HomeMy WebLinkAboutPermit Building 1980-9-12
I HISPECTIOII LIrIE....." ()/ '-
726-3769 ~ II" n 0 (ll\tl JII T,
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CITY OF SPRlilGFIELD - '. '~.:~')
COIIBIIIATION APPLICATION/PERMIT
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Job Address
Legal Description
INFORlIATlON LINt
726-3753
Sq. Ftq. 1.la;n
~q. FtlJ. Access.
Sq. Ftq. Other
flew Add XA lter Pep.
-Fence Oemo Change/Use
Other - -
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1802 Market Street
Lot 20 Block 3 Northridge
.1 ~~;~GY Sf!~~Ct=
I' Hater Heater t.1 ec L
Elee];
Owner Brenda Fossey
Address 1476 Pleasant
Phone
Range
Val u, of l'lork:
9,000.00
Builiina Penmit Info: Describe Work(i.e..
Far:lil v nes i dence \./i th ~.ttached Ga raae)
Bui ld Single
Construction Lender
Address
DES I GN TEAll
Install wall to convert to Duplex
Structural
Primary Drawing Servi ce Inc
(name)
Phone
(address)
59 Co burg Road, Eugene
(ohane no..
687-0293
Electrical
11echanical
CONTRACTORS
(I ics. no.)
(exniresl
(name)
(address)
409 Suburban Eugene
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i1ohone '1.Q.. )
6$9-1935
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(lies. no.)
02027100
(exoires)
Plumbina
Curt Filler Co.
Genera 1
: Electrical
,,_. :.~,.s..hanical
PLUIIBIrIG
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MECHANICAL i
ELECTRICAL
--.-......-"'".
NO.
.--->.~,
"F
rlJARliL
Each single fixture
==--_ -, ~,., _.~ ~FEE'" . CHARr,E ..line I". n__.__~~ ..EEL': S.IlARGf.
Residence of
SQ. FT:
furnace/burner to
BTU's
Relocated building '.1
(new fix. additional)
1
1
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1
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-NO:
2
S.F. Residence
(I bath)
Duplex () bath)
Additional bath
Ha ter serv i ce
Sewer
Storm Sewer
5.00
10.0C
2
New circuits alts.
or extensions
15,00
Floor furnace
and vent
SERVICES
Recessed wall I
Soacl:' hl:'ater and vpnti
each
Temporary Construction
Change in existing
r~~ i rtp,.nce
multifamily, comm. or
Industrial
Appliance vent
c;.eoa ra te
Stationary evap.
cnnler
I Vent fan with
sinale duct
I Vent system apart
heatina or A.C.
1 Mechanical exhaust
hood and dud
I Hood stove/heater
I
1
I
I
I
1
, 1
Of
amps.]
1
~.51)
from
C0I1H.1I NO. FEEDERS
Ilnsta11/alter/relocate
rlic;.trih. feeders
IOf amps.
1
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ISSUAtiC, OF PFRIIlT
10.00
TOTAL CHARGES lV. VU TOTAL CHJ.RGES b. UU TOTAL CHARGES 1'1. ~v
WHERE STATE L\li REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pernit
shall not be valij until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXN11NED the completed apr1ication for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordina~ces of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the'Builderts
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7n1.055 will be used on his project. .
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SIGiV\TUR~ ~":Jh.: ~
IIAI-IE(please print)
JOHN HASCALL
DAT~ '712. ~/ ~ J
Zone 1\-' ~ -.! F~~ orF I CE USE Oi~L Y r1ain
Tyoe/Const. Units Sq. Ftg.
