HomeMy WebLinkAboutPermit Building 1980-7-21
'1 IilSPECTIOlI LIi;E
726-3769
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CIIi OF SPRi;;GFIElD
COII61 ;IP,TI ON APPLl CA TI ONI PERHrT
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If/FOR/IATlO:1 U:"
726-3753
Sq.. Ftq. Hain l:J,blJU
~q. ~tg. Access.
Sq. Ft9. Other
~le\'1-1.dd J.1 ter P:ep.
__Fence__Demo__Change/Use
_Other
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Job Address
I E!lERGY SOURCES:
Heat
-I !'/a ter Bea ter
5606 MQ;n Street
legal Description TL 200, 201 MAP 17 02 33 4
LOT A MP#899, Corner Lot
Address P.O. Box 20
Boise Idaho
Phone
I Ran'1e
I, ValuE of Hark:
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Bull{;inq Permit Info: Describe l'Jork(i.e., Build Single
Family P-esidence I-lith J'l.ttached t'laraoe)
Owner
Albertson's Inc
(208)
385-6402
Commercial Lease Soace
Construction lender
SHELL ONLY
Address
DES I Gil TENt
(name)
Phone
(address)
(1 ics. no.)
(exniresl
(ohane no.)
Primary
EHr~ANN & Assoc 4504 S.W. Corbett ptlnd
D.H. Ebeling, Inc
J.D. Graham & Assoc
Lee Plants
(namp) {addt'essl
740
J:iiO-B1
V
11echani ca 1
CONTRACTORS
(1 ir:~. no.
(pxoirp<;. \
222-4221
245-0785
232-5378
686-9211
(ohoop nn
Structural
Electrical
Genera 1
Plumbino
Electrical
t.lechan i ca 1
PlUll6l1lG
ELECTRICAL I MECHANICAL
FFF CHARr,F fin , >>> I njARr,~1 NO. I ~~~ I nj.eQr.~
Residence of I furnace/burner to I
sq. FT. BTU's
INew circuits alts. I Floor furnace I
or ex tens 1 ons and vent
I SERVICES I Recessed wa 11
SD~~P hp~tpr rinrl vpnt
I I
I ITemporary Construction Appliance vent
seoar~t.p
I Change in existing I I Stationary eva';).
rps i dp},rp cooler
I multifar;]ily, com. or I I Vent fan with
Tnr1l/<;trltl.l sinale duct
'I 1 Of 1,/011 amps. 165.0C Vent system apart from I
heatino or A.C.
I COI.1H./lND. FEEDERS I i'1echanical exhaust
hood il nd duc t
I Install/alter/relocate Wood stove/heater
rfidrlQ_ fpprfprc::
I 1 Of 100 amps. 15.0q
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I I I SSUANCF OF PFR!IlT
I TOTAL CHARGES 80.0C TOTAL CHARGES
that the Electrical loJork be done by an Electrical Contractor, the electrical portion of this perni t
label has been signed by an Electrical $urervisor and returned to the Building Division
110. I
Each single fixture
Relocated building
(new fix. additional)
IS.F. Residence
(] bath \ .
Duplex (1 bath) each
Additional bath
~!ater service
Sewer
Storm Sewer
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be valiJ until the
I HAVE CAREFUllY EXMlINED the completed application for !Jermit, and do hereby certify that all.infonnation hereon is true
and correct, and I further certify that any and all work oerformed sha)l be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Orel)on pertaining to the work described herein, and that flO OCCUPAIlCY \'Iill be made
of any 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 basis for exemption is noted hereon, and that
only subcontractors and employees who are in com~liance with OP.S 7n1.055 will be used on this project.
I/Af.lE(please print) SIGr~^TURF. D~TE
FO,~ OFFICE USE O:JL Y
Zone C-2 Type/Canst. III Units Sq. Ftg. r1ain x Value
Fi re Zone III Bedrooms Occy load Sq. Ft~. Access x Value
Flood Plain Stories 1 Occy Group ~-~ Sq. Ftg. Other x Value
6UIlDIIIG PERI.IIT
Charges an~
Surcha rges
390.50
-----15.62
PD 10-9-79
P 1 an-- (k. coiMi7Tn-d--..
65%/Blda Ppr Fpp
Plan Ck. Res
30~/Bldo ppr Fpp
Fence
I<t~UNU
314.28
253 ':83m~~~~s (N~liiPmentT~522~-- --:
bU.4~ REFU~D PL.CK. I - 60.45
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Total Comb. rermi t I
TOT^l VALUATION Ibo,I'11.1)1)
PlU'.IBWG PERHIT
Charges and
Surcharges
ElECTRIC;.l PERI~H
Charaes and
Surcharges
:IECHAIII CAl PERH I T
Charoes and
Surcharges.
80.00
------3'.20---
Domo
I Sidewalk
I A/e Pavi n9
I Curb Cut
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489.32
I TOTAL
2,950.99
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CDfiBIllATlDN APPllC.;TION/PER:.I1T (CAP)
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PERMIT VALIDATION
I.
Applicant to furnish
A. .Job Address
B. Leg~l Description ,
l~ examole- Tax Lot 100, lane'County Map Reference
11 03 ,,3
2. examole- Lot 1. Block 3, 2nd Addition to
Sprlngrield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. ex~mole- heat/electrical ceilin%r fort""p,i "'~.. --.
2. exa!~:Jie- waterheater~electr;cal/l' ,'_ CITY
E. Square rootage or valuatlon, etc.
I. examole, 1250 sq. foot house, 50{
2. examole- T71new project. check-rIE
check add, etc.
F. Building permit information: (
1. example - construct single family
attached garage
2. exa~Dle - remodel existing garage
3. exam:Jle - convert single family n fer,
restaurant (change of use)
G. Value of work as defined in Section 3C
Structural Specialty Code
H. DES I Gi'l TEA:.; AilD CDiiTRACiORS
'To avoid design or construction delays '"
Division Staff must be able to contact
persons regarding design information OT
corrections, etc. - -
Abbreviated Plur,;birig, ~lechanical. & Electri (.<"
A. Exceot I.there blank soaces occur in the
portion of the Mechanical and Electrica
the ap~llcant need fill-in only the Ho. ,(e~
to the apiJropriate item(s) to be instal. \
B. Full Plumbing, Nechanical, and Electrici
are available at the Building Division
1. To conserve space on the permit form ~.
have been abbreviated ~
2. If the item(s} to be installed are n.
the abbreviated schedules you should
full schedules
C. BUILDING DIVISION STAFF WILL FIll OUT All 'F'
CHARGES QiJ THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible. the initial application wil
a worksheet only. ~here possible, Building Di
will prepare a type written copy and return it
applicant at the time the actual permit is iss
signature.
Fees and Charges
Plan check fees are due and payable at the timE
app.lication. and no plans will be processed unt
fees are paid. All other fees and Charges are
payable when the permit is issued.
~RS"'. \.
I
OF
SPRINGFIELD
(
II.
City Hall
Springfiold. Oregon
Department of Public Works
OFFICIAL RECEIPT
.No. B
"1-!2\ 19~().
:::~d From --f('. J ~ 1J-/, I) f1-- U4'",' J.
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Address 1/ ~_I- _---'.-
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Received For: - - L:)
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FOR OFFICE USE O;,lY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArJCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
DAN Sr~ITH
Ll L~T/
date
7-21-80
signature
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