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HomeMy WebLinkAboutPermit Building 1997-10-2 (2) Page 1 RESIDENTIAL PERMIT APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DIVISION BUILDING SAFETY Job Number: 970840A 225 North Fifth Street Springfield, OR 97477 Office: 726 -3759 Inspection Line: 726-3769 Location of Proposed Work: 5660 DAISY ST 4 Assessors Map #: 17023344 Lot: 23 Block: 1 Tax Lot #: 01422 Subdivision: MT VIEW Owner: RANDOLPH ALLEN Address: PO BOX 70491 Phone #: 688-5750 City/State/Zip: EUGENE, OREGON 97401 Describe Work: NEW QUAD AREA: 3RSC OFFICE USE LAND USE: 1150 ZONING CODE: PUD Item Main Garage FTG/PERIM FOUNDATION Total Value BUILDING PERMIT --- Square Feet x $/Square Feet = Value 0.00 0.00 1,217.00 1,217.00 Building Permit Fee Surcharge/Admin 22.00 1. 76 TOTAL FEE (A) 23.76 --- MISCELLANEOUS PERMITS --- Surcharge/Admin SYSTEMS DEVL CHARGES 0.00 150.61 TOTAL MISCELLANEOUS PERMITS (E) 150.61 (Excluding Electrical) unless otherwise noted TOTAL AMOUNT DUE (A, B, C, D, and E combined) 174.37 --- BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT --- This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. --- ADDITIONAL COMMENTS --- ALL INSPECTIONS SHOWN ON ORIGINAL PERMIT APPLY TO THIS PROJECT. THIS PERMIT IS FOR REVISED VALUES AND FEES ONLY. PLEASE REFER TO PERMIT ISSUED 7/21/97 FOR ALL REQURIED INSPECTIONS. Job Number: 970840A Page 2 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is 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 Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with OR~ 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. \" \" - /7 I /7 ,--->- ~ ?-/--'~ ............-:\ ", - ~ ./ s\;nature ,r I cJ - ;;l.. - c:r 7 --- Date / Date Paid: & 1-S~\DATION to A .qr; /, r (l -lV\4.~) tJ\m~ Receipt Number: Amount Received: Received By: