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Home My WebLink AboutPermit Building 1981-3-23 r\ ... ,,....TICICl"'\ I INSPECTION LINE' -:-... ,-- 72lN769 I Job Addreu !tegal Description I I Owner I Address I MAR 2 3 1"""' 1..01 "'--~""-'''iiii "~,,,,' ,-, '-..... m;J:1e~1 CITY Of SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMAtION LINE 726-3753 5892 Main Street Lot 12, Buda Suite A Mesa ENERGY SOURCES: HP Elect Sq. Ftg. Main-129h. Sq. Fig. Actin!. Sq. fIg. Other _New_Add_Alter_Rllp. I_Fence_CemO_ChangefUle _Other 38,500.00 Building Permit Info: Describe Work (Le., Build Single Famil" Residence With Attached Goraae) co ...... o ...... ...... 01 Heot Water Heater -flee t Ron~e Volue of Work: n,. rl ~V'1t 1.1 0"01'1,0,,,," 1717 Centennial Blvd SprinQfield- OreQon Phone 726-9556 97477 Inter units of a professional Doctors office bldC' Construction Lender Addr." phone DESIGN TEAM (nome) (address) (lies. no.) (expires) (phone no.) Primary Drawin9 Sprvirp Tnr 'i.Q rnhllV'g Dn:JoA f, 687-0293 ~.~'/l-.. ! r p--~ Structural Electrical Mechanica-' CONTRACTORS (name) (address) (Iics. no,) (upires) (phone no.) PlumbinQ Darrell Wilson General Contractor 1717 Centennial Rlvd ~R4 Beeson ~",;n(l_ 3-wayelectric- Chase Company q-1' -Ill 7?h_n~7Q General Electrical Mechanical 1031 - 10-81 726-1981 PLUMBING elECTRICAL MECHANICAL Each sinQle fixture Relocated building (new fix. additional) S.F. Residence (I bath) I FEE I CHARGE 5. 00 55.00 NO. FEE CHARGE NO. FEE CHARGE NO. sq. ft. New circuits, alterations or extensions furnace/burner to BTU's Appliance vent separate Stationary evap. cool.r Vent fan with sinRle duct Vent system aport from heatine or A,C. Mechanical exhaust hood and duct 3.00 6.00 11 Residence of SERVICES Duplex (l both) each Temporary Construction 2 AddiliOl"al both 1 Amps. 100 65.00 Water service 1 Sewer 10.00 Woo'd slave/heater Storm Sewer FEEDERS 7 Heat PumD Air handler to 10.000 CFM Air handler over 10.000 CFM 6.00 42.00 Amps. ?nn 1~ "n ISSUANCE Of PERMIT 10.00 TOTAL CHARGES 65. 00 TOTAL CHARGES TOTAL CHARGES ~Q nn WHERE STATE LAW REQUIRES that the Eledricol work be done by the Electrical Contrador, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the eledricol panel. I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, ond I further certify that any and all work perfarmad sholl be done in accordance with the Ordinances of the City of Springfield ond the laws of the State of Oregon pertaining to the work deiCdbed herin, and .thot NO OCCUPANCY will bet mode of any structure without the permission of the Building Division. I further certify that my r&gistrotion with the Builder's Roard is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who or. in compliance with ORS 701.055 will be used on this project. I Basis for Builder's Board exemption- NAME (pl.a.. Pdnll-D,14-UL/I/1Il J1), /JnA. 4...", "'-{SIGNATURE ~afJi1~g-- FOR OFFICE USE .ONLY DATE .1' 23-61 Zone RP Type/Canst. V-N Units Sq. Ftg. Main -129~ x 29 71 Value 7<:>. ''')0, 00 Fire Zone Bedrooms_, ""'-:cy Load 1a Sq. Ftg. Acces' x Value Flood Plain--N.n C,torie- r'lccy Group--f " Sq. Ftg. Other x Value TOTAL VALUATION 38.500.(1~ ): BUilDING PERMIT 154.00 Pion Ck. Comm/lnd 100.10 PO 3 13 b\stems Development 577 . 50 Charges and 65%/ Bld~ Per Fee - - arqe ll.S%l Surcharges 6.16 Plan Ck. Res REC 56036 30%/Sldp Per Fee PLUMBING PERMIT 65.00 Charges and Fence Surcharges Z.bU Demo TOlal Comb. Permit 371. ?Il ELECTRICAL PERMIT 80.00 Charges and Sidewalk Surcharges 3.20 Alc Pavino \ MECHANICAL PERMIT I Curb Cut Charges and 58.00 948.78 Surcharges -----2: 32-- I I TOTAL _~;<~~~f ' .. ~-::~~_,~':";~".,JA.@~JH9.il-=-~=1!.~ ,~' ~: ' ...~l.'..~~~~~J~~i:".~:l.~!.,I)_l~~."I.l.lJL,~_'..L.,..,~,": I.r , '" '":7 _!I~r.!,J.~,.. III. Applicantta sign and date Whenever possible, the initial application will be used ( ,. warksheet anly. Where possible, Building Divisian Staff~ 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 af the applicatlan, and na plans will be precessed 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 ta furnish A. Jab Address B. Legal Descriptian 1. example-tax lat 100, Lane Caunty Map Reference 2. example.Lot 1. Block 3, 2nd Addition ta Springfield 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. foot garage 2. example-if new project, check new.if addition, ehe. add, etc. F. Building permit information: 1. example.construct single family house with an attc garage 2. example.remodel existing garage into family roon ,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 Oivh Staff must be able to contact appropriate persons re~ design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedule A. Except where blank spaces occur in the description p' af the Mechanical ond Electrical Schedules, the appli, need fill-In only the'Na. Boxes adjacent to the appro item(sJ.to be installed B. Full Plumbing, Mechanical, and Electrical Schedules ore available at the Building Division 1. To conserve space on the permit form the schedul have been abbreviated 2. If the Hem(s) to be installed are not covered on th ated schedules you should cansult the full schedu C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES J CHARGES ON THE SCHEDULES V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Project Information: ( I PERMIT VALIDATION CITY OF "1 SPRINGFIELD City Hall Springfield. Oregan Department of Public Works OFFICIAL RECEIPT (( (0, 'I :\. d ~ 19 gN,. B 361411 Rec'd Fra': (\ 'K. \J~ 'R~~~'\'\\ t\-t- '( 1 Address \ \ \\ ~I:)j\t~'{\ I{\ \G] (, (I Received For: D\~ \ ~tD '\Cf0 . In,11o (I ~ 'N\), , I r;S QD 490 rO i.fJO ( I \ ~ IJ Q-6"1- m CfJ '. <\O/,.-, , -:)" ,;:;D (I ( Date ( \. ~ir '\f\~ ~ ~;;; 00 Lf'-1\ -.:;; () 3d <..-v ~II c{J '0" r\r\ r _ ( ( ('ILC Y45_~7S I 1.. . -- - . ~l \\1\f\ Amount Received li' e. I ( i \, AUTHOltrU:D SIGNATURE ~ ( '''.lTO'''TU''''.Ull ~"'''T.''. . [UO..... 0" ""0. '.'''.s '~ ( Permit Cler~ " \ I COMPLETE LEASE SPACE FOR DOCTORS OFFICE SHELL ON JOB # 801107 PLANS REVIEWED BY: name~ Dan Smith 'ignature~... k.,lfu 3-17-81 date