HomeMy WebLinkAboutPermit Signage 1981-1-23
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INSPECTION LINE
726-3769
Job Addr"..
5547 Main Street
TL 600 Map 17 02 33 4
CITY OF SPRINGfiELD
C~MBINATlON APPLICATION/PERMIT
I ENERGY SgURCES:
Heat as
Woter tieater
Range/Oven
Value of Wark:
$155,000
legal Oescriptian
Owner
C.E. John Co, Inc
I~~j Hazel Del I Avenue
,
Phone
{206}
696-0837
Address
Vancouver. Washinaton 98665
Construction lender
Address
Phone
DESIGN TEAM
(nome)
,
(address)
Primary
Kruse. Fitch & Beals NW Wenchester. Ro~~hura_ Orp~2n
Structural
Electrical
'I M.,hon;'ol
CONTRACTORS
General
(nome)
Jeff Latimer Const, Inc.
Sessler
Oliver Fler.tr;r
___'address\
3402 Overbok. Rosebura 30133
10-a-ill
r,~~
Gn~
(lics. no.)
{Iics. no.)
INfORMATION LINE
726-3753
I Sq. Ftg. Main 32RO-_
Sq. Ftg. Accen.
SX' Ftg. Other
_New_Add_Alter_Rep.
_Fence_Oemo_Change/ Use
_Other
(expires)
00
......
CO
CO
N
t11
(phone no.)
--L~ 673-7433
-~
(expires)
Plumbino
171 Su~an Plar.p. ,11lRrtinn rit\1 nR ?n_'Il,PR
I
Building Permit Info: Describe Work (i.e.. Build Single
Familv Residllnce With Attached Garafle).
I Build Round Table Pizza
I
Electricol
Mechonical
Harvev & Pr;cp 2015 NIJooPt
PLUMBING
CHARGE NO.
W;tv. J:"llnpnp
ELECTR leAL
NO, I
20 I
-,
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I~
I FEE
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1 1 I Amp., 1 no I
: )- 2~~r7~~)1
I ~ ~ \Tt ~\_').pl
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1 1
Residence of
Each sinale fixture
Relocated building
(new fix, additional)
S,F. Residence
(1 bath)
100 OiL
\q. ft,
New circuits. alterations
or extensions
SERVICES
, '
1
1
I Temporary Construction
1 Amp., 225
Ouplex (1 bath) each
Additional bath
Water senice
I
I
I FEEDERS
Sewer
Storm Sewer
I
I
I
I
I
100.001
TOTAL CHARGES
TOTAL CHARGES
ISSUANCE OF PERMIT
OO.U4
I TOTAL CHARGES
j CHARGE
I
I
I
110.00
135.00 I
1 11
I I
I I
I,n nn I
1 I
I I
I I
I I
1 I
77
MECHANICAL
NO, I
1 I hIT:tib'On.~;~,.
Appliance vent
separate
Stationary evop.
cooler
2 I Vent fan with
single duct
I Vent system apart from
heatinq or A.C.
I Mechanical exhaust
hood and duct
I Wood stove/heater
I Heat Pumo
I Air handler to
10.000 CFM
I Air hondler over
10.000 CFM
1
Gas Piping
(phone no,)
1
I
I
1
I
I
fi7?-1?1fi
OOQ_""
746-1621
I FEE
I CHARGE
7.50
13.00
I
4.50
I
I
I
12.00
I
I
10.00
27.00
valid until a I
WHERE STATE LAW REQUIRES that th. Electrical work be done by the Electrical Contractor, the alectrical portion of this permit shall not b.
label has been signed by an Electrical Contractor and attached to the aledrieol ponel. '
I HAVE 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 011 work performed shall 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 made of any structure without the permission of the Building Division. I further
certify thot my registration with the Builder's Boord is in full force o~d effect as required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.0.55. will be used onJ;?~is pr.oie .
Basis for Builder's Boord exemption: ~ \. ,.
