HomeMy WebLinkAboutPermit Building 1980-10-30 (2)
,-
r ~. _
, ~"
I ,-
... '... J' _ ~ }
- -...-' :
IIHSP(Cl'ION LINE
72 6-J 7 69
I 7377 Daisy Street
Job Add,."
)"
.:;'".
CITY Of S'RINGflUD
COMBINATION .'-'PlICATION/rUMn
INFOAMAUON LINE
71W7SJ
ENUCY' SOuRCES, I Sq. Itg. Ma;n ~~--
Heo,_.EIA_Elcct__ Sq, 'tg. ACt.". _462
wo,., H~,., _ Elcct..____l Sq. '''G. 01~' .462-&-440-
~v.__Elect. . XNew. .Add. Alte,_Rep.
Vol.,. 0' Wo,lI: .feMe __Oemo_Cho'''jle/Uw
CD
o
o
'"
a-
....
l.90~E~~on. Lot 31, McKe~~!e_H~lls
Owne,
Edward W. Lewis
2034 preslin
93.134.50
__O.h.r
Add,e"
Ph'o.e 688- 5443
Building '.rmit Info: o.scrib. Work (i.... Build Single
Family Residenu With Attach.d Goroqe)
S.F. Res; att gar
Construction Lender
2 Firenl~,.pr;;:,
Add,eu
Phone
I. DESIGN lEAM
,/1 Primary
, 1
Structural
I Electrical
I Mechanical
I CONTRACTORS
I Genefal
I Plumbina
I Electrical
(nome)
(addrllu)
{lies. no.)
(expires)
(phone no.l
(nome)
(oddreu)
(Iics. no.)
(expires)
(phone no.)
Owner
Mechanical
PLUMBING
ELECTRICAL
FEE CHARGE NO, FEE CHARGE NO,
Residence of
X 211-' ",. ft. ~5.00 1
New circuits, alterations
or extensions
25.00 SERVICES
1 Temporary Constru~tion JO.OO 5
]O.OC20.00 Amps.
1
MECHANICAL
I NO.
FEE ICHARGE
Duplex {1 bath} eath
furnace/burner fa
123,.l06_81U'.
Appliance vent
separate
Stationary evap.
tooler
Vent fan with
single duct
Vent system aport from
heotinp or A.C.
Med1anical exhaust
hood and duct
7.50
Each sinRle fixture
Relocated building
{new fix. additional}
S.F. Residence
(l bath)
x
3.00 15.00
2
Additional both
Water sel"f'ice
4.50
Sewer
,Wood stove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Amps.
Air handler over
10.000 CFM
ISSUANCE OF PERMIT
10.0(
37.0(
TOT At CHARGES
45.00 I lOlAL CHARGES
45. OOj 101AL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be Yolid until a
label has been signed by an Electrical Contractor and attached to the e"dricol panel.
I HAVE CAREFUllY EXAMINED the campleted application for permit, and do hereby certify thar all information hereon is true and corrur, 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 mode of any structure without the permission of the Building Division. I furlher
certlfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and. that only s~bcontractors and employees who ore in compliance with ORS 701.0.55 will be used on this project.
Basis for Builder's Board exemption- /7 7
NAME (pleo.. pd.t) EDWARD W. LEWIS <IGNA1URE~:c...--7C:;-d~....,.;,~
FOR OFFICE USE ONLY Deck
DA1E/"rJ"'/.f'U' ,
440 X 1.50 660.00
<'1. Ftg.Ma;. 2141 x 38.10 Volue81.572.l0
~q, Ftg, A"e.. GAR. 462 x 'l. SO Volue -It...,18'l. 00
Sq. Ftg. Othebas.emt:lont- 11.2.3-x c;, Rn Value _t:. _ c:.1 1: {..O
T01Al VAlUAlION 93,131, . 50
Zone
Firo Zone
Flood Plain--H0
R-l
NA
Type/Canst V-N
Bedroom' 4
~tari.# .) tJ/h,qAPrnpnt
1 ~nits
nccy load
Occy Group
1
'R_1. _
BUilDING PERMIT 275.00 Plan Ck. Comm/lnd
Charges (Ind 65%/ BldR Per Fee
Surcharges 11.00 Plan Ck. Res
30%/ Brdg Per Fee
PLUMBING PERMIT 45.00
Charges and fence
'Surcharges 1.80
Demo
ELECTRICAL PERMIT 45.00
Charges and Sidewalk
Surcharges 1.80
AI C PaviM
MECHANICAL PERMIT 37.00
Charges and Curb Cut
Surcharges --------
1.48
Systems Development 1 397 02
Chc,ae (1.S%\ ,.
