HomeMy WebLinkAboutPermit Building 1979-7-17
'I H'SPECTIO~1 l1~'E
726-3769
Job Address
~
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Legal Oe"ription Lot 9. Connie Subdivi~irln
7049 Glacier Drive
CiTY OF S?RIi!GFi~LD
COMBIIIATION APPl1C~,T10rl/PERI~IT
IEnergy Sp,url'es:
heat ~.I\._Elect
~d.ter heater c.lt:'l...l.
,""n('~ -':-~-':'-'i.-:
~..\ -.:-
WFORl'lAT LOri l WE II'
726-3753 .
~q. tt. maln & accsy. tlJdg.
1445 . ~5<;
---xnew add a Iter rep
-fence demolition
.... = change/use _other
.;alue of. work: _ _.______ ___
~uild;nQ permit info.: describe work (i.e,. build
iinale fam. res. with detached oaraae)
12
S.F.Residence, with attached garage J ~
....
I
I
I
(ohonp. no. I
Owner (name/address/phone) Ronald R. Carlson
5120 Franklin Boulevard. Eugene
726~6311
Construction lender (name/address/phone)
Ul:.~llliN aN1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
'.lechan;cal
(name)
(address 1
{l ics. no.l
John Lawless
SOILS: Georae
38264 McKenzie Hiahwav
Griffin 2866 Manor Drivp
(name)
(i1ddrp~<;. )
(11r:<;. nn_
Carlson-Adams Associates
Chapin-Adams Plumbinq
Builders Electric
Chapin- Adams
5120 Frilnkl in
?1RI>I>
II II
293 Monroe. Euaene
5120 Franklin
PLUllBIrlG
MECHANICAL
rlO,1
-----I Each single fixture
IRelocated building
, (new fix. additional)
IS.F. Residence
X f1 bath}
IOuPlex (1 bath) each
Additional bath
~Jater service
Sewer
Storm Sewer
I FEF i CHARGE
I
!5.001
I
n nnl
I
Appliance vent
""'Drlrate
Stationary evao.
cooler ~ '
I Vent fan wi th
5inole duct
I Vent system apart
heatina or A.C.
Mechanical exhaust
honr! and dur:t
< nil
NO t
I !:"n' I ~~ _NO
4.ob
furnace/burner to
1 1 nn , nnn BTU' s
Floor furnace
and vent
Recessed wall
~nrlr:p hp~tpr ~nrl vpnt
I
I
3
2.01il
6.01
I
I
I
I
from
1
Wood stove/heater
I
I
I
I
!SSUAflCE OF PER!iIT
~1,OO
fexoires)
747-1>701
741i_?1lin
(pxnirp5\
(ohonp nn.)
726-1>111
726-2160
4R~-nQ??
7?1i_?1lin
.'("
ELECTRICAL
I Res i 1"4'&'5 of
SQ. FT,
I l="!:"l=" \rl-l~
25.0m
I New c i rcuitsua:lts.
or extensions
ISERVICES
x
Temporary Construction 10. all
Change in existing
rP'l j cLpnrp
multifamily, COIllJl. or
Tnrluc:.trirll
Of
CO~1,/IND. FEEDERS
I Install/alter/relocate
rli"trih. fppdprc:.
IOf amp~
rlew circuits. alts.
nr pytpn"inn"
amps.
TOTAL CHARGES 1<;_ on TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done hy an
shall not be valid until the label has been siqned by an Electrical
1 I> nn I TOTAL CHARGES 35.00
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division,
t HAVE CAREFULLY EX.A.f.HNEO 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 shall be donr ir acc ance with the Ordinances of the City
of Springfield and the laws of the.- State of Oregon pert,ainin9 to the work descfr,'[d her in;-\and t,hat-NjI OCCUPArlCY will 'be made
of any structure without the permission of the Buildina Division. ,: , I" \ // /
NA~'IE (please print))C ~.Ll." D,.f:;'.,\", SIGrlATURE ()- '-(0, ~) ,(,~,J DATEI-I1-7Cf
Zones R-I/F7 1
Deey Load
BUILDING PERI,IIT
Charges and
Surcharges
PLU'1BING PERMIT
Cha rges arid
Surcharges
ELECTRICAL PER~\IT
Charges and
Surcha rges
~'ECHANICAL PERMIT
Charges and
Surcharges
FOR OFFICE USE DilLY
Flood Plain -..No.... Bdrms ~ Type Const.V-N
Sq Ftg.
Sa Ft[!,
Deey Group
Storics Units
A [ C U U ~ r SUM MAR Y
Plan Ck. Comm/lnd
fi5%/Hldo Ppr Fpp
Plan Ck. Res
30%/Bldo Per Fee 50.70
Fence
_ _ _l6J~ QQ _'_ __
6.76
____3li~QL_h
1.40 '
Sprinkler System
_h-15..00-____
1.'40
16.00
--,-----:-nr---
Demo.
A/C Paving
Curb CutI-18lf
Sidewalk 60, If
11.80
6.50
144<; Value
ll!:),) Value
19.717.00
< ~li7 nn
Storm Sewer Connec,
Other San Sewer
IOther
Other
100.00
Total Comb. Permit
434.20
SOC
TOTAL
'\
r/
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COMBINATION APPLlCATIOII/PERi1lT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- iax Lot 100. Lane County'Map Reference
jl 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exarnole- heat/electrical ceilinq/or forced air qdS
'2. eXc~ole- waterheater/eJectrlcal/or soJar
E. Square rootage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. check-nfw - if addition.
check add. etc.
F. Buiiding permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (Change of use)
G. Value of work as defined in Section 303 (a) of the
Stl'uctural Specialty Code
H, OES I G:~ TEN! ArID CONTRACTORS
, To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to tne appropriate 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 schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
0, As noted on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
,to sign the electrical label. -
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare.a type written.copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I A~VP Avictinn trp~c if nnccih'~
? Arljll<t m~r:lhJJ..lp, rlp~nollt. etr" as reolJired,
Additional Project Information:
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PERMIT VALIDATION
BP
169.00
6.76
4%
PP
35.00
1.40
,
.
4%
EP
Tempor.ary
4% 1<\;-315
10.00
.40
EP
Permanent
4% 14-3 i 1
25.00
1.00
MP
16.00
.64
4%
Plan Check Fee
50.70
CC 1-18 lineal feet
11.80
SW 65 Lineal feet
6.50
Sanitary Sewer
100.00
TOTAL DUE
434.20
1-{7-7'
Permit Clerk l!~
II
I cttpr from (;porgp (;riffin P ~ "P'l~"r!i~g soil ronrlition ,.pnll_i,.pr! ,.pt~ining wall
and footing drain
, PLANS REV I E\,ED BY:
name
signature
,
, date
"
..- ,-._'" --,,': '~:.