HomeMy WebLinkAboutPermit Miscellaneous 1980-11-3
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INSPECTION LINE
726-3769
NorlFi~"
1/-J-86
~INfORMATlON LINE
726-3753
~6,f)f)f).tJS
CITY OF SPRINGFiElD
COMBINAJlON APPLlCAJlON/pERMIT
r F .1ohn Deve 1 oDment Coml1anyon
..-- ""'B.;ilding"P~f;jt 'in'f~; -~crjb. wo;"- (i.... Build Singl.
Addr.ss ?2.2..3.-fJ~ ~~7Ql npll AVPnl1j:i Phon. 2..83.::.5.J65 family Ilelid.nc. Wilh AUach.d GarQ":lI.l
Vancouver, Washington (503) Slab. ceilina. H.V .A.C.. electrical,
- - - - - -.
Dlumbina - Children's Store
'obAdd,... 5499 Main Street
......----.--
L'9al D''',;pt;an 17 02 33 4 Tax Lot 600
Owner
Conltruction Lender
Address
DESIGN TEAM
(name)
QirhArn ~hm~nn ~ A"nr;~T~~ ~~ ,W 11,th Ave
~Prlvprtnn, np
(,5Qll-Z22d2?1
Primary
Str\lduf'al
EJectriazl
Mechanical
(NEll.GY SOURCES:
H.at _Elect
"N'U.f Heolef _ E 1 ec t
I Sq. fig. Main
Sq. Fig. Accen.
Sq. Fig. Olher
_New__Add _Alter_Rep.
...fenc. ____ Demo_Chongel Use
00
o
.....
o
.0
N
~9!.....:=:=:::---=--
Yo I... of WOfll:
12.000.00
__Olh.r
Phon",
(address)
(ohone no.)
flies. noJ
{expiresl
CONTRACTORS (nome) (oddreu) (liu. no.l (cxoiresl (phone no.)
G\Onerlll C.E. John Construction 7223 NE Hazel Dell , Vanc. ,WA 223-01 JOHN C 347LF 283-5563
PlumbinQ Schmidt Plumbing 7500-C NE 16th Avenue,Vanc.,WA 694-8535
Electricol 3-Wav Electric 4739 Main Street. SDrinqfield, OR 746-9743
hchonical Durbin Heatinq P.O. Box 1042, Eugene, OR 343-1412
PLUMBING
NO. I
FEE I CHARGE NO. I
5.00 15.001
I
I
I
I
3
Each sinqlc fixture
Relocated building
(new fix. odditiano1)
S.F. Ruidence
(1 bath)
Duplex (1 both) eoch
Additianol bath
Water service
Sewer
Storm Sewer
ElECTRICAL
MECHANICAL
I FEE
I CHARGE NO.
FEE
CHARGE
Residence of
furnoce/burner to
~TU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system aport from
heoting or A.C.
Mechanical exhaust
hood llnd duct
3.00
~1. ft.
New circuits, a/terotians
or extensions
SERVICES
Temporary Construction
1
Amps.
Wood stavel heoter
FEEDERS
Heat Puma
Air hondler to
10.000 CFM
Air handler over
10.000 CfM
1
15.00
Amgs.
200
1
3 ton HVAC
6.00
ISSUANCE OF PERMIT
10.00
15.00 TOTAL CHARGES
19.00
TOTAL CHARGES
15 _ on TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor. the electrical portion of this permit shall not be valid until a
label has been signed by an Electricgl Contrgctor and attached to Ih. .I.drical panet.
I HAVE CAREFUUY EXAMINED the completed application for permit, and do hereby certify that 011 infOrmation hereon is true and corred, and I further
certify that any and 011 work performed sholl be done in occordonC'e with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to t"e work described herin. ond thot NO OCCUPANCY will be mode of ony structure without the permission of the Building Division. I further'
certify that my registration with the .Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the bosis for exemption is noted
heron, and that only subcontroctors ond employees who ore in complionce with ORS 701.055 will be used on this project.
Basis for Builder's Boord exemption'
rO..'ll Ai.;j/;J
NAME (please print) f:=J. t::!...J.l
Zon"
C-4
Typel Const.
