HomeMy WebLinkAboutPermit Building 1981-2-10
I INSPECTION LINE
726-3769
Legal Delcription
5892 Main Street
Lot 12, Buda
Mesa
CITY Of SPRINGFIELD
COMBINATION APPLICATION/PERMIT
I ENERGY SO'r'fe'Ct
Heat
Water Heater El P.c:t
Range -NJ'
Value of Work:
Owner
Dr. Clark Roeder
1717 Centennial Blvd
235,000
INFORMATION LINE
726-.37.53
I ~<>A-
Sq. Fig. Main u-'>Uu
Sq. Ftg. Accen.
X" FIg. Other
_Hew_Add_Alter_Rep.
_Fence_Demo_Change! Us.
_Other
00
o
.....
.....
o
......
Job AddrflU
Address
Phone 746-9552
- -
Building Permit Into: Describe Work (i.e., Build Single
Family ~es,idence With A:tt~,~.h.eEU:~.I?~~g!)__
Shell OnlYior_r-tedical Building
Sprinqfield, Oregon 974]L_
Canstruclion Lender
Addren
Phone
DESIGN TEAM
(nome)
(address)
(lies, no.) _____(!~pirel)
(phone no.)
Primary
Kip M. Amend. ~A 1?21-llon~lrl Strppt,
FK Jacobson. P.O. Box #5088. Euaene
C:;lIitp R.
Eugene
----...
,---Ii \
~
~\~
(expires) '''t
9-11-81
687-0226
485-3480
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(ljes. no.)
584
(phone no.\
General
Darrell M. Wilson
726-0579
Plumbinq
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO, I
FEE I CHARGE NO. j
FEE I CHARGE NO. I
I FEE I CHARGE
Each lingle fixture
Relocated building
(new fix. additional)
S.f. Residence
(I bath)
.,~. ft.
furnace/burner to
R,TU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent ,y,tem apart from
heating or A'.C.
Mechanical exhaust
hood and duct
INA
Re,idence of
New circuih, alleration,
or extensions
SERVICES
Duplex (l both) each
Addition~~ath
Temporary Con,truction
Amps.
NA
Water service
Sewer
Wood stove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Amps.
Air handler over
10,000 CFM
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by Ihe Electrical Contractor, the electrical portion of thi, permit shall not b. valid until a
label has been signed by an Electrical Contractor and attached to Ih. electrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon i, true and correct, and I further
certify that any and all work performed ,hall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon
pertaining to the work delCrihed herin, and that NO OCCUPANCY will he made of any lfructure without the perminion of the Building Division. I furth.r
certlfy that my registration with the Builder's Board i, in full force and effect as required by QRS 701.035, that if exempt the hasi, for exemption is noted
heron, and that only suhcontraaors and employees who ore in compliance with ORS 701.055 will he used on 1his project.
Basis for Builder's Board exemption:
"GNATURE A )IJAA-Lilj1~'/1
fOR OFFICE USE ONLY
L'/
DATE ,)-/ () - 0
NAME (please print)
BUILDING PERMIT
Charges and
Surcharg8l
SHELL
489.50
----19. S6
1
ONL Y!!!!!!!
Unih
nccy load
Occy Group
R-?
Sq. Ftg. Moin
Sq. Ftg. Access
Sq. FIg_ Other
8808
Value 215.000.00
Value -3tT;0OO-;-Oo-
Value
TOTAL VALUATION 21i5 .000. OIL-
.
20n" KUl,
. Fire 20ne
Flood Plain
K-'::
NA
NU
1:0 Kt-'
Type/ Canst.
Bedroom'
C,tarie"
V-N
Plan Ck. Comm/lnd
65%1 BId!=! Per Fee
Plan Ck. Res
30%/ Bldq Per Fee
317.85 PO
SYllems Development
Charae 0.5%)
3,975.00
PLUMBING PERMIT
Charges and
Surcharges
NA
Fence
Demo
TOlal Comb. Permit
509.08
ELEORICAL PERMIT
Charges and
Surcharges
11:\
Sidewalk
I AI C Pavina
MECHANICAL PERMIT
Charges and
Surcharges
NA
Curb Cut
TOTAL
4,484.08
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1(' ~ ._.....~._~...... .
'c. .-.-...... ____.... C.......'WC.~ I.....de.
0. e.-w--
. 1. ..o'"el..h~'/.fK'ricor ceilin(l/or forced air gas
2. o.omple-woler heolerieleclrlcol/or ~
E. Square fOOl age or valuolion, etc.
1. exomple-12S0 sq. foot house, 500 sq. foot garagE
2. exomple.if new project, check new-if addition, ch
add, etc.
F. Building permit information:
1. ,examcle-construct single family house with an '0;1
, garage
2. example-remodel existing garage into family rool
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 ovoid design or construction delays, Building Divh
Staff must be able to contact appropriate persons re9
design information or job site corrections, etc.
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 approF
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 schedule
have been abbreviated
2. If the item(s) to be installed are nol covered on the
ated schedules you should consult the full schedule
e. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At
CHARGES ON THE SCHEDULES
111. Applicant to sign and date
Whenever possible, the initial application will be used as
worksheel only. Where possible, Building Division Staff yo
prepare a typewritten copy and return it to the applicant
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 01
and no plans will be processed until these fees are paid. .
other fees and charges are due and payable when the p'
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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City Hall
Springfield, Oregon
Department of Public Works r'
OFFICIAL RECEIPT
r Q ~O. B 55783("
Date rr.- - \ '._..' .19 '\ , ,
\ ""I''''~[)II II 'lL/An
Rec'd From ,-\),1 r " ,I ,). 'J), tluj' ' '.
1/11' I !~ ')r' I ,~, ," (' V'-;' I) ! "
Address !., C.t' j tTi'! 1..._..>'
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,of'
Received Eor: t..\<6 y ."2J()
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Received 441A ,07;, r J---- (.
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Amount
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-('I ~ -- UTHO'U1ED S,Q/IIIATUilUl ..,u'. r r
. SMIU.TO,,'TUIt..1 L ....'..TC.S ' EuoeNIl. O. 17.0' '-
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Permit Cler~
THIS PERMIT FOR SHELL ONLY!!!! THERE ARE NO PLUMBHIG QRELECTRI CA"l,
OR MECHANICAL PERl1ITS FOR TilE BUILDIiIG., S6MI! PLUMBING PERMITS HERE ISSUED FOR SEl'IE1
Additional Prcject Information:
ONLY, OUTSIDE THE BUILDING S.D.C. WILL BE REQUIRED ALL LEASESPACES AS SUBMITTED.
PERrtITS PRIOR TO JANUARY 1, 1981 ARE FOR OUTSIDE WORK..
PLANS REVIEWED BY:
"emf"
DAN StUTH
/aAyf;:7/~
2-4-81
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