HomeMy WebLinkAboutPermit Building 1988-6-29
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ValuE of Work
$60,000
BU1]c,lnCJ Pel
Fan11v nesld
lNFORlIATION LJlk
726-3753
So Ftq rlaln
~CJ t"t!) Access
Sq Ftq Other
Hew AddX Alter nep
--Fence Demo Change/Use
Other - --
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11l1SP~CT101I L1I1E
726?1"9
Job Address 1800 CENTI:NNIAL.
legal DmnPt,or\ ~()~ 'I ~ ~~
CI1Y UF SPRINGFIE,D
COHBlIIATION APPLICATION/PERMIT
EnERGY SOURCES
Heat
l~ater Heater
Owner
SPRINGFIELD
~'1N'\
Address
MCKENZII:-WILLAMETTE HOSPITAL
Phone
Construction lender
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UlS tGTl IE^"
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Str1Jrtural
THE AMUNDSON ASSOCIATES
(name)
Phone
(address)
Electncal
'1ectTanlcal
COIlTRJ\CTORS
Oescrlbe Work{l e . BUlld Stngle
Lh ~ttached r.araoe)
RENOVATION AS TENANT IMPROVEMENTS
FOR CI:NTENNIAL SQUARE- OFFICE AND
ADULT DAY CARE.
(11C5 no)
(exolresl
(ohane no
SPRINGFIELD.
200 S. MILL ST.
P,UllBHlG
fixture
Relocated building
(new f,X addlt1onal)
S F Pesldence
- (] b'thl
-_. Ouplex (l bath) each
___ Additional bath
(name)
(addrp'ic;)
746-8231
_4 )), \ {,S-I~
(11r.0:; no)
(p)'F)lrpC; \
(ohnn!' nn
General MCKENZIE COMMERCIAL 865 W. 2ND EUGENE 45539
Pl~,no TWIN RIVERS 2050 W. BROADWAY, EUGENE 20-96PB
Elie~m'l C & S ELEC. 2140 CENTENNIAL BLVD EUGENE 20-14C
flecm'nical HARVEY & PRICE 2015 NUGGET WAY EUGENE 77
r.g:r
("\ Each single
~c
,
1--- "'ater serVlce
t
~ Sewer
- Storm Sewer
ELECTRICAL
FFF CHARGI=' Nn
1 ";() q(iC Resldence of
So FT
New ctrcults alts
or extenslons
"- SERVICES
7-21-89
6-1-89
10-1-89
10-1-89
343-7143
683-1414
344-2236
746-1621
MECHANICAL
:rLJ:tlAE!i.E ..1!O
I
furnace/burner to
B1U's
I 'IL 1.QlABJiE.
22.~
Floor furnace
and vent
Recessed wall
~o~rp hp~tpr ~n~ vpnt
amps
.,"6
V7V
ApDllance vent
seooarat~
Stat10nary evap
cooler
Vent fan W1t'"
sin(]le duct
Vent systeM apart from I
heat1na or A C
Mechan1cal exhaust
hood tlnd duct.
Temporary Construct1on
Change 1n eX1stlng
rps 1 tteJ'll"'P
mult1famlly, comm or
TndlJc;trlal
Of
COMII II NO FEEDERS
Install/alter/relocate
ri1c;trlh fppdpl"'C;
Tyoe/Const
Bedrooms
Stones
'G\.\
Units
Occy load
Occy Group
Of
\Iood stove/heater
/..;) 1 \ 1').~(,1 1..1)-
~,;f?, Yl1
I ISSOANCf OF PFR'lIT
TOTA, CHARGES C\Cl I.d:) . TOTAL CHARGES ?? '8::> 1 TOTAL CHARGES~\h"\:),~U:-\ \ SGD
WHErE STATE l ,\~ REQUIRES that the Electncal work be done by an Electncal Contractor, the electncal portlon of'thlS pem1t
shalt not be val1J untll the label has been slgned by an Electr1cal Superv1sor and returned to the BU1ldlng DlvlSlon
amps.
I HAVE CAREFULLY EXN1IN[O t~e completed apnlication for ryermlt, and do herebY certify that all info~atlon hereon lS true
and correct. and I further cert1fy that any and all work oerformed shall be done 1n accordance wlth the Ord1nances of the C1ty
of Soringfleld and the laws of the State of Crenon oerta1nlng to the work descnbed hereln. and that no OCCllPArK'f wlll be made
of any structure wlthout the pcrm1SS1on of the GUlldlng 01vision I further certify that my reqlstratlon wtth the BUllderts
Goard ts in full force and effect as requlred by ORS 701 055, that if exempt the basts for exemptlon 1S noted hereon. and that
only subcontractors and enployees who are in comollance wlth OPS 701 055 w1ll be used on thlS prOJect
1IA1-[(please print)
Zone (' ('
Ftre Zone
Flood Plain
-
BUILDlIIG PERmT
Charqes and ""\
Surcharges oJ...
