HomeMy WebLinkAboutPermit Building 1981-11-19
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7~~769 \\\'\"\ 0 { l\
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Job Add.... 5811 Ma 1 n Street. SD.d.ng.fi p 1 Ii.
l.goIO.",;ptlon 17-02:33-44 T I lon
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. _ CITY OF SPRINGFiElD
W=OMBINATlON APPliCATION/PERMIT
I ENERGY SOURCES:
OR q7477 H.ol Electri(: HP ,
Water Heater J:'lprtrlr
Range
Value of Work:
00
I-'
a
-..r
-..r
a
...
..
Sq. Fig. Ma~n flUb
Sq. Fig. Access.
Sq. Fig. Other
-.X_New_Add_Alter_Rep'.
_Fence-':'Demo~Chonglll Use
~Other
INFORMATION UNE
726-37~~
"
Owner M.lI Pr-nnpY'tipc::
Add.... P.O. Box .10531
Euqene, OR 97440
Phon. 343-4220
$24,200.00
Building Permit Info: Describe Work (i.e.. Build Single
- Familv Residence With Attached GoroQe)
,
Complete Lease Space in Doctor's Office
Ref. Job # R10lqq & #R10lfiR
Construction lender
Addrllu
Phone
DESIGN TEAM
(nome)
(address)
(lies. no.)
(expires)
(phone no.)
EI.<ld<ol Alert Electric
Sprinqfield
Sorinafield
A
*"
747-8R23',
'\
Pdmo'Y Artemio Paz AlA
220 N.5th St ~rrirgfip1rl
Structural
Mechanical Rnn Pi prrp
CONTRACTORS (nome)
(address) (lies. no.)
(expires)
(ohone no::
Plumbing
"
M,ll Prnpprti P<:
V & M Plllt11hinn
A 1 prt I'l prt.ri r
Ron Pi erce
(Rrllrp Kinnpy) Marshal~ith
14 ~-4??n
General'
rn
~rrin~.fip1rl
Snri nnfi p 1 rl
.,
Electrical
Mechanical
Fnopnp
PLUMBING
elECTRICAL
MECHANIC~AL
NO
FEE 'CHARGE NO.
FEE CHARGE 'NO.
FEE CHARGE
Duplex (I bath) each
1
furnace/b~'rner to
lOLLOOO_BTU" " '
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C. .
Mechanical exhaust
hood arid duct . .
fi.no
Residence of
o Each sinale fixture
Relocated building
(new fix. additional)
S.F. Residence
(I both)
~ no A~ no
~'''. ft.
New circuits, alterations
or extensions
SERVICES
Temporary Construction
3.00
Additional both
1
Amp,. 200
15.00
Water service
Hl fin
1
Sewer
10.00
Wood stove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler ta
10.000 CFM
Air handler over
10.000 CFM .
Amos.
ISSUANCE Of PERMIT
11) nn
101 AL CH~RGES
65.00 TOTAL CHARGES
15.00 TOTAL CHARGES
1(> nn
WHERE STATE LAW REQUIRES that the Eledrical work be done by the Electrical Contrador, the electrical portion of this permit shall not be valid until a.
label has been Nuned by an Electrical Contrador and attached to the electrical.panel.
I HA VE CAREFUllY EXAMINED the campleted application for permit, and do hereby certify that all information hereon is true and correct, and I further
certify that any and 011 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 mode of any structure without the permiuion of the Building Division. I further
, cert1fy that my registration with the Builder's Boord is in full force and effect 0 s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
Basis for Builder's ,Boord exemption:
NAME (pl.o.. p';nt)~LL 5m.niJ.
SIGNATUR-:m.~ ~
FOR OFFICE USE ONLY
;/-/1--8/
DATE
Fire Zone
Flood Plain_No
Type/Const.~
Bedrooms
?
Units 1
Occy Load ----1D
"ccy Group R?
Sq. Fig. Main --110'::; .
Sq. Ftg. Accen
Sq. Fig. Other
x
21 . RR Value 2..UOO no
Zone .RA
etari,,"
x Value
x Value
TOTAL VALUATION ?4, ?OO on
BUILDING PERMIT Plan Ck, Comm/lnd
Charges and ,____lJL 00 65%/ Bldq Per fee
Surcharges Plan Ck. Res
4.48 30%/SldQ Per Fee
PLUMBING PERMIT 65.00
Charges and Fence
Surcharges 2.60
Demo
ELEORICAL PERMIT
Charges and ]5.00 Sidewalk
Surcharges
~fl AI C PaviM
MECHANICAL PERMIT
Charges and _____..J..2...QO Curb Cut
Surcharges
.7fi
~')~LBD
Systems Development
Charae (1.5%\
11;, no-
Total Comb. Permit
dIY.'!'"
Yl_8 1.1
TOTAL
58 2.4~
'/$~80""2.
COMBINATION APPlICATION,.MIT (CAP)
I. Applicant to furnish
A. Jab Address
B, Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot I. Black 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example.heat/electrical ceiling/or forced air gas
. 2. example-water heater/electrical/or solar
E. Square footage or vc;lluation. etc. ,
1. example.12SCl sq. foot hause, SOO sq. foot 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. 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
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
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 abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
111. 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 typewritten 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:
_. ,,-. -~ -:- ....
Additional Project Info:rmation:
PLANS REVIEWED BY:
\Pri;';'~~ <;mi th
signaturp
Ad~
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. . PERMIT VALIDATION
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