HomeMy WebLinkAboutPermit Building 1981-3-19
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Owner
MJL Properties
P.O. Box 10531
180,000.00
INFORMATION LINE
726-37 S3
Sq. Fig. Main 6611?
Sq. Fig. Acton.
Sq. Fig. Other
-X_New_Add_Alter_Rep.
_Fence_Demo_Changol Use
_Other
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INSPECTION LINE
726-3769
CITY OF SPRINGfiELD
COMBINATION APPLICATION/PERMIT
Water Heater
ENERGY SOU~C.~,
Heal t 1 ec t Hea t Pumps
Elect
~lP
JabAdd'e.. 5811 Main Street (Units
logal DO''';p''.n 17 02 33 44. TL 100
O.E.F.G.H.l
Ronqe
Value of Work:
Address
Ph.no 688-8000
Building Permit Info: Describe Work {i.e.. Bo.tild Singl.
Family Residence With Attached Goroc;el
Euaene. Oreann q744n
r~nstruction-p~ofess~ona~-Of~~
Buildin~ shell only
Construction lend.r
Address
DESIGN TEAM
Phone
(name)
(address)
(lies. no.)
(expires)
(phone no.)'
Electricol
Warner Engineering
78 Centennial Loop, Suite A .97401
~ 747-8823
~
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Primary
Artemio Paz Jr, 220 North St~ Street
Structural
c:.;:Imt:a
M.,han;'al Roaers Ena; neeri na
CONTRACTORS (name)
G.no,.; MJL Properti es (Bruce
(oddress)
(lies. no.)
(expires)
(~hone no.\
Kenny) P.O. Box 10531, Eugene, 97440
689-2374
Plumbina
Electrical
Mechanical
PLUMBING ElECTRICAL MECHANICAL
NO. FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE
15 Residence of furnace/burner to
Each sinAlefixture 5.00 75.00 s~. ft. D.TU's
Relocated building New circuits, alterations Appliance vent
(new fix. additional) or extensions separate
S.F. Residence Stationary evap.
(1 both) SERVICES cooler
Vent fan with
Duplex (1 both) each T em'porary Construction 5 single duct ~_n(1 l".nn
1 600 50.00 Vent system aport from
Additio...al bath Amps. neatin~ or A.C.
Mechanical exhaust
Water sllrvice hood and duct
Sewer Wood stove/heater
Storm Sewer FEEDERS 5 Heat Pump 6.00 30.00
5 200 15.005.00 Air handler to
Amps. 10.000 CFM
Air handler over
10.000 CFM
ISSUANCE OF PERMIT
'0.00
55.00
TOTAL CHARGES
75. 00 TOTAL CHARGES
125.00
TOTAL CHARGES
WHERE STATE lAW REQUIRES that the Electrical work b. don. by the Electrical Contractor, the eledrical portion of this p~rmit sholl not be valid until a
label has be.n signed by on Electrical Controdor and attached to the eledrical panel.
I HAVE CAREFUllY EXAMINED the completed 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 sholl b. done in accordance with the Ordinances of the City of Springfield and the Lows of the Stat. of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further
certlfy that my registration with tho Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractan and employees who ore in compliance with ORS 701.0.55 will be used on this project.
"1
Basis for Builder's Board exemption-
NAME (please print) nfJ......r=, W~ (~'{
?
Units
Occy Load
Occy Group
SIGNATURE~ ~ l\. ~J, ':-.......
FOR OFFtCE USE ONLY ~-'- ~ I
~,. Ftg. Main fifi4?'
Sq. Ftg. Access
R_? Sq. Ftg. Other
DATE VI'=> Is I
.
RnT
Zone R A
Fire Zone
Flood Ploin
Rn_'<~
to RP
Type/Canst.
Bedroom'
<:tori8'~
V-N
x
x
x
Value
Value
Value
l8n.nno. nn_
TOT At VALUATION
HlU ,UUU. UU
BUILDING PERMIT 407.00 Pion Cle. Camm/lnd .
Charges and 6S%/Bldq Per Fee
Surcharges 16.28 Plan Cle. Res
30%/Bldq Per fee
PLUMBING PERMIT 75.00
Charges and Fence
Surchorg.s 3.00
Demo
elECTRICAL PERMIT
Charges and 125.00 Sidewalk
Surcharges 5.00
AI C Pavinq
MECHANICAL PERMIT 55.00
Charges and Curb Cut
Surcharges -------2-;-fJ
Systems Development
.Charae (1..5%)
Illan check fee of 576.55 paid
'~Il Lu; 1 J; flY :i. all J Z j uu~
IW' 68 & 8Wl qq
2.70n.(In
Total Comb. Permit
688.48
TOTAL
3,388.48
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PERMIT V ALIDA TION
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B, legal Description
1. example-tax lot 100, lane County Map Refere
2. example.Lot 1, Black 3, 2nd Addition to Springf
. C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceilinq/or forced air gc
2. example-water heater/electrical/or ~.: . ,i
E. Square footage o~ valuati~n, etc. .
1. example-1250 sq. fOot house, 500 sq. foot gara
2. exomple.jf new project, check new-if addition, I
add, etc.
F. Building permit information:
1. 'example-construct single family house with an t
garage
2. example-remodel existing garage into family rc
'.' 3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Sp'ecialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Di
Staff must be able to contact appropriate persons r
design information or job site corrections, etc.
II, Abbreviated Plumbing, Mechanical & ElectricalSchedu
A. Except where blank spaces occur in the description
of the Mechanical and Electrical Schedules, the apF
need fill.in only the No, Boxes adjacent to the appr
item(s) ta be installed
B. Full Plumbing, Me<:hanical, and Electrical Schedule,
are available at the Building Division
1. To conserve space on the permit form the sched,
have been abbreviated
2. If the item{s) to be installed are not covered on t
. ated schedules you should consult the full sched,
C. BUILDING DIVISION STAFF WiLL FilL OUT All FEES
CHARGES ON THE SCHEDULES
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CITY
OF SPRINGFIELD
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Received For:
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1500
3nn
\,2..5 00 (
Vj'.OO
~500
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17- 7 ()() CD (
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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III. Applicant to sign and date
Whenever possible, the initial application will be used
worksheet only. Where possible, Building Division Staf,
prepare a typewritten copy and return it to the applicc
, 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 na plans will be processed until these fees are paid, All
other fees and charges are due and payable when the permit
is issued.
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V. FOR OFFICE USE ONLY
Permit Clerr
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
FIRE HYDRANT ON ASTER STREET TO BE INSTALLED PRIO~ TO CLOSiNG !N BUILDING.
COORDINATE WITH FIRE DEPARTMENT
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Additional Project Information:
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PLANS REVIEWED BY:
. LORNE PLEGER
name,- - -
~ignature
~~e.~~0'
date
3-19-81
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