HomeMy WebLinkAboutPermit Building 1981-4-1
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INSPECTION LINE
726-3769
CITY Of SPRINGfiELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
Job Add"" 5892 Main Street Suite 7
legal De.";p"o, Lot 12, Buda Mesa
ENERGY SOURCES:
H.a' Flprt f-IeaUump-
Water Heoter -f-l eG-:
Ran~e
Valuo of Work:
28,780.00
Sq. Ftg. Main
Sq. Ftg_ Access.
Sq. fIg. Other
_New_Add_Alter_Rep,
_fence_Demo_Change' Use
_Other
Complete Lease So
Building Permit Info: Describe Work (Le., Build Single
Familv Residence With Attached GoroQe)
44fi
Owner Or. (':1 ;u"'1r W Rnj:lorllQ,V'
1717 Centennial Blvd
Springfield, Oreqon 97477
Phone
746-9552
co
....
<=>
N
Cl
CO
Address
Comolete Me~ical le2<~ ~pacQ
Address
1.t, N~tinn~l
Mohawk Branch
R2n~
Construction lender
Phone
DESIGN TEAM
(nome)
(address)
(lies. no,)
(expires) Ii (phone no.)
~l
)~'17
~~
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(expires)
(phone no.)
Plumbing
Darrell Wilson. 1717 Centennial Rlvrl
Beeson Plumbinq
3-Wav Flp~tri~
Chase Co
~s:l4
Q_ll_s:ll
771>_n<;70
General
Electrical
Mechanical
1031
10-81
726-1981
PLUMBING
ElECTRICAL
MECHANICAL
No.1
7
FEE CHARGE NO.
FEE CHARGE NO.
FEE CHARGE
Duplex (1 bath) each
Temporary Construction
2
furnace/burner to
II.TU's
Appliance vent
separate
Stationary eYap.
cooler
Vent fcln with
single duct
Vent system apart from
heatirg or A.C.
Mechanical exhaust
hood and duct
3.0016.00
Residence of
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(l both)
<;nn ,<; nn
1q. ft,
New circuits, alterations
or extensions
SERVICES
Additional both
Amps.
Water service
Sewer
Woad stove/heater
1
Amps.
200
l!i nn
HeatPumpJl7 ;alr'Qo:::IrlJJ ;C'C'II::.rl ",;+Or,
A;, ha,dl.. to J' ob # 810175 Permits
10.000 CFM
Air handler over
10.000 CFM
Storm Sewer
FEEDERS
ISSUANCE OF PERMIT
1n nn
16.00
TOTAL CHARGES
35.00 TOTAL CHARGES
15. 00 I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be dOM by the Electrical Contractor, the eledrical portion of this permil shall not b. yalld until a
label has boen signed by an Electrical Conlractor and attached to the eledrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and corred, and I further
certify that any and 011 work performed sholl 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 modo of any structure without the permission of the Building Division. I further
cortrfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis fa, 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 Board exemption'
<IGNATURE~d~
FOR OFFICE USE ONLY
DATE'C!tY-!l (
NAME (pleoie print)-+
.
"
NO
Type/Canst.
Bedroom'
c:.to,ie'
V_N
Units
1
0:1. Ftg. Main
Sq. Ftg. Access
Sq. Fig. Other
996
x 2R - QO_Value
?s:l.7Rn
Zone R P
Fire Zone
Flood Plain
f'\ccy Load
f'\ccy Group~-~
Value
Value
TOTAL VALUATION
x
28.780
BUILDING PERMIT
Charges and
Surcharges
124.00
'---':-96--
Plan Ck. Comm/lnd
65%/SldQ Per Fee
Plan Ck. Res
30%/ Bld!=l Per Fee
80 60 PD 3-23 t~y.tem. Developme,'
. - tho roe {l,5%1 '
REC 56128 ,
411...10....
PLUMBING PERMIT
Charges and
Surcharges
35.00
l.'1U
Fence
Demo
Total Comb. Permit
197.60
MECHANICAL PERMIT
Charges and
Surcharges
16.00 I
-----:64--1
Curb Cut
I
I
___L__
I
I
I
LOTAL
629.30
ELECTRICAL PERMIT
Charges and
Surcharges
15.00
.bu
Sidewalk
I AI C PavinQ
,..
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III. Applicantta sign and date
Whenever possible, the initiol application will be used r
worksheet only. Where possible, Building Division Staf, ')., .-
pre, p~r.~.a typewritten copy and return it to the applieo ~.
the time the actual permit is issued for his signature. "-
I Fees cuid Cha;g~s .' " ('"
,t,
Plan check fees are due and payable at the time af thel-:-~_ , . . . . '
and na plans will be processed until these fees are paid. All
ather fees and charges are due and payable when the permit
is issued.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Jab Address
B. Legal Description
1. example-tax lat 100, Lane County Map Refere,
2. example-Lot 1. Block 3, 2nd Addition ta Springf f~
C. Name, etc. of ~wner and construction lender '
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gc
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example-1250 sq. foat house, 500 sq. faat gara "
2. example.if new project, check new-if addition,. c."
add, etc.
F. Building permit information:
1. example-construct single family house with an c
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 Sectian 303 (a) af the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid 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 & Electrical'Schedu
A. Except where blank spaces occur in the description
. af the Mechanical and Electrical Schedules, the apF
need fill-in only the No. Baxes adiacentto the appr
item{s) to be installed
B. Full Plumbing, Mechanical, 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
w.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
CITY OF
SPRINGFIELD
(
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City Hall
Springfield, Oregon
Department af Public Wark.
OFFICIAL RECEIPT
(] No. B S 619 8 (
Date 4 -I 19 ^'
/' Rec'd Fram (I ,cn(i I{f7 / ()r-'/~l)tf:i
1.d. I' -
Address n 11 (' PilT/Ilil'! / (}(J
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Received For:
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Amaunt Received (f _-L_
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AI/THO..IZIED 51GHATUlllIE
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Permit Clery
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
STTF llLVTFl.j "'In f'T~f' m'pnDTMF~IT f'nJM ~ ll.nllTOCn
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Additianal Project Infarmatian:
t
THIS PERHIT FOR Cor~PLETION OF A LEAse SPAr.F FOP A nnr.rnRS nFf'Trl'
THE BUILDING SHELL'IS JOB # 801107
PLANS REVIEWED BY:
name
LORNE PLEGER
signature ~{IYn ~ l-l-yp(y,r
....ate
3-31-81
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