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HomeMy WebLinkAboutPermit Building 1980-12-16 (2) r- , ;:~? '.~~ .:<- .~>~. .:~. :.~" " -- IHSPIClION UN' 72W7" 1",,'OUU,tlON LINE 1]-....J1)] .... -""'Iol~"" .. ell ....'~c.,'IIh., (0-.......'.0_ .,'''",... '0". ,.....,,,'1 Job A.....o.. 2026 Donn\,' 111 . . '_'00..._ loch4ven ~b'l... ;!ol:Jlo ~'.j:>dIY"I~n -__w__.. ___ . lot 33, Block 3 Owne. RObert--Co.c~r~,~Ge~e !. Bem.ar"t Ht"at:.-",. -" .. ----.-.. -_.-.. Add.... 663 We'st tentennl'al Blvd Sari nofie I dL_Or_ego"__R477. 1,,,,,,;1 :..'w"\ I:~ :., "'J __.,.:.:HJ ~.. "t ...... .il h "'..... :9ca.CoQ c_ co o .... .... .<> ..... ....-..-- :.t "J .:>....... ........ "do' A:... I.p. ...... :._ (l'o.l;,o.iUI. ......... 1..._." .'_'_ ...... 7~1-1~20 ............... ~...._ :...... a_I- ~.. .._-,. '"'...... 1-..11 ..~-. ...:.. ~_..... c.---:'r. _ _._ .......___ Can'truc:tian L..nd.,' Sf ng 1 e .C~r;>ort ~n<l AltJcned S tor~Qe Shed ~~bile Home.Plumb~~9_~ E~ectrlcjl ser~iSE Add.... Pharw DESIGN TEAM (nam.) Primary Garret Maupin. P.O. Box 846. Sorinafield (addr.nl (Iiu.roo.) (..p;...i ip~,:,:,,_~.l 746.:85H Structural EI.c:trical M.chanical General CONTRACTORS (nam.) Hiatt Brothers Construction, (addreu) 663 West Centennial (lies. no.) (.xoir..) Inhane no.) Boulevard, Springfield 741-1420 PlumbinQ Electrical M.chonical PLUMBING ELECTRICAL MECI-JANICAl NO. fEE CHARGE NO. FEE I CHARGE ' NO. I FEE ICHARCE Resid.nce of I furnace I burner to Each sinRle fixture SQ. ft. Il,TU's R.lacat.d building N.w circuits, alterations I I Appliance ...ent (n.w fix. oddition~1) or .xtensions Mparate I S.F. Residence I I I Stationary eyop. (1 bath) SERVICES coal.r I I I I V.nt fan with I Duplex (l bath) each Temporary Construction sinRle duct I I I I Vent system apart from I Additional bath Amps. h.atinq or A.C. I I I I I M.chanical exhaust I Water s.rvice hoad and duct I Sewer I I I I Wood sto...e/heoter I I Storm Sewer I FEEDERS I I I Heat ;umo I 1 I Mobil e Home I I I I I Air handler to I Amos. 10.000 CFM I Servi ce 115.001 1 Mobile Home I I I I Air handler ov.r I 10.000 CfM 1 I 1 Service I 110.001 -, I I I I I I I I I I I 1 I I I I I I I I I I I ISSUANCE OF PERMIT TOTAL CHARGES 15.001 TOTAL CHARGES 10. 00 I TOT A' CHARGES WHERE STATE LAW REQUIRES that the Electrical work b. done by the Electrical Contrador, the electrical po!tion of this permit "'011 not be valid until a labol has bHn sisned by an Electrical Contrador and attached ta the el.ctricol pa~l. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information .her.on is true and correct, and I furth.r certify that any and all work performed shall be done in accordance with the Ordinances of the CitY of Springfi.ld and the Laws of the State of Oregon pertaining to the wark d.scribed herin, and .that NO OCCUPANCY will b. made of any structur. without the perminian of the B~'ilding Division. I further c:ortrfy that my registration with tho Builder's Bocrrd is in full force and eff.ct a s required by ORS 701.055, that if exempt the ba.is for exemption is noted heron. and that only subcontractors and .mploy.es who are in compliance with ORS 7.01.055 will bet uled On this project. Basis for Builder's"Board exemption- NAME (please print) Dr.. 0'...... (,,) l' If '- OJ... "GNATURE /QVA _ ifdAP J _ OATE/l -It. -'lo fOR OFFICE USE ONLY I'IM':) Type/Canst V-I~ Inill Sq. Fig. Main 240 5.10 "olu. J22A..J)D Zon' . Fire Zone Bedrooms ,,",ccy Load Sq. Fig. Access 1'2. . 9.50 "olu. ---6.8..4 . 00 Flood Plain c.tori.. "ccy Group_ M-l Sq. Ftg. Othe~ Value l!:lUCl.UU .