc,inn 1,.",.1..
I Addr."
CITY OF SPRINGFiElD
COMBINATION APPLICATION/PERMIT
. iNFORMATION LINE
726-3753
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ENERGY SOURCES:
I Sq, ".,,Main -,64--
Sq. Fig. Aceen. _
____I SQ. fIg. Other
I X New.... .Add _Alter_Rep.
Fence _Demo_Change/Use
2048 Donne 11 y
Lochaven Mobile
Home Subdivision
H.af
WO"', H.al., ___
& Bernard Hiatt
Blvd
Other
co
a
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a
L at 32~_BloCk 1
Own" Robert Cochran, Gene
Add".. 663 West Centennial
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Vol... of wo,ll:
Phone
741-1120_
2508.00
Suilding P..m;1 I...fo: o.~~'j~ Wo;~ (i.l!.:B;;iid-~~i;"
!om'!r...!l.,idenc. With AlIa,h.d G~'~9!L-
_ __~ingle_gara9~_and__1119b!1e
and El ectri ca 1 servi ce
home olumbino
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OESIGN TEAM
Primary Ga rret
("om.)
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{'iCl. "0.1
(expir.,)
(phone no.)
Maupin, P.O. Box 846. Springfield. Oreoon
97477
746-8514
Structural
Electrical
Mechanical
CONTRACTORS
General Hi att
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(lies. no.l
(expires)
(phone no,)
BrQth~r~ Construction 663 W~~t C~ntpnn;,l R1vrl_ Sorinaf~lrl_ Orp
_741-1420
Plumbing
Electrical
Mechanical
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_I, .W,HhEU ~~~TE .lAWdRbEQUIRES, that the Electrical wadrk be dhando by h'he ~~ed~ica,l Con,'rador, the electrical portion of this permit shall not be valid until a I,
au. o.....n ~9ne y an E ectrical Contradar an attoc e to I e e..drlCD pane.
PlUMBING elECTRICAL
NO. I fEE ! CHARGE NO. I
lIesidence of
Each linDle li"'1I,e .':t.ft.
Relocated building New circuits, alterations
(new fiA, additioftOll or extensions
S.F, Reliden(.e I
II bath) SERVICES
Duolu (1 bolh) each I Temporary Construction I
Addilional bath I A.mpl. I
Wat.r ..,.,ice I I
Sewer I I
Storm S.wer I FEEDERS I
1 Mobile Home I A.mDs, I
Service 15,00 1 IMobi 1 e Home I
IServi ce I
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TOT AL CHARGES 15.00 TOTAL CHARGES
MECHJ~NICAL
FEE I CHARGE NO. I
I fEE" I CHARGE
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110.00
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furnace/burner to
I\TU's
Appliance yent
separate
Stationary eYap.
cooler
Vent fan with
sinAle dud
Vent system aport j:rom
heating or A.C.
Mechanical exhault
hood and duct
I Wood stove/heater
I Heat Puma
I Air handler to
10.000 CFM
I Air handler oYer
, 10.000 CFM
ISSUANCE OF PERMIT
10. 00 I TOTAL CHARGES
"HAVE CAREFULLY EXAMINED the campleted application for permit, and do hereby certify that all information hereon is true an::l correct, and I further
certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the lawl of the State of Oregon
pertoining 10 the work described herin, and that NO OCCUPANCY will b. made of any srructure without the permiuian of the B~lilding DiYision, I further
certify that my regiltration with the Builder's Boord is in full force and effect 0 s required by ORS 701.035, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Bo,;, fa. 8,;ld,,', Boa,d ..ompt;a.' AY ,j) J
NAME (please print>_V-= 4"l_ Lv I" \ [( L t.7 C./ft- SIGNATURE ~ tlI A ft~
_ DATr! z..
jf.-fC
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FOR OFFICE USE ONLY
Zon-
MHS
Type/ Const.
Bedrooms
C,tarie"
V-N
Units
ntcy load
,." 'cy Group
cO'l
Value
Value
Value
TOTAL VALUA'rION
.
".ou
c~UIl.UU
Fire Zone
Flood Plain
M-l
Sq. Ftg. M.::tin
C:q. Ftg. Acces"
Sq. Ftg; Other
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?SOR 00
.:;10
Plan Ck. Comm/lnd
6S%/Bld!1 Per Fee
Plan Ck. Res
30%/ Bld~ Per Fee
Systems Deyelopment
Chame fl.S,,"l
IPaid with Mobill
IHome Setup perm t~
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BUILDING PERMIT
Charges and
Surcharges
24.00
7.20
PLUMBING PERMIT
Charges and
Surcharges
15.00
..JJ
Fence
Demo
Total Cnmb Pnrmit
74.96
ELECTRICAL PERMIT
Charges and
Surcharge;
10.00
68'
6.80
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TOTAl.
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74.96
MECHANICAL PERMIT
Charge. and
Surcharges
Sidewalk
I Air p__,""
I Cur~ ;~~--~
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1
10.00
.'tu
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I, Applicant ta furnish
A. Jab Address
B, Legal Description, ..
1. example-tax lot 1 00, lon~- Co~~ty Mop Refer;nce i 7 03 . ..
2,_ example-Lot LBlock 3,,2nd,Addition to Springfield Eslalf ..r
C. Name, etc. of owner and'c~nstruction ie~der'. . ....
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example.water heater/electrical/or solar
E. Square footage or valuo"tion, etc. -
1. example-1250 sq, foot house, 500 sq, foot garage
~. example-if new project, check ,ne.w-if addition, check. (
. "add, etc. '. 1,,- ...... ...~. .
F. Building permit information: ..
1. example-construct single family house 'with' an a,ttoch, . (.
garage
2. example-remodel existing 9C1rage into familfroom
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, 'Builaing Divisil
Staff must be able to contact appropriate persons rege
design information or job site corrections, etc.
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PERMIT VALIDATION .:".
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COMBINA TION APPLICATION/PERMIT ,(CAP)
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CITY' ,
OF SPRING':""
City Hall E l 0
o Springfield 0
epartment af'p r~gOn
OFF I C , A l RUb/Ie Work.
ECE/PT
No. B 5538'~
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II. 'Abbreviated Plumbing, Mechanical & Electrical Schedule,
A, Except where blank spaces occur in the description pI
I h Irt
of the Me.chanical and Electrical Schedu es, t e appli ~
need fill-in only the No, Boxes adjacent to the appro
item{s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the sched,
have been abbreviated
2, If the item(s) to be installed are not covered 0;'
ated schedules you should consult the full schec
C, BUILDING DIVISION STAFF WilL FILL OUT ALL FEE'
CHARGES ON THE SCHEDULES
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III, Applicant to sign and date
Whenever possible, the initial application will be us' I"
worksheet only. Where possibl.e, Building DivisiC?n S' \.~ 8'1"
prepare a typewritten copy and return it to the app ,-::-r'.'
the time the actual permit is issued'for his signatun ..;. \...""
IV, Fees and Charges !
Plan check fees are due and payable at the time 01-
and no plans will be processed until these fees are paid, All
other fees and charges are due and payable when the permit
is issued.
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V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
5 foot wide setback sidewalk to be installed with Cit
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Additional Project Information:
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PLANS REVIEWED ,BY,
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1""~
-Lorne Pleger
nome .
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signature
date
12-11-80
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