HomeMy WebLinkAboutPermit Building 1980-11-6 (2)
ValUE of Hark:
21,500
Buil(;ina Permit Info: Describe Hork(Le., Build Single I
Far.1i 1 v Res i dence "Iith P.ttached C1a raqe)
Mobile home setup with
improvements
DoubQL WLd.L
(lics. no.) (exn~res)
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1 IrISPECTION LHlE
726-3769
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CITY OF SPRIi~GFiELO
COIIBIilATION APPLICATION/PERMIT
I EilERGY SOIJ.RCES:
Job Address -. 2048 Donnellv. Sorin\!field I Heat Electric
Legal Oe<cription Lochaven Subdivision I !'!ater Heater
I Ranqe
Lot :5z.bLoc..e 3
Gene & Bernard Hiatt & Robert
. vochran ~ 142
Aduress 663 H. Centenn~al P'I'",'l- 0,
Springfield
Owner
Construction lender
Address
DESIGN TENI
{name)
Phone
(address)
Primary
Stn:c~.'~..!l
Electric:!l
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Genera 1
Ciiatt Bros.
Springfield
Investments
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Penselin Electric
Springfield
20-48C
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i CHARr.E
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1 rwc,qr,cl
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rm I
I Residence of
INew c;rcu~ts alts.
or extenSlons
I SERVICES
. ~'- ::-;:~ f~X:~'J:-e
.~eioc~teQ Guildinq
I (new. iix. Jdaitio~al)
is.F. Resioence
,(1 b.thl
IOuPlex (I bath) each
Additional bath
Temporary Construction
Change in existing
resJ(tenc~.
Imultifamily, comm. or
Tndustrial
~!a ter servi ce
Sewer
Storm Sewer
Of
amps,
c-
,',
IIlFORllATION LlI'lt
-'
72\-37S3
So. Fto. I.hin
~q. ~tg. A,:cess.
So. Ftg. Other
flel'i Add A Her fl:ep.
-Fence D;~o Change/Use
Other - -
-
-
,Q:-
o
(phone no.)
(p,(!::1fec;1
Ifl.honf PQ, )
741-1420
741-1186
:~ECP.A ':rCAL
~J(L I I ~f:"1='
I furnace/burner to
lTlI's
I Floor furnace
and vent
I Recessed wall
SOilCP. heater and vpnt
I rHAQr.~
I
I
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
I Vent system apart from I
heatinQ or A.C.
I ~lechan i ca 1 exh,lus t
hood ,1nd dur.t
Uood stove/hea~:er
COI1I.\. /lND. FEEDERS
Install/alter/relocate
dic;trih. fppnpr<;
Of amps. I'
I
I
I ISSlIANCf OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this perr.lit
shall not be '1alH until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXf.J.1HlED t~e completed apf1lication for rJermit, and do hereby certify that all infonnation hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Sorinqfield and the laws of the State of Oregon pertaining to the I'lork described herein. and that tlO DCCUPAUCY will be made
of any S~~Jcture ~ithcut the ~ermission of the Building Division. I further certify that my re~istration with the Builder's
Board is in full force and effect as required by DRS 701.055. that if exempt the basis for exemotion is noted hereon. and that'
only subcontrdctors and er.mloyees \'1ho are in compliance with OP.S 701.055 will be used on this pro,ject.
S1G:!/ITURE jQ~d ~l.
IIAf.IE(pIease print) D.R-.."" It!, \;/ c.. t7J~
FOr. orF!C~ USE OnLY
Zone M -H'S Tyoe/Const. r'n-H Units Sq. Ftg. rlain
Fire Zone Bedrooms Occy Load Sq. Ftg. Access
Flood Plain Stories Occy GroupJ2-:"'l Sq. Ftg. Other
BUILDiNG PERi.lIT
ChJrges anc
Surcharges
. /LO 00 . Plan Ck.
__'"J ...J______ 65VBlrln
Plan Ck.