- TOTAL VALUATION BUILDING PERMIT 20.00, Plan CIl:. Comm/lnd I Systems De...elopm.nt I Charges and -------- 65%/ BldQ Per Fee CharAe n.5%' Surcharges .80 Plan Ck. Res I t!ome Setup Permi s 30'" BldQ P.r F.. 6.00 PLUMBING PERMIT , I Charges and 15.00 Fence Surcharg.s .60 I Total Comb. Permit I 69:60 Dem. ELECTRICAL PERMIT 10.00 I Sidewalk fiR I I I Charges and F. Rn Surcharges .40 lAIC Pa...ina I I MECHANICAL PERMIT I Curb Cut I Charges and w________ 1 1 n..Jln 69.60 Surcharge. I I TOTAL ; I. Applicanl10 furnish -.;-',.~ i-~., -:','":... ... ..... ,_'. _:i A. Job Address .:'" 'V ,-.-...- ,.'",< .... '~_ ~ -..",. ""- "':.I. I> .... ..... ..,. .~, ~ 'J'>' ~,-, ~'ia:-,' 8: legal Description '''.,... ".:- ~... .-~; .. w. ~j ..- .~.; p '..,~, .. - ~ 1. example-tax lot 100, lane County Map,ReferencE','''' n., ,II., , ;. ,- 2. example.Lall. Block 3'l'l~;!,dditian.t?\Springfiel,-"(',,,,,. C I T y~. 0 F'~:SP RING FIE L D ,_'_' C. Name, etc. of owner and construction lender : O. Energy Sources 1. example-heat/electrical ceiling/or forced air qas 2. example-water heater/electrical/or solar E. Square footage or valuation. etc. . 1. example-1250 sq. foot house. 500 sq. foot garage 2. example-if new project, che"ck n-ew.=i{ addition, ch. add, etc. F. Building permit information: 1. example-construct single family house with an att garage . 1'". 2. example-remodel existing garage into family roor 3. example-convert single family residence into restaurant (change of use) G. Value of work os defined in Section 303 (0) of Ihe Structural Specialty Code H. OESIGN TEAM AND CONTRACTORS ( To ovoid design or construction delays, Building Divi! Staff must be able to contact appropriate persons res;; design information or job site corrections, etc. COMBINA nON APPLICATION/PERMIT (CARt " ' .,';:.'-<l II. Abbreviated Plumbing, Mechanical & Electrical Schedule A. Except where blank spaces occur in the description pc of the Mechanical and Electrical Schedules. the applil need fill-in only the No. Boxes adjacent to the appro, Item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules ore.ovailable at the Building Division .~ 1. To conserve space on the permit form the schedult have been abbreviated 2. If the item{s) to be installed are not covered on thl oted schedules you should consult the full schedult C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES A CHARGES ON THE SCHEDULES III. Applicant to sign and dote Whenever possible, the initial application will be used 0: worksheet only. Where possible, Building Division Staff , prepare a typewritten copy and return it to the applican' 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 0 ..,;, and no plans will be processed until these fees ore paid.~.. other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~:~4.' ,: ~-. .~t:.. . . ;" . \..~. -' o . 'PERMIT- V ALI~~ ~!<?N '~ .......::... . .//~~.;';J:_. :- ,:-.. -:':-:l: .. '" . '~':'."'. ':.,...~; ~\ .~ " ""l'~. .... ',f;. '..,.-f , ( ., I ~, ( City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEiPT ......- \. I I 55382 ' ;' .'", .( I.. I .... ........ , I I (I J i I ,( ~_ - ~'6-- _ ",: ' ~.O. __,~ Dote 17 - 1'5 i9l{{) . . (' Rec'd From I-(nH wn\.'S+ ._ . =:> " Address h;n5 w. (Pmf?lfflnO . - ltXllo.)J.12V\ lm s:. 10.00' .00 1~.OO Inn l()cxj LtO In 00 / G '60 ( (,I Received For: hf/ <" ( w ~6b , e, /\016 c fP (', c . !-iO r vet=" !?JJ.J,...... Y I) Ifr I c' (, (b ( Amount Received (oCI (r{') c' ('E..- ( ~',I (I)n " - A~RrtED 5IGNATUIIII: ...ILTO...TU.....ULL ..".......1. luG.".. 0" .'.01 ..."., (- ~ ( ., (, "\, Permit Clerk 5 feet \oIi~~ <etback sidewalk to hp ~~s":""rl with C'+~, :tilR~ard ;;:;rl;:::1; Additional .Project Information: .(" PLANS REVIEWED BY: ,;. ~ ,., ....-'. nom"'" Lorne PleQer "ignatur'" ~.,~- ~-~ . / ( --,/ , ~ate 12-11-80