HomeMy WebLinkAboutPermit Building 1980-7-2 (2)
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legal Oe<cription TL 2601
MAP1? 03 22 2
CITY OF SPRlilGFIElO
CDr1BliIATION APPLlCATION/PERMrT
EilERGY SOURCES:
Heat Electric Heat
Hater Heater Elect
Ranqe
.INFORllATION LINe
726-3753
Sq, Ftg, 1.lain
Ptmp.:q, Ftg, Access,
Sq, Ftg. Other
New Add Alter Rep,
-Fence Demo Change/Use
Other- -
CX>
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V1
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....,
I IrISPECTION L1IIE
726-l769
Job Address
1045 Gateway Loop
lsn N~~+h h~n S~rppt
Springfield, .Oregon 97477
Phone
Valu€.1)f Hork:
,,000.00
Built;ino Permit Info: Describe \'Jork{i-,e..
Family l1esidence I'lith j'l,ttached Garaqe)
Build Single
Owner AOL
Address
i?~!'v!_ ~es Inc
746-4311
Add Petitions and Restrooms to Existing
Building':.
Construction lender
Address
UeSIGil lEAn (name)
Primary John Amundson
Structural
Electrical
f1echanical
CONTRACTORS (name)
Genera 1 R. Milho11en
Plumbino Hunley Plumbinp;
Electrical 3-Way Electric
Phone
(address)
(lics.no.)
(eXf);res)
{chone no.',
(address)
f1 ics. no.'
(pxnirpc;)
(ohMP nn
~lechan; ca 1
PlUllBIrlG
ELECTRICAL
MECHANICAL
110.1
~IEach single fixture
I'Relocated building
(new fix. additional)
Is.F. Residence
(1 bath)
louplex (1 bath) each
IAdditional bath
I ~Ia ter servi ce
I Sewer
Istorm Sewer
FFf I CHARGE
5.00110,00
I
.Jl(l
FCC
CHARliE. ...lliL...1
FFLJ:IlAB.IiE.
SQ, FT.
furnace/burner to
BTlI' 5
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr rinrl vpnt
1
Temporary Construction
Change in existing
rpc:, i Qf'nrp.
multifamily, com. or
TnrltJc;.tr;ril
10f amps.1
I COm'I,1I NO. FEEDERS
IInstall/alter/relocate
rlic;trib. feeners
IOf 200 amps.
1
I
I
I
I 1
I
I
I
15.0q 1
Apoliance vent
SPDilriltp
Stationarv evao.
cooler ~ .
I Vent fan wi th
sinale duct
1 Vent syster.l apart
heatino or A.C.
IMechanical exhaust
hood ilnd durt .
1 Hood stove/heater
3.00
from
Install ductwork
for existing hea1
r'1.U11.fJ
4.50
10.00
17.50
I ISSUANCE OF PFR'HT
TOTAL CilARGES 10.00 I TOTAL CilARGES 15. O~ TOTAL CHARGES
WHERE STATE l1W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this
shall not be valii until the labe~ has been signed by an Electrical Supervisor and returned to the Building oivisi?n
I HAVE CAREFULLY EXM1INEo the completed aprlication for permit, 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 ac~ordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon oertaining to the work described herein, and that fIC OCCUPAHCY 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 ORS 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees "ho ~re i~ comaliance with or.s. 7(11.055. \'1i~1 ~ us on this prO.ject. J.7 ,_)
A.O.L.SerVlces.,Inc. v. r /",,-'"} );!'.......
HAt.1E(please print) SU-;iIATURFf." _ L.1:.....-.:'-L.~A""7'J:L~-'I DP.' - - -~,....
FOP. OFFICE USE orllY r}/;---"
c-4 i-I HR If
Zone Type/Const. Uni~s Sq. Ftg. Hain x . Value
Fire Zone11 Bedrooms Occy load Sq. Ft9. Access x Value
.l.. Jj-c cUL+U ) , uuu. uu
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
perr.lit
TOTAL V AlUA TI 011
BUILDING PERI.IIT
Charges anc
Surcharges
, Plan Ck, Comm/lnd
32.00 65%/Bl do Per Fee
----l..:~8"----Pian Ck, Res
lO%/Blde Per Fee
10.00 Fence
------:40----1 Demo
_ ___15-" QQ.._ __J Sidewalk
.60 I A/e Paving
L___L7_SQ_ I Curb Cut
I .70 ---,...- .
?o.Ro
'Syster.1s Development I
Charoe (1.5.,)
PlUI.IBING PERMIT
Charges and
Surcha rges
ElECTRIU.l PERI~IT
Charges and
Surcharges
Plan CheCK Fee Due.
20.80
77.48
Total Comb. Permit
11ECHAfll CAl PERI1 IT
Cha rges and
Surcharges
I
I
1 TOTAL
98.28
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COMBINATION APPLlCATION/PERNIT (CAP)
! .
I. Appl icant to furnish
A. Job Address
B. legal Description (
1. exa~ple- Tax Lot 100. lane County Map Ref ~,
II 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
Sprtngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examo] e- hea t/ e 1 ectri Cd 1 eei 1 i ng/or force
2. examole- waterheater/electrlcal/or solar (
E. Square rootage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foe
2. example- if new project, check-new - if (
check add. ete.
F. Building permit information:
1. example - construct single family house ~
attached garage
2. examole - remodel existing garage into fc
3. examole - convert single family residencE
restaurant (change of use)
G. Value of work as defined in Section 303 (a) e
Structural Specialty Code
H, DES I GN TEM! ArID CONTRACTORS
To avoid design or construction delays, Buile
Division Staff must be able to contact apprOf
persons regarding design information or job ~ (
corrections. etc.
II. Abbreviated Plu~bing. Mechanical. & Electrical S(
A. Except \'/here blank spaces occur in the descr'
portion of the Mechanical and Electrical Sch(
the applicant need fill-in only the No. Boxe~ 4J~
to the appropriate item(s) to be installed
B. Full Plumbing, Nechanical, and Electrical ScI
are available at the Building Division r
1. To conserve space on the permit form the \ec
have been abbreviated
2, If the item(s) to be installed are not CI
the abbreviated schedules you should con!
full SChedules (,
C, BUILDI1:G DIVISION STAFF WILL FILL OUT ALL FEI
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be deliv!
electrical contractor for signature by his e'
supervisor. The general contractor is not at
to sign the electrical label.
Applicant to sign and date
Whenever possible. the initial application will f
a \'lOrksheet only. Where possible, Building Oivi~
wi 11 prepare, a type written copy and return it tr
applicant at the time the actual permit is issuel
signature. (
IV. Fees and Charges ~
Plan check fees are due and payable at the time th- ~"_'
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable ~/hen the permit is issued.
CITY
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PERMIT VALIDATIDN
OF
SPRINGFIELD
(~
City Hall
Springfield, Oregan
Department of Public Work.
OFFICIAL RECEIPT
For:
L!"O} /'i
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( OmVfi
{ri - rOJe
Amount Rec.eived --I (j f
(
Received
pj)
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Date r;- Z jcPr1o. B 53890C
( Rec'd Fro",Bc:c.5CU\JJ:lto_6...:dU'lC C
(irAddres~n ~I U~r~, t5S _ c
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Ill.
V, FOR OFFICE USE Q;ILY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
II. .
Permit Clerk
\
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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:
name
LOHNE W. PLEGER
signature
~02<<0 C::V'~~a.---
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date
6-30-80