HomeMy WebLinkAboutPermit Building 1981-4-21
INSPEcnON LINE
726-3769
.
CITY Of SPRINGfIELD
COMBINATION APPLICATION/PERMIT
.
INFORMATION LINE
726-3753
IcP
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Job Address
4:38 Scotts Glen,
Lot 37
Springfield
ENERGY SOURCES:
Heat
Waler Heah!r
Range
Value of Work:
legal Description Block 3,
Lochaven Hobil(LHome Subdivision
own"Gene, Bernard Hiatt & Robert Cochran
$20,200
Sq. Ftg. Main
Sq. FIg. Access.
Sq. ftg. Other
_New _Add _Alter _Rep.
__Fence ._Demo_Change/ Use
XOth" bLtJ
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Add,,,, 663 W. Centennial Phone 741-1420
Sorin~field Or. 97477
Build;;'g Permit Info; Delcribe Work (Le,. Build Single
f~."ily Re,.dence With Attached Gorage\
Con,truction lender
Mnnilp nnmo 'S'ot&_H<r"\. cidev:l'r11,s
oorches. -sewer&ow~ter 0
Addreu
Phone
DESIGN TEAM
(nome)
(addreu)
(liCl. no.)
(expires)
(phone no.)
Primorv
Structural
Electricoi
Mechanical
CONTRACTORS
(nome)
(address)
(IiCl. no.)
(exp;rtnl
(phone no.)
PlumbinQ
Hiatt Bros. Investments
Chalkers Backhoe Service
Soringfield
Soringfield
Electrical
Ponaol;n ~locr~;~
C::p.:",i T'\ gf'i 01.-1
?G..=.fUl1"
741-1420
746-7867
7 L. 1 _ 1 1 8,';
General
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO. I
I
I
I
I
FEE
I CHARGE
I
I
I
Residence of
furnace/burner to
6TU',
I FEE
CHARGE I
i I
I
NO,
FEE
CHARGE
NO,
Eoch single fixture
Relocated building
(new fix. additional)
S.F. Re,idenco
(l bath)
'Q: ft.
New circuits, alteration,
or extensions
SERVICES
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sinqle duct
Vent sy,tem aport from
hooting or A.C.
I Mechanical exhaust
hood ond duct
I
Duplu (1 both) eoch
Temporary Construction
Additional both
Amps.
I
1/
I
I /
I
I
I
I
r
I TOTAL CHARGES
I WHERE STATE lAW REQUIRES that tho Electrical work be done by tho Electrical Contractor, the electrical portion of this permit shall not be valid until ,a
label has been signed by an Electrical Contractor and attached to the electrical panel.
Woter 'ervice
I
/0.001
I
1,(:/11"') I
I I
I
I
I
I I
;ilsiV I
Wood slavel heater
Sewer
Storm Sewer
FEEOEllS
I
I
In.tY) I
I
I
I
I
: Ie at Puma
Air handler to
10.000 CfM
M,U,
I
I
I
I
I
Amp,.
M.JJ." J..l",,'" uP
Air handler over
10.000 CFM
TOTAL CHARGES
ISSUANCE Of PERMIT
I n.oo I TOT At CHARGES
I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that 011 information hereon is true and correct, and I further
certify that any and 011 wark performed shall be done in accordonce with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permiuion of the Building Division. I further
certrfy that my registration with the Builder's Boord is.in full force and e#.ct as required by ORS 701.0.55, that if exempt the basis far exemption i. noted
heron, and that only subcontractors ~nd employees who are in compliance with ORS 701.055 will be used on this project.
Bosis for Builder's Boord exemp'ior"
NAME (please print)
"IGNATUR~
FOR OFFICE USE ONLY
DATE
zone-M.I4. ~.
Type/Canst
Bedrooms
c'.,ril"'.
'lnits
""'ccy load
"ccy Group
Sq. Ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
Value
x Value
Value
TOTAL VALUATION~/").qp
Fire lon'
Flood Plain
iB'NG PERMIT
Charges and M t H .
Surcharges ,
'2-1'1 vNIT';
PLUMBING PERMIT
Charges and
Surcharge,
,0'\ I Pion Ck, Comm/lnd
J./IJ./?/l 6S%/Blda Per fee
I Plan Ck. Res
_ 30%1 Bld~ Per Fee
I Systems Development
CharClG (1.5%1
'LL 30'0.00
ELECTRICAL PERMIT
Charge. and
Surchorgos
",'
,
_____---2S=00 Fence
l.fJD ~ . ~.P;"
:.- ,
_____-'-O.Ot;L Sldewolk LJtJ
I C/o lAIC Pavina
I Total Comb. Permit
93.:l 0
I\~,
SoD;>
MECHANICAL PERMIT
Charges ond
Surcharge.
I~.
Curb Cut l!)
;..
/ I. Ko
I
I TOTAL
-#394,.;'0
PcU.d 6. ~ ~5ftJ33c;
~OMBINATlON APPLICATION/PEe (CAP)
I. Applicant 19 furnish
A. Jab Address
B. legal Description
1. example-tax 101 100, lane County Map Reference 17 03 43
2. example-lot 1, Black 3, 2nd Addilion to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example.heat/electrical ceilin9/or forced air gas
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1, example-1250 sq, foot house. 500 sq, fool garage
2. examole.if new project, check new-if addition, check
add, etc.
F. Building permit information:
1. examole.construct single family house with an Qttac~ed
garc.ge
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty'Code
H, DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Division
Staff must be able to contact appropriate persons regarding
design information or job site corrections, etc.
II, Abbreviated Plumbing, Mechanical & Electrical'Schedules
A. Except where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill-in only the No. Boxes adiacent to the appropriate
item(s) to be installed
B, Full Plumbing, Mechonical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
hove been abbreviated
2. If the item(s) to be installed are not covered on the abbrevi~
ated schedules you should consult the full schedules
C, BUILDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only, Where possible, Building Division Staff will
prepare a typewritten copy and return it to the applicant at
the time the actual permit is issued for his signature.
IV. Fees and Charges
Plan check fees are due and payable at the time af the application,
and no plans will be processed until these fees are paid. All
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:
Additional Project Information:
PLANS REVIEWED BY:
naml'"'
",ignature
A~
. PERMIT VALIDATION
" "" I
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Permit Clerlo-
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date 4/-::? / ~ f( /
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