Bedrooms "_
<:torir-"
V-N
1
fire Zone
Flood Plain NO
~
BUILDING PERMIT
Chofges and
Surcharges
60.00
'.'1U
PLUMBING PERMIT
Charges and
Surcharges
.15.00
.60
15.00
.60
19.00
--------
.76.
ELECTRICAL PERMIT
. Charges and
~ufchafges
MECHANICAL PERMIT
Charges and
SUf(harges
SIGNATURE../1// J
FOR OfFICE USE ONLY
w~~
/6-~-'i<-
DATE
Units
'Jcc:y Lood
.....cc:y Group
1
x
Value
Value
Value
,
1-
\
i
Sq. Ftg. Main
Sq. Ftg. Accen
Sq. ftg. Other
x
B-2 _
x
TOTAL VALUATION 1? . 000 00
Plan Ck. Comm/lnd
65%/BldCl Per Fee
Pion Ck. Res
30%1 Bid.. Pl"r Fee
--. -_._--~-----
39.00 PD 10-27. Grlt.m, D".lapm.nt
i:Warae (J .5%1
Ktl, :l:lUOO
fence
Demo
Total Comb. Permit
Sidewolk
A..'r:. P':''':~3 .
Curb Cut
~13.36
__1___.._-----
I TOTAL
City Hall
Springfield, Oregan
Department of Public Works ("
OFFICIAL RECEIPT
No. B S 51 00 (
it" Dote 11- il?' 199D ' .
Rec'd From C P') , Inl1 () '0JJ){!)/),o. (
(11. dd -7iL?;J IJE HAW/OEfl!
A ress , , "\ '" C(JI c:c::. (
i '.."- . --:: .~ :......, \ \ I .~_._l--:::: "-^-" I i ,- ::X->--'"
( VIvVI ,~v \I ----
J?",- 'l\
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example.tax 101 100, Lone County Mop Refere'
2. example.Lat 1. Block 3, 2nd Addition to Springf
C. Nemer etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gc
2. example-water h~ater/electrical/or solar .
E. Square footage or voluatio!'1 etc.
1. example. 1250 sq. foot house, 500 sq. foot gara!
2. example-if new project, check new-if addition, c
add, etc.
F.. Building permit inform~tion:
:1. example~construct single family'hous'e with an 0
garage
2. example-remodel existing garage into family rOI
3. example-conyert single family residence into
restaurant (change of use)
G. Value of work os defined in Section 303 (0) of the
. Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divi
Staff must be able to contact appropriat.e p~rsons re
design information or job site corrections, etc. .'
II. Abbreviated Plumbing, Mechanical & ElectricalSchedul,
A. Except where blank spaces occur in the description p
of the Mechanical and Electrical Schedules, the appli
need fill-in only the No. Boxes adjacent to the appro,
ilem(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit fo'rm the schedulE
have been abbreviated
2. If the item(s) to be installed are not covered on thE
oted schedules you should consult the full schedul,
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI
CHARGES ON THE SCHEDULES
PERMIT V ALIDA liON
p
CITY
OF
SPRINGFIELD
(
Received For:
B(.J
6.0/'
\f'
.
(cD. cu
1_,~O
1500
("'()
jC"j . on
In(~
!Cl.00
, ':0
c
pp
(
~Olt)
C(P
<f
i\OI/\
I"
~\P
(
LtC! 16
(b,
_..__1
"
1
(
.C
c
c'
(I
c-
(I
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Amount Received :..L
C4J
....,,ht10"'ZE:D $lGNATUIIIE:
'..tllTa"'.Tu.....Ull ~,,,..Ttl"S . tlUGtl..ll. all ,.,.01
,.
III. Applicant tD sign and dote
Whenever possible, the initial application will be used os C'
. worksheet only. Where possible, Building Division Stoff "
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 ore due and payable at the time of the aF!-
.. and no plans will.be processed u~til these fees ore paid. AII'
other fees and charges are due and payable when the permit
is issued.
(I
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V. FOR OFFICE USE ONLY
Permit CierI-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1.
1
Additional Project Information:
-
PLANS REVIEWED 'BY:
. /7!
( - I/., ..
'ignatu~~l !f?
~ote
DAN SMITH
10-31-80
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