HomeMy WebLinkAboutPermit Building 1980-10-31
\
~~I_' ~!~~.,.ej,..(..-,:.~.~~:
.' .I~ I ",,' .l...
..1 .~. }.!.:..
.\,,,,..,,,..,,
. -. \-
...~-..-.11~:..: .~I~:~:~..",!~':..w....~~
Ill..I"'!!!!lllL
.:
11..,.1 i
I.lL._ ~.~I
cnY OF SPRINGfiELD " -- . ..
COMBINATION APPLICATION/PERMIT
'/')
--'-
"5:(:E?..
, INFORMATION LINE
726-3753
0:>
o
.....
o
w
w
INSPECTION LINE.
726-.3769
Ralph & Viola Jenson
Owner
Add.... 6935 Main Street
SprinGfield. OreGon 97477
Phone
747-7283
I ENERGY ~OURCES: I Sq. Ftg. Main _? 1 k
Hoo" R F Sq. Fig. Aceeu.
'Water Heater -Ele.rt Sq. Ftg. Other
Ronqe ~,,:,!:: _New_Add_Alter_Rep.
Value of Work: I_Fence_DemO_Change, Use
6480.00 _Oth.,
Building Permit Info: Describe Work (i.... Build Single
Family Residence With Attached Goraae)
Job Addrf'!u
6935 Main Street
TL 1600, Map 17 02 35 30
Legol Delcription
Construction Lend.,
Residential addition - living room
and storage room
Addreu
Phone
DESIGN TEAM
(ncunel
(address)
(lies. ~o.) (expires) (phone no.)
AI
~
>~\l!
(lies. no.) (expires) '\1 (phone no.)
31199 1-9-81 484-2431
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
Gener(ll
Dan Journey 32637 Coburg Bottom Loop
Plumbinq
Electrical
Owner
Mechanical
PLUMBING ELECTRICAL MECHANICAL
NO I I FEE I CHARGE NO. I FEE CHARGE NO. FEE I CHARGE
I I Residence af I furnace/burner to
Each sinqle fixture ~.,. ft. I~TU's
I Relocated building I .-T I 2 New circuits, alterations ~5.00 -, Appliance vent I
(new fix. additional) or extensions , separate
I S.F. Residence I I I I I Stationary evap. I
(1 bath) SERVICES cooler
I I I I I I Vent fan with I
Duplex (1 bath) each Temporary Construction sinqle duct
I I I I I Vent system apart from I
Additional bath Amps. heatinq or A.C.
I I I Mechanical exhaust I
Water service hood and duct
I Sewer I I I Wood stovel heater I
I Storm Sewer I I FEEDERS I I Heat Pump I
I I I Amps. I Air handler to I
10.000 CFM
I I I Air handler over I
, 10,000 CFM
I I
. I
I
TOTAL CHARGES
TOTAL CHARGES
15.00
ISSUANCE OF PERMIT
I TOTAL CHARGES
WHERE STATE lAW REQUIRES Ihal the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been ,igned by an Electrical Contractor and attach.d to the .lectrical panel.
I HAVE CARE FUll Y EXAMINED the campleted application for permit, and do hereby certify that 011 information hereon is true and correct, and I further
certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further'
certify that my rttgistration with the Builder's Board is in full force and ~ect as 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 thil project.
Basis for BuildCl'r's Board exemption:
NAME (pl.... p';nt)~fll-.'('('~\ \ IV)C ~t<\lllrV\PU
~
1
Units
"'ccy Load
"'ccy Group
R-3
Sq. Ftg. Main
Sq. Ftg. Access --2l.fi
Sq. Ftg. Other
x "alue
x 3..O...llO_Value
Value
TOTAL VALUATION
'.
~
DATE.j.J - ~ -~D
I
I
6480.00
SIGNATURE DQ ~I\{\. ~\. ,)~ LA 1'\ v..~
FOR OFFICE USE ONLY
Zone
Fire Zone
Flood Plain
R-l
NU
Type/Conlt.
Bedroom'
C:;tori~'
V-N
BUilDING PERMIT
Charges and
Surcharges
40.00
6480.00
1. 60
I Plan n. Comm/lnd
65%/ BldCl Per Fee
I Plan Ck. Res
30%/ Blda Per Fee
PLUMBING PERMIT
Charges and
Surcharges
Fence
/;41D j()-/<./ -RO I ~~~;:s(~~~:opment
12. 00")L/'~9r;
PI;;.;'. ;;.;,(._" L~
.~
57.2'0
ELECTRICAL PERMIT
Charges and
Surcharges
Total Comb. Permit
15.00
.bU
. 0
Q -
.w
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
63.26
61QO
-'I
// I A'
AiIL~~
., .
\
'.I.~'~ I~I,..!J...L 111Lt:' J("(. _."~<". JJ. U.;.\..,
(.......~ ,c.:::-
~ ~ .....,;,
Iii 1....11.0,1
"'COMBINATION APPLICATION/PERMIT (CAP)
. I. Applicant to furnish
A. Jab Address
B. legal Description
1. example.tax lot 100, Lane County Map Reference 17 03
2. example-Lot 1. Black 3, 2nd Addition to Springfield Estate
C. Nome. etc. of owner and construction lender
O. Energy Sources
1. example-heat/electrical ceiling/or forced air qos
2. example-water heater/electrical/or solar
E. Square footage or valuation, -etc.
1. example.1250 sq. foot hause, 500 sq. faot garage
2. example-if. new project, check new-if addition, check
add, etc. ~
F. Building permit information:
1. example-construct single family house with an attached
garage
2. example-remodel existing garage into family room
3. exomple.convert single family residence into
restaurant (change of use)
G. Vaiue 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 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 the appropriate
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
ore 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 abbre
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
.
III. Appiicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, Building Division Staff will
prepare a typewritten copy and return it to the applicant at
the time the actual permit is issued for his signature.
IV. Fees and Charges I-
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 chorges are due and payable when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,I __
Additional Project Information:
.-
00-'(\-'j\ '-\\\\\
.:>,\)''1\.\'::;''
'-" v, '--'
",',
~-- --"
PLANS REVIEWED BY,
DAN 51.11TH
c;ignature
( n:crr~ ' ;--\
1..1,1.1
"t\
\
" ,
I IIIIII (I
,.,~
,,'
PERMIT VALIDATION
(
CITY OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
(
No. B 5 5 0 8 (
/1- 3- 19AO
( Rec'd From ~ f\ ~ \rl \ 1\ '\\(ilJv-
( ,,",...9-, 'dIO"''l ~~:, "_~' 'i:~ ,
l\,()OU-
UO/r) \ (n() -
\~UO
L\q~ LeO
(
Date
#.
Received For:
~ b\~~.
"
(
\ (') \.') () r'\
,-
'-
(
I. oC) ~lOt\
.~()
(
(
Amount Received Qf ') \l\ () (~ V
( ~ (['1((
(
~
,t,'lrlIolOIUZED SIG"IATUAl'""""
~..".. (.
...ltlTO....U....Ull....'..'It...ItUCIt..1t 0..'''0'
c
Permit Cler~
10-31-80
date