HomeMy WebLinkAboutPermit Building 1981-7-28
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INSPECTION LINE
72W769
Job Address c;,3D-Ed~.omt"\n+_-Wa,}J
logal Do"dpHon 1 7~0:k34=l3-(n30n
Owner Jnp n;lvic:.
Address
530 Edaemont Way
Sprinqfield. Oregon
State GI
Construction Lender
Address
DESIGN TEAM
(name)
Pdma'y Hochstein Construction
Structural
Er~ctrical
Ml'lchcnicol
CONTRACTORS
(name)
Generallio.c.b..s..tpin rnnc;;trIJc.:tinn
PlvmblnoA 1 ert Pl umbi nq
ElectricolnflVP, Fl p.r.t.rir.
Mechanical
PLUMBING
NO, FEE t CHARGE
Each sinqle fixture I
Relocated building I
(new fix. additional)
S.F. Residence I
(1 both)
Cupltlll: (1 bath) each I
Additional bath I I
Water service I I
Sewer I I
Storm Sewer I I I
3 Relocate fixturds 115.00 I
I I I
I I
I I
I I
I I
TOTAL CHARGES 15.00
.....
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CITY OF SPRINGFiElD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
l'l"ct
Heat
Water Heater
Ranq-
Value of Work:
\
10,000.00
Building Permit Info: Describe Work (i.e.. Build Single
Family Residence With Attached Garaae)
Phone
726-1 Q70
addition tn l'xi,tino ,inn1" f~mi1v r",
97477
Phone
(address)
(lies. no.)
INfORMATION LINE
726-3753
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P.O. Box #7624. Euoene. Oreoon
(address)
(lies. no.)
Sq. Ftg. Main
Sq. Ftg. Access.
Sq. I'=tg. ~~er
-,-New_Add_Alter_Rep.
_Fence_Demo_Change! U se
_Other
(expires)
(phone no.)
p n R"x #76?/1 ""-9ono ~:>S2~
10 Van Buren. Euqene
P 0 Rnx It23....3nri nqfia1 rl.
ElECTR ICAl
NO. '
I FEE
-I
I CHARGE
I
Ii 5:'00
I
I
/1R4_QQ/1/i
(expires)
(phone no.)
Residence of
so. ft.
..__...~
2 New circuits, olterations
or extensions
SERVICES
Temporary Construction
Amps.
FEEDERS
Amps.
~_A?
4A~4/i
345-3055
z..46-~640
MECHANICAL
NO,
FEE
CHARGE
furnace/burner to
ATU's
Appliance vent
separa Ie
Stationary evap.
cooler
Vent fan with
sinqle dud
Vent system aport from
heating or A.C.
I Mechanical exhaust
hood and duct
I Wood stavelheat~r
I Heat Pump
I Air handler to
10.000 CFM
I Air handler over
10.000 CfM
X Extend htQ SVS.
14.50
I
I
10.00 I
14.50
TOTAL CHARGES
ISSUANCE OF PERMIT
15, 00 I 10T Al CHARGES
I 'nits
n.'Y Load
Occy Group
D_~
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not 1M valid until a
label has bHn signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFULLY EXAMINED the campleted application for permit, and do hereby certify that 011 information hereon is true and correct, and I further
.:.rtify that any and all work porformed sholl be done in accordance with the. Ordinances of the City of Springfield and the Lows of the State of Oregon
pertaining to the work described herin. and that NO OCCUPANCY will b. mode of any structure without the permission of the Building Division. I further
cartrfy that my registration with- the Builder's Boord is in full force and effect 0 s required by ORS 701.055, 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. .
8asis for Builder's Boord exem'ption ~ . / ~
NAME (ploa.o p,;n') ~A/.A//--y.JI m, ./?,,. JI5'!r.-/L) SIGNA1URE~;"'-~~,~DATE 7-..;;J]-P/
~~~~ I
1 '" "g. Main -176 x Volvo 1 0.000. 00
c,. Ftg. Access' x Value
Sq. Ftg. Other x Value
R-l
VN
Type/Canst
Bedrooms
~torie4
1
Zone
Fire Zone
Flood Plain
r01AlVALUAlION 11l,nOIl IlO
BUilDING PERMIT 52.00 Plan Ck. Comm/lnd I I Systems Development
Charges and 65%/ Bldc:t Per Fee Charae f1.5%)
Surcharges 2,08 Plan Ck. Res ~5.60PO 7-22-81J 56943
30%! BldQ Per Fee
PLUMBING PERMIT I I
Charges and l~_lln fence
Surcharges ,60 I I Total Comb. Permit
Demo
ElECTRICAL PERMIT [ Sidewalk I I
Charges and 15.00
Surcharges I AI C Pavina I I
~n
MECHANICAL PERMIT 14.50 I I I
Charges and Curb Cut .
Surcharges ,---~-:-SS----I I I TOTAL 100.36
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I. Applicant to furnish
,A. Jab Address
B. legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot 1. Black 3, 2nd Addition to Springfield E.tntp..
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example-~oter heater/electrical/or solar~.;.;
E. Square footage or valuation, etc.
1. example-1250 sq. foot hause, 500 sq. foot garage
2. example-if new project, check new-if addition, che-
. add, etc.
F. Building permit information:
1. e"xample-construct single family house"'with an afte
garage ' Rec'd
2. example-remodel existing garage into family roon (
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 Divis ('
Staff must be able to contact appropriate persons reg '-..
design information or job site corrections, etc.
~OMBINATION APPLICATION/PERMIT (CAP)
II. Abbreviated Plumbing, Mechanical & Electrical Schedule,
A. Except where blank spaces occur in the description pc
of the Mechanical and Electrical Schedules, the applic
need fill-in only the No. Boxes adjacent to the approF
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 schedule
have been abbreviated
2. If the item(s) to be installed are not covered on the
ated schedules you should consult the full schedul,
C. BUilDING DIVISION STAFF WilL FILL OUT ALL FEES AI
CHARGES ON THE SCHEDULES
III. Applicant to sign and date ('
Whenever possible, the initial application will be used a~
worksheet only. Where possible, Building Division Staff "
prepare a typewritten copy and return it to the applicant -
the time the actual permit ~s issued for his signature. (
IV. Fees and Charges
Plan check fees are due and payable at the time of the a ec.
and no plans will be processed until these fees are paid. .
ather fees and charges are due and payable when the p!,-..... '
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
name
signatur-:-
PERMIT VALIDATION
(
CITY OF
n
SPRINGFIELD
(
City Hall
Springfield, Oregan
Department of Public Work.
OFFICIAL RECEIPT
(I
( Date C'\'~ It c9A 1.B \ No. B
Fr~mr\'&~OOn ''-B(\~j
Address lJV .~. \isf-. ''1 \~~
56968(1
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