HomeMy WebLinkAboutPermit Building 1980-8-20
I- I;~ ri nt.. i-:J
CITY OF SPRlilGFIELD
CGrlBHlATION APPLlCATlOII/PERMIT
EilERGY SOURCES:
Heat 01 o,..t-.,..."',.,.
!.Iater Heater elec tric
Ranqe p.lp.c-,t,.;"
ValuE of Hark.:
CONST., INC. 70,234.50
P~one'/~b-b,t"Bb!il(,:lnq Permit Info: Describe Hork(i..c.,
Familv f1esidence Hit.tt Jl..t.t.,,<:.h~d r,araop)
lIIISPECT.lOII L1IIE
726-3769
.
Job Address
633 Polbva
lot #19 TJKE
VILLAGE
Legal Description
Owner'
Address
GREG'S ELECTRIC &
1465 OKSANNA ST
SPRINGFIELD. OR. 97477
Construction Lender FIRST NATIONAL :lANK OF ORE GON
Add Main St. Spfld. '/26-L ~O~
ress Phone I
ut:::I1l:irl rtNl (name) (address)
.
-I
.-,
-,
2?. .~
INFORlIATlON LINe II
726-3753 \
Sq. Ftq. 1.lain 1itf~
~q. !='tg. Access. (
Sq. Ftq. Other
lie" Add Alter ~ep.
--Fence Demo Change/Use
Other- -
.y)
....-~.
.
(-
"
S.F.RES., ATT GAR - Woodstove
Build Single
1.:..-<]
,~.
I ~
..J
Primary DRA.1n~rr SER'rICE. INC. '59 COUSURG ED
Structural
Electrical
!1echanical
CONTRACTORS
(namel
( addressl
General c;rCl~lc ~::'..S-=::':":'''2 -E:~=~
Plumbino CONTRACT PLTJH3ING 2038
Electrical Greg I S Elec t. & Cons t.
ROLF HEATING CO. 8~805
~lechani ca 1
111 he:: f'o1....c "'I 1""l"" "'I
N. 2nd
1465' Oksanna
Lost Ck.
PLUI1BIrlG
ELECTRICAL
NO. I
I FEE 'CHARGE Nn
Each single fixture
Residence of
1 '7?n sq. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
1
S.F. Residence
(j bath)
Duplex (1 bath) each
I
J1...
Temporary Construction
Change in existing
re~; d~.rlce
multifamily, comm. or
Inrluo:;trial
25.00
SERVICES
1
Additional bath
10.00
~Iater service
Sewer
Storm Sewer
IOf
I COI~.1. /I NO. FEEDERS
IInstall/alter/relocate I
rlic:.trih. fppdpro:;
Of amps.1
I
amfls.
TOTAL CHARGES
WHERE STATE L,\W REQUIRES
shall not be vali~ until the
Zone
R-l
Units
Occy load
Occ'y Group
V-N
3
1
Tyoe/Const.
Bedrooms
Stories
Fire Zone
flood Plain
NO
R-3
'.
BUILDIlIG PERHlT
Char,;cs an;;:
Surcharges
. Plan Ck. Corran/lnd
65~/Bldo Per Feo
Plan Ck. Res
30%/81 dQ Per Fee
Fence
Isystems Development
Cha rce (J. 5~)
_7~~[) 5:~7:-?rQn -
229.00
9.16
35.00
PLl.:!~8I~IG r(R~-l1 T
ChJr'}cs Jnd
$urCI'lJrgcs
(lies. no.)
(lies. no.)
(exoires)
(ohone no.
6e7-0293
(p)(nirpcd
(ohnnp nn.
8e65 6/2V81
20-114
20-2(5
2024
t ~n' I rI-lAR(:1=' NO.
25.0.0 1
~I
I I
I 14
I
6/19/81
b/ jO/(51
12/15/eo
n6-6404
746-0220
726-6404
937-2688
MECHAN I CAL
furnace/burner to
100.000 BTU' 5
,
I 1='1='1=' I r1UI.l:U~1=' i
I
I
I
I
I
I
I ISSUANCF OF PFR!lIT
35.00 I TOTAL CHARGES 35.00 I TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of this
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1WED the completed application for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all \...ork oerformed shall be done in accordance with the Ordinances 'of the City
of Springfield and the laws of the State of Ore(]on pertaining to the work described herein. and that IW OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Guilder's
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project.
