HomeMy WebLinkAboutPermit Building 1981-3-12
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INSPECTION LINE
726-3769
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CITY OF SPRCNGFIELD)
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
726-3753
L.gal De",lptl!..ot 2 of 4B' s
TL 5100, Map 17 02 31 31
Karst Bergsma
456 North 72nd Street
Phone 746-9999
ENERGY sOM'I{SS, Sq. Ftg. Main ~
Heat Sq. Ftg. Access.
Water Heater t.1 ect Sq. Fig. Other
Ran_go ~~ _New_Add--.XAlter_Rep.
Value of Work: I_Fence_Demo_ChangefUs.
7,500.00 _Oth.'
Building Permit Info: Demibe Work (i.e., Build Single
Family Residence With Attached Garaae)
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Job Addren
3305 ~~in Street Suite C
Owner
Address
Sorinaf1eld. Oregon
F~i~t~n ~tnrp ~n~~p Npw pntr~nrp
Add 2 bathrooms
Construction lsnder
None
Phone
Address
DESIGN TEAM
(nome)
(address)
(lies. no.)
(expires)
(phone no.)
Primary Owner
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Structural
Electrical
Mechanical
Plumbing
(name) (address)
M.G. Boles 84408 N Enterprize Road
Springfield Plumbing
Lynn's Electric
Gas Appliance Service
(lies. no.)
2906500
(exD_iresl
(Dhane no.)
CONTRACTORS
G..n..rol
2-1-81 746-9028
JOB SITE PHONE # 726-a01~
Electrical
Mechanical
PLUMBING
ELECTRICAL MECHANICAL
FEE CHARGE NO, FEE ' CHARGE NO. FEE 'CHARGE
1.00 25.00 Residence of furnace/burner to
'9' ft. 1 11..~nnn BTU's F. nn
2+ New circuits, alterations ~5.00 Appliance vent
or extensions separate
Stationary evap.
SERVICES cooler
Vent fan with
Temporary Construction 2 single duct ~.nn , nn
Vent system aport from
Amps. heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
FEEDERS Heat Pump
KelOCate 15.00 Air handler to
Amps. ,.,1; 10,000 CFM
Air handler over
10.000 CFM
1 Gl\S Pio1na ) .00
NO,
5
Each sinQle fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
ISSUANCE OF PERMIT
10.00
TOTAL CHARGES
25.00
TOTAL CHARGES
30.00
TOTAL CHARGES
24.00
WHERE STATE LAW REQUIRES that the Electrical work be daM by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an EIocb'ical Contractor and attached to the electrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and corred, 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 af Oregon
- pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further
;: I t certlfy that my registration with the Builder's Boord is in full force and effect a I required by ORS 701.055, that if exempt the basis for exemption is noted
,.~ j :"~:'fO:n:UI::::.a:,:u~::::I::' and employe.. who a.. in <ompllan" with ORS :~1.055?~~uoedan th~h ~
. NAME (pl.a.. PdntlA--AJ.. (7~nLi;' <. SIGNATURvtl---" ~ik7::?"'~ DATI-- ~~/g /
FOR OFFICE USE ONLY
t'"' (;-4 3-N 1 " 3108
Zone Type/Const. Units c,. Fig. Main "
Fir~ Zone 'U\ Bedrooms occy Load Sq. Fig. Access
Floo~ Plain NO <::torier 1 "'ecy Group-B=.? Sq. Ftg. Other
Value 7.500.00
Value
Value
TOTAL VALUATION I,:JUU.UU
x
x
x
BUILDING PERMIT
Charges and
Surcharges
44.00 Plan Ck. Comm/lnd
65%IBlda Plllr fllle
1.76 Plan CIe.. Res
30%/ Blda Per Fee
25.00 Fence
1.UU
Demo
30.00 Sidewalk
1.20 Alc Pavinn '~
28.60 PO 3-9-81
RECiI 66004
Systems De....lopment
Charoe (1.5%\
NA
PLUMBING PERMIT
.C~argat:Clnd
Surcharges
Total Comb. Permit
~\._'..' ._,.. ';..J -)~ .
',"" '127';'92
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, ~.... 'j
ELECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges' and
Surcharges
j, ~ ',~~.
24.00 Cu,b Cut
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TOTAL
"..';'127.92
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COMBINATION APPLICATION/PEa (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Descriptian
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-LotI. Block 3, 2nd Addition to Springfield Estates
C. Nome, 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. foat garage
2. example-if new project, check new-if addition, check
add, etc.
F. Building permit information:
1. example-construct single family house with an attached
garage
2. example-remodel existing garage into family room
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 Division
Staff must be able to contact appropriate persons regarding
design information or job site corrections, etc.
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.. PE~~IT VALIDATION
11. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description portion
af the Mechanical and Electrical Schedules, the applicant
need fill-in only the No. Boxes adjacent to the appropriate
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initiol application will be used as a
worksheet only. Where possible, Building Division Staff will
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 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
Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1, Fire Department final reauired before Occuoancy aranted.
Additional Project Information:
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SEE JOBH 801223 FOR COMPLETION OF LEASE SPACE SUITE "A", TERRY'S PRODUCE MARKET.
SUITE "B" IS STILL UNLEASED
PLANS REVIEWED BY:
nom""'
LORNE PLEGER
'ignatu~rlU ~fqU
dat~ 3-12-81