PLU'~B I NG PERMIT
Charges and ~
Su~charges ::::>
ELCCTRlcn PERl'n
(' J r'Jes and u
:: _ (. 'arges -,
.: ~ANICAL PEPMIT
Charges and (
Surchar~es ~
S I GilA TURf
FOP OFFICE USE DIlLY
So Ftg l1aln
Sq Ft9 Access
Sq Ftg Other
\
~~-
ni
Con'nr1I nd
PJ'r Fpp
Res
Per Fee
"':l.. \ r CJ:::) Plan Ck
_y~lC2_______ 65tlBldo
\ '" '1>C;J Plan Ck
oJ. 30ttBl do
__:\.Q_~~___ Fence
"-\ ~3
r'(. '1 So
----\-\~----I AlC Paving
___~'9-,.??___-' Curb Cut
4 /5 I
I Demo
I Sidewalk
DATE
x Value
x Value
x Value
TOTAL VALUATlDrI
'20 3 <.fs
/t()5' '-2 ,..JSystens Development
I <0 "" O~Charoe (J 5<)
I
I
I
I
ITotal Co~b rermit
I
I TOTAL
\.)l~
I
I ~ (k. ~ \ _ I
~-~
1.
115
~ II
1
- 1
,
,
,
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COMBINATION APPLICATIONIPERMIT (CAP)
III
Appl1cant to furn1sh
A Job Address
B legal Descrlpt10n
1 example- Tax lot lOa, lane County Map Reference
1/ 03 43
2 example- lot 1 Block 3, 2nd Addlt10n to
springtleld Estates
C Name, etc of owner and constructlon lender
o Energy Sources
1 example- heat/electr1cal ce1l1nq/or forced a1r Qa5
2 examole- waterheater/electrlcal/or 501ar
E Square footage or valuatlon, etc -----
I examole- 1250 sq foot house. 500 sq foot garage
2 example- 1f'l1ew proJect, check-n€w - lf add1t1on,
check add, etc
F BUlldlng perm1t 1nformat10n
1 example - construct slngle fam11y house w1th an
a ttached garage
2 examyle - remodel eX1st1ng garage 1nto famlly room
3 examyle - convert slngle famlly resldence lnto
restaurant (change of use)
G Value of work as deflned 1n Sectlon 303 (a) of the
Structural Speclalty Code
H DESIGN TEAM ANO CONTRACTORS
To avo1d des1gn or construct1on delays, BUlldlng
01vlslon Staff must be able to contact approprlate
persons regardlng deslgn lnformat1on or Job slte
correct1ons, etc
Abbrev1ated Plumb1ng, Mechanlcal, & Electrlca1 Schedules
A Except where blank spaces occur ln the descrlptlon
port1on of the Mechanlcal and Electrlca1 Schedules,
the appl1cant need f111-1n only the No Boxes adJacent
to the approprlate ,tem(s) to be lnstalled
B Full P1umb1ng, Mechanlcal, and Electrlca1 Schedules
are avallable at the BUlldlng Dlv1510n
1 To conserve space on the permlt form the schedules
have been abbrevlated
2 If the 1tem(s) to be 1nsta11ed are not covered on
the abbrevlated schedules you should consult the
fu 11 schedu I es
C BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
D As noted on the CAP, the label must be del,vered to the
e1ectrlca1 contractor for slgnature by hlS electrlcal
supervlsor The general contractor 15 not authorlzed
to 51gn the electncal label -
Appllcant to slgn and date
Whenever posslble. the lnltlal appllcatlon wlll be used as
a worksheet only Where posslble. BUlld1ng D1vlslon Staff
wlll prepare a type wrltten copy and return It to the
appllcant at the tlme the actual permlt 15 lssued for hlS
slgnature
Fees and Charges
Plan check fees are due and payable at the tlme of the
appllcat10n, and no plans w1l1 be processed untll these
fees are pald All other fees and charges are due and
payable when the permlt 1S lssued
IV
V
FOR DFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY.
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PERMIT VALIDATION
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PermIt Clerk
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Permlt appllcant exempt from reglstratlon wlth the BUIlder's Board because
AddItIonal ProJect InformatIon
PLANS REVIEWED BY
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slgnature~
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