HA:.IE(please print) GREGORY SCHP~"fKYN SIG;IA~.h ~ D~TE 8/20/80
Fn" O<>I(C IISF 0:11 Y 47 4' , ,
.... '._ ___ _. , - w _".,.,_
1 Sq. Ftg. Ilain 1720
Sq. Ftg. Access 495
Sq. Ftg. Other
6.00
1
1
I
I
I
Appliance vent I
s'POil.riltp
Stationary evap. I
cooler
I Vent fan wi th 3.00112. O(
sinole duct
I Vent system apart from I I'
heatina or A.C.
I rlechanical exhaust I
hnnd ilnd rlurt 4 1:)(-
Il'IO~~ stove/heater I S.OC
I
I
I
Floor furnace
and vent
Recessed wall
SOilrp hPntpr nnd vpnt
10.00
37.50
perlilit
x38.10
x 9.10
Value65,532.00
Val ue 4.102.50
x Value
TOTAL VALUATlOlI'O, ~J4. ~O
1,053.50
(LECT~IC,~.L i'[Rr~IT
Ow r'1e.. tlnd
SUrChJrc;es
I
19.121
ITotal Comb. rermit
1. 40 , ecmo
c:50C~ I Si~~~alki9-l.li3-'-
- -/--Cc.,"E4I'---1 A/~'~avin9 .---
37.50 IC~rbCut 18'
,- - - - - -1.: 5"0---'
MECIl~'lI C.\l PEP.'11T
Charrte.. tlnd
Surctlollf'jl!S
11.80
381.48
TOTAL
1,435.00
.. ..
.
COMBINATION APPLiCATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Ref,
11 63 43
2. example- lot 1. BlocK 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam.l?le- heat/electrical ceilinq/or forcec ~
2. examole- waterheater/electr;cal/or s~
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot
2. example- if new project, checknew - if de (fa
check add, etc.
F. Building permit information:
.1. example - construct single family house wi
attached garage (
2. examole - remodel existing garage into fan
"3. examole - convert single family residence
restaurant (change of use)
G. Value of work as defined in Section 303 (aJ ot ~
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Build:
Division Staff must be able to contact appropr t;
persons regarding design information or job si
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Scl
A. Except where blank spaces occur in the descrir f..'
portion of the Mechanical and Electrical Schec ~
the applicant need fill-in only the No. Boxes
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schf t;':)
are available at the Building Division
1. To conserve space on the permit form the ~
have been abbreviated
2. If the item(s) to be installed are not CO\ to
the abbreviated schedules you should conSl \t~
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEE~
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delive,
electrical contractor for signature by his ele
supervisor. The general contractor is not aut
to sign the electrical label. ---
Applicant to sign and date
Whenever possible. the initial application will bf
a worksheet only. Where possible, Building Oivisi
will prepare a type written copy and return it to
applicant at the time the actual permit is issued
signature.
IV. Fees and Charges.
Plan check fees are due and payable at the time of 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.
Ill.
V. FOR OFFICE USE ONLY
.
,-
(
PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
(
.
()
()
_ rJONO. B 5 4 4 0 2 0
Dale A - l5 1 ~() , .
Rec'd Fro~1Y ro/), yO Oft t. ((n,'Y:~' 0
Address I ~(o~(Y)~.sannQ. 0+
Received For: FR "2-2-0.CO
4016 (J/ I?J
pp ?)5.0C)
40J fJ ) ,4d
Y'j) L~.OO
t1(97D 1.00
Ivlr fin ?)I.50
J.CSO
.c;JJ! G(~ i 3' c::.
( ,~?~
Sd {./ /{)~3 EO
G:r Amount Received
1,4 ?4 ,~P7 ()~
(I,D
I "UTHO!lIZED SIC"."TU!l1[
.NE~TO".TU'''..U~L ~""<TUI$ . EUGl"E 0" .7.0'
(
\..
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
I
I
I
J
Permit applicant exempt from registration with the Builder's Board because:
Addi ti ona 1 Project Infonnati on:
PLANS REVIEWED BY:
name
signature
date
0
0
0
i
0 ~
~
0
0
(I
(I
(I t
-~
j
a
n
:'j
,f
--
...4 .