HomeMy WebLinkAboutPermit Building 1981-4-22
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INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Job Addre"
1 08.L~o.s.taLW~ v
Legal Description 17-03-22-2
Tax Lot 2603
I
I
I Owner
I Addren
I
I Construction lender
f' I Addreu
C 1 DESIGN TEAM
.k: I Primary
'"""I
v Structural
'@IIEI.<ld<el
Mechanical
.:)-1 CONTRACTORS
Sj General
J(.
I Plumbina
I Electricol
n,
~ Mechanical
C
~
State Farm Mutual Automobile Insurance
One State Farm P1 aza (~Q~) 62~6.8.1?
B10ominatan. Illinois 6170.1
Each sinRle fixture
Relocoted building
(new fix. additional)
S.F. Residence
(1 balh)
Duplex (1 balh) each
Additional balh
Water service
"wner
Phone
(name)
(addren)
ENERGY SOURCES:
Heat_g;:lC fllV''larg
Wafer Healer ---9 a ,c::.
Range ~a.
Value of Work:
INFORMATION LINE
726-3753
Sq. Ftg. Main ~t1.UJ.1
Sq. Ftg. Accen.
Sq, Fig. Olher
X_New_Add_Alter_Rep.
_hnce_Demo_Cf'lange/Use
_Other
$386,134.0n
Building Permit Info: Describe Work (i.e,. Build Single
Familv Residence With Attached GQroael
Tn~~ance C1aimS-Of~ice-
(lies. no,)
Tl.linois'"
(lies. no,)
ELECTRICAL
I FEE
CHARGE NO.
(Xl
~
o
N
~
(Xl
(expires)
II1E:!
(phone no.)
MmUnOSOn ASSOC'at
(503) 746-S2.J.1
1 Q8Sl
(expires)
MECHANICAL
~
furnoce/burner to
.1.nl)",OO(\_BTU"
Appliance ...ent
separate
Stationary evap.
cooler
Vent fan with
single duct
I Vent system aport from
1 heoti"g or A.C.
r Mechanical exhaust
hood and duct
I Wood slo...el heater
I Hoot Pumo
I Air handler to
10,000 CFM
I Air handler o....r
10.000 CFM
(ahone noJ
687-8Dn7
FEE
I CHARGE
Don R. Tenbrook
SDrinofie1d Plumbino
A & M E1 ectrir:
" r NO.
117
'1"1
c
C
,c
If;1
I
..51 60' Sew", 10.00/1 OOlf
l'':;~ I'
11030 Storm Sewer
(.1 I
eel I
I I
,21 I
'I I
~ I ~
~I TOTAL CHARGES
~ I WHERE STATE lAW REQUIRES that the EI.ctrical work b. done by the Electrical Contractor, the electrical portion of .his permi' sholl not b. valid un'il a
lab.1 has bMn signed by an EI.ctrical Contradar and attached to the electrical panel.
I
.Q
,~
ct
Dean F. Hilfinoer
same
same
4nnLMpara Rln9' R1.
'--. ft.
1n.nr.
50.00
25.00' 50.00
11 0 . 00
1
3
1
I condensino units
I unit heater
loas DiDina
?..OO- l.a...oo...
I
I ~ nn
14.50
I
I
I
I
I
6. Oop 8 . DO
16.00
12. DO
10.00
61.50
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby cortify that 011 information hereon is true and COrrect, and I further
certify that any and all work performed shall be done in accordance with the Ord;nonces of the City of Springfield and the Lows of the Stote of Oregon
pertaining to the work d.scribed herin, and thot NO OCCUPANCY will bl) mode of any structure without the permission of the Building DI...ision. I further
certify that my registration witn the Builder's Board is in full force and effect os required by ORS 701.055. Jha' ., .... the bosis for exemption is noted
heron, and thot only subcontractors and employees who are in compliance with ORS 701.055 will b. u~edon this project '
C;:lmg
(nome)
(address)
Eugene.
Oreoon
8eamer
PlUMBING
FEE I CHARGE
~.n( R~.nrl
I
I
I
I
I
NO. I
Residence of
New circuits. alterations
or extensions
SERVICES
1
1
Temporary Construction
Amps.
600
10.0C
110.0C
FEEDERS
2
Amps.
225
I
I
I
I I
205.001
TOTAL CHARGES
NAME (pleas. print)
Balis for Build.r's Boord exemption-
lon'
Fire Zone
Flood Plain
C-4
n.a.
