HomeMy WebLinkAboutPermit Building 1980-6-24 (2)
I HiSPECTlD:1 LIIIE
726-3769
Job Address
Legal Oe~cription
688
, 'M'-~" JUN 2 i Iseo
.' ,,-;.:1.. CITY UF SPR!iIGFIELD
COllBlilATlON APPLICATION/PERMIT
EilERGY SOURCES:
Heat Baseboard Elect
!.Jater Heater Elect.
Ran~e El:ct
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W
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.
Map Reference 18 02 05 1 2
INFORtlATION Lli'It.
726-3753
So. Ftg. (.lain J.UUU
~q. Fta. Access.
5q. Ftg. Other
Ilel< Add A Iter rep.
--Fence Demo Change/Use
Other -- -
Owner
Fern Way
Minor Partition 607, Lot B
Joseph P. Tabor
Phone
ValUE: of l'Jork:
11,805.30
Bui~:inQ Penllit Info; Describe \'lork(Leo. Build Single
Familv nesidence With Attached Garaae'
Address 1445 West 11th Street
Eugene, Oregon 97401
Construction lender
Address
Ut:Sllii{ I E.All lname)
Primary R.C:. Rrp~~pv
Structural
Electrical
t1echani ca 1
CONTRACTOR5 (name)
Genera 1 Owner
Plumbina Owner
E1 ectrica 1 Owner
~1echan;cal Owner
PLUfIBIrlG
110.1
lEaCh single fixture
IRelocated building
X (new fh. additional)
S.F. Residence
(1 bath)
Duplex (I bath) each
Additional bath
~!a ter servi ce
Sewer
Storm Sewer
683-4889
Foundation & renovation of moved house
Phone
(address)
(lics.no.)
(exoires)
(phone no. J
1 h4~ Wf'st. 11 t.h St.rf'f't.. RlI"'f'nf'
683-4889
(address I
(l le,,_ no.)
(expires)
(ohone nn.)
ELECTRICAL
MECHANICAL
FEE' CHARGE: rm
~~~ rH~Rr,~ NO
rH~Qr,i='
><>
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
15.00 or extensions
Floor furnace
and vent
I SERVICE5 CHANGE
I
115.0C
Recessed wall
ScaLe heater and vpnt
ITemporary Construction
IChange in existing
re~.i qe;nce
ImultifamilY, camm. or
Indus.trial
Appliance vent
seoarate
Stationary evao.
cooler ~ .
Vent fan wi th
sinole duct
I Vent system apart from I
heatinq or A.C.
I Nechanical exha4st
hood and duct
I Hood stove/heater
I
I
I
I
amps.1
Of
C011H./lND. FEEDERS
Install/alter/relocate
distrib. feeders
IOf
I
I
I
amps.j
ISSUANCf nF PFRrllT
TOTAL CHARGES 1'1. Oc. TOTAL CHARGES 15. OC TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be valii until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for ~ermit. and do hereby certify that all information 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 Springfield and the Laws of the State of OreC)on pertaining to the work described herein, and that tiC OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as;required by ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used_on this project.
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IWIE(please print)
Zone 'R_ 1
Fi re Zone
Flood Plain
III
NO
BUILDIIIG PERIIIT
Clla rges an~
Surcharges
PLUI1BlNG PERlllT
Charges and
Surcharges
ELECTRIC~.L PERI~IT
Charges and
Surcharges
11ECHANICAL PERI1IT
Charges and
Surcharges
JOSEPH P. TABOR
./
, ( -J.~
DATL ':'{vS-
SI"IIATURE
FO~ OFFICo USE
1 S~,
Tyoe/Const. V N
Bedrooms
or~L Y ., ."
, f1aiti 893 x 12. 10 Value 10.805.,0
F~_g.
Ft~. Access FDN x Value LOOO.OO
Ftg. Other x Value
TOTAL VALUATION 11,805.30
Units
Occy Load
Occy Group R- 3
Sq.
S~.
Stories
1
FDN 10 00 Plan Ck. Comm/lnd
. 65%/Blda Per Fep
--------40--PTdn Ck. lies
30~/BldQ Per Fpe
Systems Development
Charae (1.5")
1-11.7.08
1
I
I
I
I 41. 60
218.68
3.00 PD
REC#
6-11-80
I
I
I
ITotal (omb. rermit
______l2-...QQ__
60 I
Fence
Demo
15.00
- --- -- --- ---
60
Sidewalk
A/C Paving
Curb Cut
I
I TOTAL
.
.. _. ... - -
-..
.~'.
COMBlIMTION APPlICATI01//PERHIT (CAP)
N
I II.
I. Applicant to furnish
A. Job Address
8. legal Description
1. examole- Tax lot 100, lane County Map Ref'
II OJ 43
2. examole- lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources t"
1. examole- heat/electrical ceiling/or forcel \ir
2. examDle- waterheater/electrlcaJ/or s~
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. fOOl /"
2. examole- if new project. check new - if de tir
check add. etc.
F. Building permit information:
1. exa~Dle - construct single family house wi
at tJched garage
2. examole - remodel existing garage into fan
3. .examale - convert single family residence
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of ~
Str~ctural Specialty Code
H. DESIGN TEAN ArlO CONTRACTORS
To avoid design or construction delays. Buildi
Division Staff must be ?lble to contact appropr ~..
persons regarding design information or job si
corrections. etc.
II. Abbreviated P1Ulr.bing. ~lechanical. & Electrical Schl )....
A. Except where blank spaces occur in the descrip' q
portion of the Mechanical and Electrical Schedl
the applicant need fill-in only the No. Boxes (
to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical. and Electrical Schec ~s
are available at the Building Division
1. To conserve space on the permit form the sc
have been abbreviated
2. If the item(s) to be installed are not cove (0:
the abbreviated schedules you should consul
full schedules
C. BUIlOIiiG DIVISION STAFF WIll FIll OUT All FEES
CHARGES Oil THE SCHEDULES
D. As noted on the CAP, the label must be delivere
electrical contractor for signature by his elec
supervisor. The general contractor is not auth,
to sign the electrical.label. ---
Applicant to sign and date
Whenever possible. the initial application will be I
a worksheet only. Where possible, Building Oivisiol
wi 11 prepare a type written copy and return it to tt (
applicant at the time the actual permit is issued fc
signa ture.
IV. Fees and Charges
Plan check fees are due and payable at the time of t I
application. and no plans will be processed until th ~
fees are paid. All other fees and charges are due ~
payable when the permit is issued.
PERMIT VALIDATION
- CITY
OF
SPRINGFIELD
c
Date
f). II
City Hall
Springfield, Oregon'
Department af Public Warks
OFFICIAL RE.CEIPT
No. B
19/[)
'-,!) h'Y-('
53924(.
(' Rec'd From ':.~,
c.
Address
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Received For:
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Amount Received
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V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
DRIVEWAY CULVERTS REQUIRED
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: SEPARATE PERMIT REQUIRED FOR ANY ADDITIONAL WORK
IMPROVEMENT AGREEMENT REQUIRED
THIS PERMIT IS TO BE ISSUED AFTER HOSUE MOVING PERMIT IS APPROVED AND SIGNED
.. I .. .. oM' ..... ... . ..~. . ... ..
PLANS REVIEWED BY:
name
DAN SMITH
signature
I~.n . Jm'(2h _'
da te t, -18- f?Z)
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