82.50 - 68.70 PD 3_';':;':;' ,,1.:0:; _ _ 3€l
Total Comb. Permit
425.5B
7.50
TOTAL
1,836.40
I. Applicant to furnish
A. Job Address
B. Legol Description ',: .
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot 1. Block 3, 2nd Addition toSpringfield Estates
C. Name, etc; of owner and construction lender
D. Energy Sources (
1. example-heat/electrical ceilin~/or forced air go .
2. example.woter heater/electrical/or solar
E. Square footage or valuation, etc. .
1. example.1250 sq, foot house, 500 sq. foot gara! (
2. exomple.i~. new project, check new-if addition, c
add, ,etc. '.
F. Building' permit information: ("
1. exam'ple-construct single family house with an' 0 ~L
Date
gorage
2. example-remodel existing garage into family ro
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 Di\l
Staff must be able to contact appropriate persons rE (~
design information or job site corrections, etc.
COMBINATION APPLICATION/PERMIT (CAP)
II. Abbreviated Plumbing, Mechanical & Electrical'Schedul
A. Except where blank spaces occur in the description F
of the Mechanical and Electrical Schedules, the appl
need fill-in anly the No. Boxes adjacent to the apprc
,item(s) to be installed
B.. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building ~ivision
1. To conserve space on the permit form the schedu:
have been abbreviated
2. If the item(s) to be installed are not covered on tf
. . , '.ated schedules you should consult .the full schedu
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES J
CHARGES ON THE SCHEDULES
~ III.
Applicant to sign and date
Whenever possible, the initial application will be used c ("
worksheet only. Where possible, Building Division Staff
prepare 0 typewritten copy and return it to the applicar
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,
and no plans will be processed until these fees are paid.
other fees and charges are due and payable when the F
is issued. 1-:- .
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
. ,<,,::;--.,. ."'-.."
.....:"-'.~~,~""
'>. ---.....
',,- ~ ". . "'=.~
--0 --~~..s~~~~....~~
Additi.o~QI ,Project Information:
PLANS REVIEWED BY:
nam~
'lignatur-o
PERMIT VALIDATION
CITY
OF SPRINGFIELD
c
City Hall
Springfield, Oregon
Department af Public Works
OFFICIAL RECEIPT
(
55051 .
(
"
(
No. B
1980
From ~ 01 L~.eD l$l,', i IS (
_ Presljn.' RLlJ-(
1-l~CO
I 1 .on
L\ ~.o()
I.~
q~,(j(j
1.P10
'~JOO
\ . qC()
"1 . F.Y)
PL~ Qp.lL-ex:JL I ~. P/')
A~~'r;;~ ~%;w~~~. .:
tn-3D
Rec'd
Address '10;)4
Received For:
PO
(
L\CfJ{)
,1'0
'.
'PP
?\ (j \/\
e-P
~
(
,(
(
(
t...H..J
(
l\Oln
(
~11)
(
(
~(
(,
C42
AUTHOltlZIED SIGNA TUitE
I ~ 15" ". '....ULL ..,,,..'''''15. IlUGIl..Il. 0111 euO.
(
.e.".e
(
Permit Cler~
_.
.Jate