30::/Blda
__15.LD__ Fence
(n() D~mo
10. C'X:)Sidewalk
------21n--- A/C Paving
Comll nd
Ppr !='pp
Res
Per Fee
PLU,.\B ING PERI-Il T
Charges and
Surcharges
ELECTRIC~.L PERI~IT
.Charges and
Surcharges
IIECHAN I CAL PERI1IT
Charges and
Surcharges
Curb Cut
om//-t. - f fJ
x
Value
\'alue
Value
x
x
TOTAL VALU/.TIOII
.Systems Development
Charo. (1.57,)
131.-2,50
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Total. Comb. rermit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
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Ill.
IV.
V.
FOR OFFICE USE ONLY
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PERMIT VALIDATION
Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100, Lane County Map R
17 03 43 (' ,
2. ex'mole- Lot I, Block 3, 2nd Addition t
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or for' . ~
2. eXJmole- waterheater/electricai/or sOla
E. Square footage or valuation, etc. -
1. ex,mole- 12S0 sq. foot house, 500 sq. f (g.
2. examole- if new project. check-new - if ~:
checkadd, etc. Dote
F. B:..;i1ding pemlt 'information:
:. e...:::;. - (ooS:C"=, single family house th Rec'd
cittdcn~Cl garage
2. exa~~l~ - remodel existing garage into
3. examJle.- convert single family residen
~~3~~~ra~t ~chanae of use)
-- ':=L~ cf '..~t"'iI: as ce:f1ned in Section 303 {a}
S:~uctural Specialty Code
H. DES IG,I TE.:',.\ ArlO CONTRACTORS
To avoid design or construction delays, Bui :"9
Division Staff ;,;ust De able to contact appr '1:-
persons regarding design information or job
corrections. etc.
~t:b:"evia:e: Ph::::binc. ~.~echanical. & Electrical
. ~x:~~t wnere oiank Sudces occur in the desc ~.
::n.ion of the ;':echanical and Electrical $c
:~e aoolicar.: need fill-in only the No. Box
t:J tne doorO::lriJte item{s) to be installed (,
~. ~:..:11 Ph'::::~;:":9, ~-~::-chanical, and Electrical S '(']I'
=:"e evaila~le a: :he 3ui1ding Division
1. To conserve space on the permit form th
nave Oeen dbbreviated
2. If the item(s) to be installed are not
the abbreviated SChedules you should co
fuli schedules
C. 8UfL0I1IG DIVISION STAFF WILL FILL OUT ALL F t' ,.
CHARGES 0,1 THE SCHEDULES
O. As noted on the CAP, the label must be deli
electrical contractor for signature by his
suoenisor. The general contractor is .not
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial application will
a worksneet only. Where possible. Building Div
will prepare a type written copy and return it
applicant at the time the actual permit is issu
Signature. .
Fees and CharQes
Plan check fees are due and payable at the time Cti
application. and no plans will be processea unt+-
fees are paid. All other fees and charges are U.JC ulh."
payable when the permit is. issued.
CITY OF
SPRINGFIELD
City Hall
Springfield. Oregan'
Department of Public Works
OFFICIAL RECEIPT
No. B 5 51 04-
19<1D '
From H/d& BVO ctnu
Addresslolo;:) cU{.Irrrln.Jrt.f..U,',
JI-tw
2..0 1.../ ~
H-t-!
bonnell L!
?\O [:0
Received For:
nBi,
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pp
J5.CO
(u/;
ID.OO
.40
,(J.o ) 6
ctP
(~r
5Yr/(;
3ZZ . c:YJ
Amount Received
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tth' 8Y
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"UTHORtZED SIGN"TURE
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...UTO...TV.....UI.I. ~"'''T[''S . ~uC>~..~. 0" 5740'
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
... ..... ....~... .... '.R _..._._.. .,.." ..._.._ ".. .. _
signature
name
date
Rt.
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