/-
NAME(pl.o..pdn') (i6Ft:: LBZ)M/~..e. SIGNATURE ~ ~~-nATE/-Z7-f3L
FOR OFFICE USE JJI((~ h ~ - r------- ':
3285 x Volu. 11140.000 I
S;j:p Tll)jlLIDLe.lI1"rt~ Volu.' 1U.I)UU _
t'avlna x 6000' Volu. (,5.0UlI \
TOTAL VALUATION 15'>;rTlln on
Zone
C-4
li:q, Ftg. M
Sq. Ftg. Access
Sq, Ftg. Other
V-N
Type/Const.
Bedrooms
Units
"Jccy Load
"ccy Group
Fire Zone
Flood fllain
L
A-.j
O;:"ori...
BUILOING PERMIT 347.00 I Plan' Ck. Comm/lnd I 240.18 PO 1 13 ~stems Development 2,325.00
Chorges and 6.5%/ B/del Per fee - -. aroe (1..5%)
Surcharges lJ.l:Sl:S [ Pion Ck. Res I remp Label
30%/Sldo Per Fee .20
PLUMBING PERMIT 100.00 I Fence I CR~DIT FO~ OVERPAID PCF -14.63
Charges and
Surcharges '1.UU [ Oemo I I Total Comb. Permit
5R? _ 1 fi
elECTRICAL PERMIT 55.00 I Sidewalk I I
Charges and
Surcharges t.ZU lAiC Pt;lvina 6000' I "l? I
nn
MECHANICAL PERMIT 27.00 I Curb Cut I I 2.892.73
Charges and
Surchorges ----r.oo--- l_ I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant ta furnish
A. Jab Address
B, legal Description
1. example-tax lot 1 DO, lane County Map Reference 17 03 43
2, example-lot 1. Block 3, 2nd ,Addition to Springfield Estates
C. Nome, etc. of owner and construction lender' .
D. Energy Sources
1. examole.heat/electrical ceiljng/or forced air gas
2. examole-water heater/electrical/;'r 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, che
odd, etc.
,", F.< 'Building permit information: _
1. example-construct single family house with an "ctte '~,J
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 Sectian 303 (a) of the
, Struc!ural Specialty Code " ','
H. DESIGN TEAM AND CONTRACTORS
. '..-To.av:oid design .or construction.delays, Bu.i.lding Divisi
Staff must be able to contact appropriate persons reg'
design information or job site corrections, etc. (
II, Ab'b;e~iated Plumbing, Mechanical"a, Electrical 'Schedules
A. Except where blank spaces occur in the description po
af the Mechanical and Electrical Schedules, the applic,
need fill-in anly the No. Boxes adiacent to the approp
item(s) to be installed , .' ,
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 not covered on the'
ated schedules you should consult. the full schedule
C. BUilDING DIVISION STAFF Will Fill OUT All FEES M
CHARGES ON THE SCHEDULES
'.
, B.
III. Applicant ta sign and date
Whenever possible, the initial application will be used as
worksheet only. Where possible, Building Division Staff v.
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 t~e af
,.. ,and no plans ""ill pe processed until these fees are paid, I
, 'other fees and charges are due and payable when th~j>e
is issued. ~<i.~ '0--'
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V. FOR OFFICE USE ONLY
(
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BE SATISFIED ,BEFORE OCCUPANCY:
,PROJECT CONDITIONS TO
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Ad.ditiona) Project Information:
PLANS REVIEWED BY:
. '7i.'--:"'-:'-' ;."
. ., . .,; ~ ...
LORNE H. PESGER
c;ignatur""
,
namp.
__oj
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PERMIT VALIDATION
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. SOG .. 31c536
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C TV OF SPRINGFIELD
CI
City Hall
Springfield. Oregan
Department of Public Works
OFFICIAL RECEIPT
(
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B 55652(1
No.
Date r - 23 19~'
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Received For: \j
f5P ~1 DO
~O)() 1?)~5{
len.Oo
400
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2_ 1... 0
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A\(, Pf1lJ-h9 32.00
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1-22-81