Fi re Zone Bedrooms Occy Load Sq. Ft!]. Access
Flood Plain NO Stories 1 Occy Group R-3 Sq. Ftg. Other
BUILDING PERMIT
Charges ane
Surcharges
PLU'1BING PERMIT
Charges and
Surcharges
ELE~TRICAL PERr~1T
Cha rges and
Surcharges
11ECHAII I CAL PERI'I! T
Charges and
Surcharges
x Value
x Value
x Value
TOTAL VALUATION 9. nnn. no
48.00
------1:-gz---
Plan Ck. Comm/lnd
65%/Bldq Pe- Fee
Plan Ck. Res .-
30%/BldQ Per Fee
Fence
Syster.'ls Development
Charoe (1.5,,)
14.40 PO
10.00
--------:-40---
Demo
15.00 I Sidewalk
------------IH
.60 A/CPav;ng
14.50 I Curb Cut
------------1
..56
Total Comb. rermit
-- TOTAL
91. 00
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COMBINATION APPLICATION/PERMIT (CAP)
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Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100. Lane County Map Reference
11 03 43
,2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heatl,electrical ceiling/or forced air" gas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examele- if new project. check-n€w - if addition,
ch~ckadd,ett. .i
-r-'. lIunding. perm"it 'informc:tion:
L . Example .'." C:O:1si:ruct. single family h0USE: .~!it:l ('.il
attach~l( gaia.ge '
"2. examD'le.. remodel ex~~.-i:;ng gari.ige into t1;nily rocm
3.,- ~~~~E~" COilvert. S"j":lg1"e famiJy rcs:idei1C~,. -ini"ll
restaurant (change 01' use)
G. Vil'lue of.work tiS (iefii1:?G 'jn Se::ction 303 (a) ~f .thE.
Structural Spp.ciali::y Codf: <l
'11., DESIGN lEAI.1 AND CUNTRACTORS .i
To avC"j ct dts-j gr( m'" r.onstYllC"fiofl del;;~'~. Sui rr1iW:I
Division Staff must be' (l.b'le to cont?-(;-i: (lpprn~l.iate
persons regr:rd'j IIg des i 9i~ i rt"!--oi-,irrl t'j on 01' :i ou ;_~ -j"i;~
. cQrrect ions. et.(;. '.;
^bbrelfiateci Plumbing. Heche-xdc81" ,& Ere(".-~i"j'_:[:'1 S"~l-,.:du'H;:-:
A Except ~'Ih€re bl;;nk space~ occur in the ci..:~sr.r'lpt.ioil
portion of 'l:he Nechanical and E'tect.richi SdJ'(;:duh:s.
.the appl.;cant need f"in..in oOlly..trn: 1\0.. BCIXCt. adjaceirt
tathe appropriatE'! 'item(s-): to be iilstJn~d "
Pi.. Full. Plumbing, '.r-lfchhn"ica.l, an(\;' F:.Jel.:,t.rir.al SC;1ecll.11:-,s
. are availeble. at the Bunding Oiv'jsioil .
1. . To CDn"SCi~VE:: spar:e on the rtrmh. furm th,:'.schedules
haVE .been abbi~eviatp.c1 ',,;
(.'. If the' itp.m(s).tu b::: 'jnstalled. are not ('"c;vered on
. the' 'nbbr:evi;:,ted sci,edld(:s yin' sh.ould COilSUlt the
full st:hedules
. C. BUILllJNG DIVISION STAFF ~ILl "FIl.l 'OUl ALL rl[S AND
CHARGeS ON THE SCHEOULES , '
n. As noted o'n the CAP, ihe...label' ml!st be .del"ivt~rerl co.thQ
elertrical contractor for signat.ure by his electr-jca'J
,supe-rvisor..' The general cor.tractor'.is not outl1orize(]
to s19n the electrical la.bel, --
. Applicant to sign and date
. Whenever possible. the initial application will tie used ~s
a worksheet unly. Where possible, Buil'di'ng ~ivision Staff
will prepar~ a type written copy and.return it to the
applicant ~t the time the actual permit -is issuen fur' his
signature.
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.
PI.
IV,
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PERMIT VALIDATION
:ITY
OF
SPRINGfiELD
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City Hall
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
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FOR' OFFICE USE ONLY
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PRO,JECT CONDJTlONS TO HE SATISFIEO BEFORE OCCUPAnCY:
,
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-'- -----.- .-- --~'- ---.-......---..-..-.-....--.--...--.-- -..
........-:
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Permit appl icant: exempL, ';'rom regi'stration .lith' the Bui lder' S Board because:
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Additi anal Project Informati on:
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PLANS REVIEWED BY:
name
DAN SM ITH
signature
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dat~~_7_Q-.'HL-._:J
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