HomeMy WebLinkAboutPermit Building 1980-10-6
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I INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Job Addreu
5803 Main Street
ENERGY SOURC'El
Heat ect
Waler Heater -.Ele_ct
Range ~, oc+
Yolve of Work:
l.gal D.",;ptianTax Lot 200 Mao 17 02 33 44
Owner
Robert E. Corey
1476 Capital St N.E.
Salem. Orecon
166,739.65
Building Permit Info: Describe Work (i.e., Build Single
Fomil" Residence With Attached Gerace)
Address
Phone
Build New Bob's Restaurant
Construction Lender
Address
Phone
DESIGN TEAM
(nome)
(address)
(lies. no.)
Primary
Donald Richardson ATA
A1~ I iha~+y s+ N~
Structural
Electrical
Mec:hanicol
-'~ ~.'._'
--
INFORMATION LINE
726-3753
Sq. F'g, Me;n -223E
Sq. fig. Access.
Sq. fIg. Other
_New_Add_Alter_Rep.
_Fence_~Demo_Chongel Use
_Other
(expires)
(Xl
C>
C>
(Xl
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(phone no.)
4 363-0101
'W'-
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CONTRACTORS (name) (address) (lies. no.) (expires)
G,n..el U.S. Housing & Development Corp 2257 McDilchlist SE 11200
Plumblnq ~\'\'S:Q "'- S;:~ . J~ ,_,.t:-Q ~
I EI,,,","I cr h f\ Cl "''' 9' Q b 1'~
I M.,"en;,el lBJo..f\ C"\c\{()~~
I PLUMBING ) ELECTRICAL
I NO. I
116
1
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FEE CHARGE
FEE
I CHARGE NO.
NO.
Residence of
5.00 80.00
sq. ft.
New circuits, alterations
or extensions
El1ch single fixture
Relocoted building
. (new fix. additionol)
S.F. Residence
(1 bolh)
SERVICES
Duplu (l both) each
Temporary Construction
1
Amp.. 600
50.00
Additional bath
Woter service
lnn
400
Saw", 10.00;;,00 L F. 10.00
Sle,m S.W", 10. 0011~0 L.i' .40. ot 3
Amps.
25.0075.00
FEEDERS
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I TOTAL CHARGES
MECHANICAL
2
f'9I'l'''OeOn", 'e
, ~TU's
Appliance vent
separate
Stationary evop.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.c.
Mechanical exhaust
hood and duct
1
2
2
Wood slove/heoter
Heal Pump
Air handler to
10.000 CFM
Air handier over
10,000 CFM
1 Gas Outlet
130. oy TOTAL CHARGES
125.00 TOTAL CHARGES
,
ISSUANCE OF PERMIT
(o:.hone no.)
364-1624
FEE CHARGE I
;.00 2.00
4.50 4.50
f.OO 6.00
4. 50 9.00
2.00
~,
10.00
43.50
WHERE STATE LAW REQUIRES tha' the Electrical work be done by the Electrical Contractor, the .Iedrical portion of this permit shall not b. valid until a
label' hos been signed by on Electrical.Controctor and attached to the electricol panel.
Zon~
Type/ Canst.
~edrooms
Storie-
Sq. Ftg. Main
Sq. Ftg. Access J?1h
Sq, '!Jilwil1ag 14,977
Fire Zone
Flood Plain ~
Site
Review
1
# SR 80-34
Units
n-cy load
Occy Group ----B.:?
.
.15 Value
TOT At VALUATION
.
I 245.05 PD 8-20 .~W.m. D...lapm.n'
~I,brae 11.5%)
IRt Lu t' I -/f511'371
BUILDING PERMIT 377 . 00 Plan Ck. Comm/lnd
Chargos and 65%/ Bld~ Per Fee
Surcnarges ----1'5'.-08-- Plan Ck. Res
30%/ Bide Per Fee
PLUMBING PERMIT 130.00
ChargGs and Fence
Sui-chorgll's O.}jU
Demo
ElECTRICAL PERMIT 125.00
Chorgas and Sidewalk
Surcharges O.UU
A/e Pavino
MECHANICAL PERMIT 43.50
Chargel and Curb Cut
Surcharges --------
1 74
40,no
Total Comb. Permit
I TOTAL
OATE~#~
Value
Vel.. --16.Q.,OOlLOO_
6.n9.6s'
166,OOil.;;~
2,501 Oq
742.52
3,243.61
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Jab Address
B. legal Description
1. example,tax lot 100, Lane County Map Reference 17 n~ A~
2. example. Lot 1, Black 3, 2nd Addition to springf C I T Y
C. Name, etc. of owner and construction lender (
D. Energy Sources
1'. example-heat/electrical ceilinQ/or forced air qa
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1, example,1250 sq, foot house, 500 sq. foat gara~
2. example-if new project, check new-if addition, CI {r<
add, etc,
F. Building permit information:
1. example-construct single family house with an ai ("
garage
2. example-remodel existing garage into family roc
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 i
To avoid design or construction delays, Building Divi~ \
Staff must be able to contact appropriate persons re~
design information or job site corrections, etc.
OF
SPRINGFIELD
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City Hall
Springfield; Oregan
Department 01 Public Works
OFFICIAL RECEIPT
_ ~O. B 5 4 823 (
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Date \J (\
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Rec'd From~~~n m(\ t-q~QC-\1\\ tQt
Address c-\fC'll"- . u:Lk' - (
Received For: ~~ , n\ J. .~~
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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 approp
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.
ated schedules you should'consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN
CHARGES ON THE SCHEDULES
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IV.
III, Applicant to sign and date
Whenever possible, the initial application will be used as 0
worksheet only, Where possible, Building Division Staff wil
prepare a typewritten copy and return it to the applicant a
the time the actual permit is issued for his signature.
Fees and Charges
Plan check fees are due and payable at the time of the app
and no plans will be processed until these fees are paid. AlII-
other fees and charges are due and payable when the permit
is issued,
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V. FOR OFFICE USE ONLY
Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED.BEFORE OCCUPANCY:
Additional Project Information:
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PLANS REVIEWED BY:
nam'"
c-ignaturo
...lot,.,.