HomeMy WebLinkAboutPermit Building 1980-10-3
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INSPECTION LINE
726--3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
Owner
Gene&Bernard Hiatt & Robert Cochran
663 W. Centennial Blvd Phone
Sorinofield. Oreoon 97477 741-1420
ENERGY SOURCES: Sq. ftg. Main --L1Q,;
Heat Fl pr'h..i r: Sq. ftg. Access.
Water Heate{-le<i"tr-i~ Sq. Ftg. Other
Ranqe -Electr:' r _New_Add_Alter_Rep.
Value of Work: I_Fence_Demo_Change/ Use
105,565.00 _Othe,
Building Permit Info: Describe Work (i.e., Build Single
Familv Residence With Attached Garaael
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Job Add,e.. 4280 Main Street
legol Dem'pHon Tax Lot 2200Mao 17 02 32 31
Dunkin Donut
:>.K. ou-<:o
Restaurant
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Address
Construction Lender
Address
Phone
ROI
80-1-2
DESIGN TEAM (name)
Dunkin Donuts
{address}
(lies. no.)
(expires)
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
(address)
(lies. no.)
(expires)
(phone no.)
Electricol
Ppn<plin Flprtrir ~nrin9fiplrl
?n_dRf
741-1420
683-1414
741-1186
PlumbinQ
Hiatt Brothers Investments Above
Twin Rivers Plumbinq Euqene
1416
20-96
Gllneral
Mechanical
PLUMBING
ELECTRICAL
I FEE CHARGE NO.
~.OO 80,001 Residence of
S9' ft.
I I New circuits, alterations
or extensions
SERVICES
1 Temporary Construction
1 Amps. 400
MECHANICAL
NO.
FEE CHARGE NO.
FEE CHARGE
16
Each sing.le fixture
Relocated building
(new fix. additional)
S.f. Residence
(1 both)
1
1
1""""o.1l>=>e, to
~~).v~BTU's
X~X~X~tturnace
separate 80.. 000
Stotionary OYOp.
cooler
Vent fan with
single duct
Vent system apart from
healinQ or A.C.
Mechanical exhaust
hood and duct
7.50
6.00
Duplex (I bath) each
10. 00 2
35.00
3.00 6.00.
Additional balh
Sewer
Wood stove I heater
14.50
I
Waler service
1
Storm Sewer
FEEDERS
Heal Pump
I Air handler to
10.000 CFM
Air handler oyer
10,000 CFM
Amps.
Gas Outlets 1-4
2,00
ISSUANCE OF PERMIT
10.00
36.00
TOTAL CHARGES
80.001 TOTAL CHARGES
45 _ 00 I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by tho Electrical Controctor, the electrical portion of this permit shall not be yalid until a
lab.1 .has b_n signod by an Electrical Contractor and attached to tho electrical panel.
I HA VE CAREfULLY EXAMINED the completed applicatian 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 o,ogon
pertaining to the wark described herin, ond that NO OCCUPANCY will b. mado of any structure without the permission of the Building Division. I furthor
certify thot my registration with the Builder's Boord is in full force and effect 0 s 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 701.055 will be used on this project.
.
Basis for Builder's Board exemption-
NAME (please print) n (;..// ,.;J i. 5'
{l L;;?,/' /..7/;'
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c:.IGNATURP- =:..}....-r,-'.--7.:r;t
FOR OFFICE USE ONLY
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10- 3 - (-.:)'
DATE
Zone I~-~ - 1,-'1
Fire Zone NA
Flood Plain ~
Typo/Canst
&edrooms
Ctorie-
V-I~
X
1
IInits
nccy load
Occy Group
1
Sq. Ftg. Main
Sq. ftg. Access
Sq. Ftg. Other
l/tSb
. vol.e ~<: , J 1 0 . UU
x Value
. Vol.e 13.250.00
TOTAL VALUATION -1.05. ~Il~ ~ nn_
B-~
A.C.
BUilDING PERMIT 273.00 Plan n. Comm/lnd
Charges and. 65%/ Bldq Per fee
Surcharges lU.!:I~ Plan Ck. Res
30%/BldQ Per Fee
PLUMBING PERMIT 80.00
Charges and Fence
Surcharges .3.20 I
Demo
ELECTRICAL PERMIT 45.00 I
Charges and Sidewalk
Surcharges 1.80 Alc P,,'no 13.250
MECHANICAL PERMIT 36,00
Charges and Curb Cut
Surcharge, ---------
1.44
177.45
Systems Development
Charoe (1.5%\
1,384.73
PI an Chec k
177 . 45
519.36
Total Comb. Permit
fiR. 00
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COMBINATION APPLICATION/PERMIT (CAP)
"'I.
Applicant to furnish
A. Job Address
B. legal Descripti~!,-~ ' ", .
1. example.tax lot 100, Lane County Map Reference 1
2. example.Lot 1. Block 3, 2nd Addition to Springfield,
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. example-water heater/electrical/or ~
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,' che<
add, etc.
F. Building permit information:
1. example.construct single family house with an ath
garage
2. example. remodel existing garage into family roor
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 Div;
Staff must be able to contact appropriate persons re
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechonical & Electrical Schedul
A. Except where blank spaces occur in the description
of the Mechanical and Electrical Schedules, the app
need fill.in only the No. Boxes adjacent to the appr
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedule,
are availa.ble at the Building Division
1. To conserve space on the permit form the sched
have been abbreviated
2. If the item(s) tobe installed are not covered on
ated schedules you should consult the full schee
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEE~
CHARGES ON THE SCHEDULES
If) _ Q . No. B
" <.....) 19??O
( Rec'd From. ~hft \2')1()~
,.ed _A~dress (() .l_? 'Z\ ~.O . 0 ~ J\ 1\ loll (I
" Received For: 11~. ~--_'6; 7-3,00 (l
~\'1V '1\ lr~ 44;; , ) D CI 2- . ( ,
~. fijtJo
\L!9n"~ '20
':-.(). () 0 f'l-v US' oo(
491; i. '60 (
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. ') 4CoJ I, Lfq. r
(1.C(f'~_ I 77,I..fS,
\~LU~\ ~)~~OU'(
. rY'.~ 0' _ u / <'~.L\Lf. 73 '
Amount Received~JJ ,) 'f' "( ~/() (
(, ,1m.) .
5"(LTo".n""...u~UT~ ORl1:IED SIG"'''TU''E- .
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III. Applicant to sign and date
Whenever possible, the initial application will be use
worksheet only. Where possible, Building Division Stl i.~i
prepare a typewritten copy and return it to the appJit-.
the time the actual permit is issued for his signature.
IV. Fees ond Charges
Plan check fees are due and payable at the time of the application,
and no plans will be processed until these fees are paid. All
other fees and charges are due and payable when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
Site Review 80-26
Resolution or Intent 80-102
PLANS REVIEWED BY,
nam'"
DAN S,HTH
~ignatur-:"
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PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
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Permit Cler~
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10-3-80