BUILDING PERMIT
Chorges and
Surcharges
PLUMBING PERMit
Charges and
Surchorges
ELECTRICAL PERMIT
Charg.s and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
ISSUANCE OF PERMIT
TOTAL CHARGES
V.. R.. T~-O\...1 Gtl.-r... ~SIGN':.rU'E--C
. . / ~-
fOR OFFICe; U~1: ut'tL'V
<- .d
DATE ~ -2..'---6'1
jype/Const.~ Unih
:o.edrooms I"'Iccy Load
O::'orie- 1 'Occy Group --B.:.?
669.50 Plan Ck. Comm/lnd
65%/BldQ Per Fee
26.78 Plan Ck. Res
30%1 Bldi=l Per Fe.
;>n~.nn fence
R" ?n Demo
11 O. 00 Sidewalk
4 4n AI C Po...in"
___..9.1...!.-50 ___ Curb Cut 2
? A~
Sq. Ft9. Me;n --980(\
0::--:. Ftg. Accen
Sq. Ftg. Other-J>a.v..inS
435.18
111.0n
20.00
x
Value
Valu.
Val.. .J~3!l.6..1lO-
x
x
TOTAL VALUATION
Sysfems D.....lapment
Charae (1.5%\
Total Comb. Permit
TOTAL
11,7AA
1RIi,114
00
nn
5.792.01
1.24D.R4
7,468.03
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
2 A. Jab Address
~ B. Legal Description .. .. '"
~ 1. example-tax lot 100, Lane County Map Referen
" 2. example-Lot 1. Black 3, 2nd Addition to Springfi,
C. Name, etc. of owner and construction lender.
D. Energy Sources
1. example-heat/electrical ceilin!l/ar farced air!la
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example-1250 S4. faat hause, 500'sq. fOat gara!
2. example.if new project, check newaif addition, c
add, etc.
" F.,.: Building permit information: .
. 1. example-construct single family house with on c
garage
2. example-remodel existing garage into family rc
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 {oj of the
Structural'Specialty Code
H; DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oi
Staff must be able to contact appropriate persons I
design infurmation or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & ElectricalSched,
A. Except where blank spaces occur in the description
of the Mechanical and Electrical Schedules, the apl
need fill-in only the No. Boxes adiacentta the app
item{s} ta'be installed
"B. "full Plumbing, Mechanical, and Electrical Schedule
are available at the Building Division (
1. To conserve space on the permit form the sched
have been abbreviated
III. Applicant to sign and date
Whenever possible, the initial application will be used-
worksheet only. Where possible, Building Division Stal
prepare a typewritten copy and return it to the applicl
the time the actual permit is issued for his signature.
IV. fees and Charges
Plan check fees are due and payable at the time of th,
and no plans will be processed until these fees are po
"" ,"ather fees and charges are due and payable when th,
is issued.
'y. FOR OFfiCE USE ONLY
PROJECT CONDITIONS TO BE SATISfiED BEfORE OCCI
1.
2.
Fire DeoArt~p~t Final In<nprtion RPQ
Site Plan Review Final Inspection He
Additional Project Information:
PLANS REVIEWED BY:
nam,..
Lorne Ple~er
':ignatur,.,. .
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CITV OF SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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Date
r' Rec'd From Q. e
: '"
Address 'Sf) .? 0
IK ~t\(l
Received Far:
No. B
1981
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S6351(
c
hn
m({)q.50
20.78
d ()!)". 1)0
~. R.d()
II (). no
Y.40
({Jr, 50
::;'.'-1(0
C ~()J)I nq l'~'?" ()O
(1 .1 .1 r-b (f 11 tf) l1 \ rl. () no
/.' ~'4n RL/ If'
2. If the item(s) to be installed are not covered an C.. 11 rJ'
ated schedules you should consult the full schec .. ~'-_ I . j /tl . j 1 ../
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEE! C I T V 0 F S P R I N G FIE l'O' .
CHARGES ON THE SCHEDULES (
City Hall
Springfield, Oregon
Department of Public Works .
OffiCIAL RECEIPT
c.
L) -~a 198' No. B 56352(
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,~; Rec'd From, . k. . g Ilbf'COIC, I nee
Address.~c::S<O I j") IsJ N-,
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Received For:
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Amount Received
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