HomeMy WebLinkAboutPermit Building 1981-10-19
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INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
Sq. Fig. Main -1WO
Sq. Fig. Access.
Sq. Fig. Other
_New_Add_Altor_Rep.
_Fence_Demo_Chonge! Use
_Xo'h" .
Job Addreu
3520 Olympic Street
T.L.
ENERGYGSOURCES,
Heat as
Water Heater E 1 ec
Renae
I Volue of Work:
Legal Description 17 -02-30-00
1924
OJ
.....
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....
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Own" Conkl in Company Inc
Add.... 4209 6th Avenue West
Eugene, Oregon
Phone
484-4515
$25,000.00
Building Permit Info: Deu:ribe Work (i.... Build Single
Family Residence With Attached Garoa.}
Complete lease space
Construction lander
(name)
(address)
Reference see Job #793129
(expires)
Address
DESIGN TEAM
Phone
Primary
Lane Construction Co.
Structural
E].<ld,o] Builder Electric
M.,honl,o] Harry & Price
CONTRACTORS
(nome)
(address)
General
Lane Construction
Firman & Sons
Builder Electric
Harry & Price
815 Dorris Street
1285 Taft Street
293 Monroe Street
2015 Nugget St
Co.
Plumbing
Electriccl
Mechanical
PLUMBING
ElECTRICAL
NO. FEE CHARGE NO.
7 Residence of
Each single fixture 5.00 35.00 .".ft.
Relocated building 2 New circuits, alterations
(new fix. additional) or extensions
S.F. Residence
(1 bath) SERVICES
Duplex (1 bath) each Temporary Construction
Additional both Amps.
1 Water service 10.00
1 Sewer 10.00
Storm Sewer FEEDERS
Amps.
TOT Al CHARGES
55.00 TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Eledrical Contrador, the electrical portion of this p.rmit .hall not be valid until a
lob. I has been .igned by an Electrical Contractor and attaeh.d to the el.drieal panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true ond correct, and I further
c.rtify that ony and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Or.gon
pertoining to the work described herin, and that NO OCCUPANCY will b. made of any structure without the permiuion of the Building Djvision. I further
certlfy that my registration with the Builder's Board is in full force and effect os required by ORS 701.055. that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
IJ., Q
Basis for Builder's Board exemptio"..
NAME (pleasG print>D ~ 'JIll
(!f>Cl.1
SIGNATURE
FOR OFFICE USE ONLY
Zon' M-3
Type/Const.~R
Bedrooms
Units
':>ccy Load 1 ~
nccy Group--B..=.?
Fire Zone
Flood Plain
Citod."
1
BUilDING PERMIT
Charges and
Surcharges
I Plan Ck. Comm/lnd
112.00 65%/Bldg P.. F..
4 481 Plan Ck. Re.
o 30%/ Bldo Per Fee
55.00 I F.n,.
-------;~~I D.mo
15 _ 001 S;d.wolk
_ nn lAIC PayiM
24.00 I Cu,b Cu'
--------;,-;1
PLUMBING PERMIT
Charges and
Surcharges
ElEGRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
(lies. no.)
(phon. no.>
(lies. no.)
(expires)
(phone no,)
1715
688-5836
Oct loR?
F;AO_~A~Q
485-0922
746-1621
MECHANICAL
FEE CHARGE NO.
FEE CHARGE
15.00
furnace/burner to
A,TU's
Appliance vent
separate
Stationary .Yap.
cool.r
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
1.00 /;.on
I
2
Wood stoyelheater
Heat Pump
Air handler to
10.000 CFM
Air handl.r o".r
10,000 CFM
X ~as to 4 outlets
1 Heat pump
') 00
6.00
ISSUANCE Of PERMIT
10_00
15 . 00 TOTAL CHARGES
?4 nn
J)~
DAJ{r tiFf
1200
x2D-R1
Vo]u. 25 . noo 011..-
Value
c:,. ftg. Main
1:". Fig. Acceu
Sq. Ftg. Other
x
x Value
TOTAL VALUAT]ON \ 25.000.00
Pl Ck fee $74.75 .
10-13-81/B57 4331 ~~~;:" ,~~'~:opm.n'
11.\ \\\\--~
Cl\\\I:1M\ ~"
l';:tal Com~. Permit -
375_00
~C'O
.9lc2
TOTAL
',,\\011.
71/
.-
214.24
Lo\q ,20
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Jab Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot 1. Black 3, 2nd Addition to Springfield Estates
C. Name, 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-l 250 sq. foot house, 500 sq. foot 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 os 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 regordin
design information 'or job site corrections, etc.
II. Abbreviated Plumbing, Mechonicol & Electrical-Schedules
A. Except where blank spaces occur in the description portion
of the Mechanicol and Electricol 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 ore not covered on f!1e abbr...
oled schedules you should consult the full schedules ., (
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
nl. Applicant to. sign and date
Whenever possible, the initial 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 ore due and payable at the time of the applicc ("
and 00 plans will be processed until these fees ore paid. All .
other fees and charges are due and payable when the permit l-
is tssued.
V. FOR 'OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
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PLANS REVIEWED BY:
1<:
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1" /,1.
I '/ ~,::.,
nam'"
Dan Smith
"'ignatur'"
PERMIT V ALIDA TION
CITY OF SPRINGFIELD
(
City Han
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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Amount Received , WHo ,20(1 0
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Permit Cieri.
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10-16-81
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