HomeMy WebLinkAboutPermit Building 1980-10-6
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INFORMAtiON LINE
726-3753
_,..._........_ ~050 Ol)'::!lllc Str~~t
~",,'o.~~_ 17 03 25 31 it 7700
I Sq. frg. Main
_ _ Sq. Fig. Accen.
"'1 $q Fig. Other
t. ec t[ 1 ec t. . N~w _AddA.Alter_Rep,
. Fencl! _Demo_Change I Use
Other
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Building P.rmi'-Info: o.H"b. ......o.i \;.e., Build Single
family RII,id."le W;'~"'I"Hr..d Gorog_'
Remodel lease space for Mr. Roberts
--- ---.-
Clothing Store (Formerly health food
store) - --------
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Vol_ a' WOf.1
O-~. Bruce Roberts
6336 0 Street
Addr...
Springfield. Oregon 97477
10.000.00
Phone
726-5967
Con\truclion lend.,
Add'e"
Phone
DESIGN TEAM
(address)
(lie" no.)
(nomel
Primary
Ili.lLPprr~
fi78 r.ountrv r.1ub_Rond Suite g
Sh'ucturol
3ocria>1
Mechanical
CONTRACTORS
(nome)
(address)
,Ilies. no.)
17415
General
Don Baur
Plumbino
~ieC:ic:a1
Raloh Vetter. 3660 Harlow Road
20-110-6
.""e<honicol
PLUMBING
ELECTRICAL
NO,
CHARGE
FEE
NO.
FEE
CHARGE
Residence of
Each sin91e fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
'",:.ft.
New circuits, alterations
or extensions 2 or marl ~
15.00
SERVICES
Duplex (I both) each
Temporary Construction
Additional both
Amps.
Water service
Sewer
Storm Sewer
FEEDERS
Amps.
r
I
I
I TOTAL CHARGES
I
(Cltpirel)
(phone no.)
681-270R
I
I
I
(ohone no.) I
746-7260
(expires)
MECHANICAL
NO, I
I
I
I
I
FEE
I CHARGE I
I
I
I
I
I
I
I
I
furnace/ burner to
R,TU's
Appliance venl
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heatin~ or AC.
Mechanical exhaust
hood and duct
I Wood stove/heater
I Heat Puma
I Air handler to
10_000 CFM
I Air hondler over
10,000 CfM
I
I
I
TOTAL CHARGES
ISSUANCE Of PERMIT
15. 00 I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Eledrical Walk b. done by tho EI.drical Cantlactor, the el.drical portion of this p.rmit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electlical panel.
I HAVE CAREfULLY EXAMINED the completed. application for permit, and do hereby certify that all information hereon i. true and correct, and I further
certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the lows 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 furlher
certify that my registration with the Builder's Board is in full force and e-ffect as required by ORS 701.055, that if exempt the basis fa; exomption i. noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
Sasis for Builder's Boord exemption:
NAME (ploooo p,(nt) 32-> 'Nio~do Q,~\
SIGNATURE
C"\
~,<"l,Onf>(?~1...\
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DATE l1/i.djRO t--.
I.
fOR OFFICE USE ONLY
C-2
Type/ Const
Bedrooms
~Iori~.
Zon~'
Fire Zone
Flood Plain
'nits
.....ccy Load
"ccy Group
Sq. Ftg. Main
c:-:. Ftg. Accen
Sq. Ftg. Othor
L4UU KemOde I x
x
1
ll-L
Value
Value
Valul
lU, uu(J.lJO-
52.00
plan Ck. Comm/lnd
65%/Slda Per Foe
Plan Ck. Res
30%/Sldq Per Fee
TOTAL VALUATION
I ~~~e'~-5 Develop~~n.t
Charae (1.5%\
33.80 PO 10-21-60
RECI! ~4959
BUilDING PERMIT
Charges and
Surcharges
2.08
PLUMBING PERMIT
Charges and
Surcharges
fence
Demo
elECTRICAL PERMIT
Charges and
Surcharges
15.00
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
. fiO I"A/C PaviftQ
I Curb Cur
---------L_,_
Total (Qmb. Per,.,it
69.68
I
! TOTAL
69.68
I. Applicant to furnish
A. Jab Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example.Lat 1. Black 3, 2nd Additian ta Springfield' "-.,....-
C. Name, etc. of owner and construction lender
D. Energy Sau rces
_1. example-heat/electrical ceiling/or forced air qos
2. example.water heater/electrical/or solar
E: Squarefaotage or valucition, etc. '
1. example.1250 sq. foot house, 500 sq. foat garage
2. example-if new project, check new.if addition, chec
odd, etc.
'. ::..n-teing permIt information:
1. ,example-construct single family house with an otto
corooe
_ ~m-oie-re~odel existing garage into family room
_ ~:r.;:le<::~~ single family residence into
restaurant (change of use)
G. Vaiue 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 Oivisi.
!.._::. must be able to contact appropriate persons regc
design informarion or job site corrections: etc.
""---?-.-.-;
COMBINATION APPLICATION/PERMIT (CAP)
II. A!J.bre.viated Plumbing, Mechanical & Electrical Schedules
A4 ~'pt where blank spaces occur in the description pOI
of the Mechanical and Electrical Schedules, the opplicc
need fill-in only the No. Boxes adiacent to the appropl
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
aled schedules you should consult the full schedule!
C. BUilDING DIVISION STAFF WILL FilL OUT ALL FEES AN
CHARGES ON THE SCHEDULES
.
III. Applicant to sign and date (
Whenever possible, the initial application will be used as.
worksheet only. Where possible, Building Division Staff w
prepa're 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 af the ap fa\
and no plans will be processed until these fees are paid. ) ,
other fees and charges ore due and payable when the pet4;.,"
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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.
Additional Project Information:
PLANS REVIEWED BY:
nom'"
Lorne Pl eger
~_o
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~ignoturl'"
PERMIT VALIDATION
(
CITY OF
d
SPRINGFIELD
(
City Hall
Springfield, Oregon
Department of Public Work.
OFFICIAL RECEIPT
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55111(1
No. B
Date //- & 1920
Rec'd From l.t-fU't;.u) Ilfl"/ I' .!rUL.i
Address /0 l~f'c:~~,;~~~i
Received For:
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Amount Received
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"UTHOItIU:D 5IGN"TUItE
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S"llTO,,'TU""'Ull """TI" . luCI:"~ 0' ""01
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Permit Clerk
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10-28-80