HomeMy WebLinkAboutPermit Temporary 1980-12-18
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CITY OF SPRINGFIElD n~C 1 \) -"""",",NFORMATION L1N.
COMBINATION APPLlCATlON/PEJllllfJTlflED ..,Y, -, ,'- 72<'3753
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INSPECTION LINE "
726-3769
ENERGY SOURCES: Sq. Ftg. Main oUU
H.a' Forced Ai r El ect Sq. F'g. Am...
El ect Sq, Ftg. Oth.,
_New_Add_Alter_Rep.
I_Fence,_Demo_Chang./uWI
_Othe-.
Building Permit Info: Describe Work (i.e" Build Single
Family Residence With Attached Garage)
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Job Addre"
5892 Main Street
Legal Description
I nt l?, Ru.d~ Mp<~
Water Heater
Ran_fie
Volue of Work:
"Dr. r.lark W. Rnedpr
. .
1717 Centennial Blvd
Sprngfield, Dregon 97477
Con.,,",,;oo lond., Cost Mobil e Leasi n9
Add,... P.O. Box 66288, Portl and
Owner
Addre"
Phone
746-9552
Set UP 20'X40' Double Wide Mobile ~edical
OffIce For Temporary Use (6 Months)
Phone
659-7550
DESIGN TEAM (name)
(addre,,)
(lies. no.) (expires) (phone no.)
485-8545
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Wcs. no.) (expiret' ~ (phone no.)
Ptima'y Stanlev Associates
3227 Donald. Euaene
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addre,,)
PlumbinQ
Darrell M. Wilson
Norbert & Sons
3-Way El ectri c
NA
General
Electrical
Mechanical
PLUMBING ElECTRICAL MECHANICAL
NO. F" CHARGE NO. F" CHARGE NO. F" CHARGE ~
Residence of furnace/burner to
3 Each single fixture \. nn 1~. nn .,. ft. lTU's
Relocated building New circuits, alterations Appliance vent
(new fix. additional) or extensions M1parate
S.f. Residence I Stationary evop.
(1 batk) SERVICES cooler
I Vent fan with
Duplex (1 bath) each Temporary Construction single duct
I Vent system aport from
Additional bath Amps. heating or A.C.
i 1 M.H. Office Temp 10.00 Mechanical exhaust
Water service hood and duct
Sewer \1 M.H. Office Serv,: 10.00 Wood stove/heater
Storm Sewer I FEEDERS Heat PumD
1 Mobil e Office I Air handler to
Amps. 10.000 CFM
Hookup 15.001 J~ Air handler over I
10.000 CfM
ISSUANCE OF PERMIT
TOTAL CHARGES
30.00/ TOTAL CHARG'S
20.00, TOTAL CHARG.S
WHERE STATE LAW REQUIRES that the Elemical work 1M dollCl by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
laIMI has bMn signed by an Electrical Contractor and attached to the electrical panel.
J
I HA VE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further
certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Laws of the Stat. of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will b. mad. of any structure without the permission of the Building Division. 1 further
certIfy that my registration with the Build.r's Boord is in full force and effect os required by ORS 701.055, that if exempt the basis ~or .xemption is noted
heron, and that only subcantractors and employees who or. in compliance with ORS 701.055 will be uled on this project.
Basis for Builder's Boord exemption:
NAM' (pl.a.. pdn') .D;th:FIl... ~ ' It };/ <: nA , '
S1GNATUR'~ ~
FOR OFFICE USE OWLY
DATE~7'" Z"Z.... ~O
R-P
Type/Canst V-N I ~nits
Bedrooms n,tCY Load
l)torief 1 "'ecy Group B-2
40.00 plan Ck. Comm/lnd
65%/Blda Per fee
Plan Ck. Res
30%1 Blda Per Fee
30.00 Fence
L~U
Demo
20.00 Sidewalk
.tlU Ale Pavina
I Curb Cut
~-------- I
0::.. ftg. Main
Sq. fig. Access
Sq. Fig. Other
.
.
Value
Value
Value
Zone
fire Zone
FI~d Plain
.
TOTAL VALUATION
BUILDING PERMIT
Cha~R~~.~nd
sX,X_l(Setup
Systems Development
Charae n.S%}
PLUMBING PERMIT
Charges and
Surcharges
I Total Comb. Permit
I (LABEll
I
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I TOTAL
92.00
(20)
ELECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charge. and
Surcharges
92.00 (92,20)
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I. Applicant to furnish
A. Job Addre..
8. legal Description
1. example-tax lat 100, lane County Map Reference 17 03 43
2. example.lat 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
. 2. example-water heater/electrical/or solar
E. Square footage or valuation, etc. . .. '-.' .' - -. ".
1. example-1250 sq. foot house, 500 sq. fOat 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 attach
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) af the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivisior (
Staff must be able to contact appropriate persons regarl
design information or job site corrections, etc.
COMBINATION APPLICATION/PERMIT (CAP) '__";
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description porti
of the Mechanical and Electrical Schedules, the applican ('
need fill.in only the No. Boxes adjacent to the appropri,
item(s) to be installed
B. ,full Plumbing, Mechanical, and Electrical Schedules
are available ot 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 a
ated schedules you should cansultthe full schedules
C. BUILDING DIVISION STAff Will fill OUT All fEES ANt
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial opplicatio~ will be u~e~ as a
worksheet only. Where possible, Building Division Staff wi!
prepare a typewritten copy and return it to the applicant a
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 apl
and no plans will be processed until these fees are paid. A
other fees and charges are due and payable when the perl
is issued.
V. fOR OFfiCE USE ONLY
PROJECT CONDITIONS TO BE SATISfiED BEfORE OCCUPANCY:
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Additianal Proiect Information,
PERMIT VALIDATION
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CITY OF SPRINGFIELD
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City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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Address
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Received For:
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Amount Received lJ! f:), '..J
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AUTHO....ZED 5IGHATUItE~
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SEE JOB NUMBER 801107 FOR PERMANENT BUILDING AT -THIS LOCATION. :
STATE WILL O.K. STRUCTURE FOR INTENDED USE AND ALLOW CITY TO INSPECT FIELD MODIFICATIONS.
PLANS REVIEWED BY,
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LORNE PLEGER
'ignature~llUJ (J '--Ptf. ~tr / aIJlJ_~a~ 12~1-80