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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) f'/ ,1' <...r " 1 IrISPECTION LHlE 726-3769 .. 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 ..=----~-~-...~ . --"-' -" --..-_. ---.- "..' -.-1. . -.; i~:.;::~~s~: ii~r:<;. n~. Genera 1 Ciiatt Bros. Springfield Investments ~. ,-.....~ , -......... -. .. :I'::':::"~::~: Penselin Electric Springfield 20-48C ..~:-"!-. :' ;L;;~~:.::;~ ~!..~c:-:::: C.':'L e-- i CHARr.E e-- 1 rwc,qr,cl I I I I I I 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 I I I Total. Comb. rermit TOTAL _,_~.. ,,_,.... ... .... .r , I : ....... .-- ".1....._,. ...__. COMBINATION APPLICATION/PERMIT (CAP) I. I " . . I l Ill. IV. V. FOR OFFICE USE ONLY I I I I I . 1 "f' . . \ \ ..... ... ........., .~. '..- 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, ,eG pp J5.CO (u/; ID.OO .40 ,(J.o ) 6 ctP (~r 5Yr/(; 3ZZ . c:YJ Amount Received ?/?{6~r/.:D ~ Gp tth' 8Y ( "UTHORtZED SIGN"TURE ( ...UTO...TV.....UI.I. ~"'''T[''S . ~uC>~..~. 0" 5740' ...".s ] Permit Clerk ( I I I (- '.. ( ( c f. '. ( ( ( ( c PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .."... . "......~ ."". ..~' Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: I ~.... .....~ . R. . n. J PLANS REVIEWED BY: ... ..... ....~... .... '.R _..._._.. .,.." ..._.._ ".. .. _ signature name date Rt. j ..,,,I