HomeMy WebLinkAboutPermit Signage 1987-11-13
CITY Of SPRINGfiELD
COMBIIIATION APPLICATION/PERMIT
EilERG'LSOURCE5..:. A
Heat Elec. L .
Ilater Heater --21"",,-
Ran~e
'J
tt.'
I INSPECTION LINE
726-3769
Job Address ~-;J75 Gateway St.
Lega 1 Deseri pt i on See attached
l~r5_ ~"'7'44.N L:;h.t,W7~<::/A1-I!:.~Ar..
Owner Chevron U.S.A.
Address 1301 5th Ave.. R=m 2900
Seattle. WA 98101
Phone
Construction Lender
Address
Ut:.~l(jN II:.Ar.'
{nameJ
Phone
(address)
..
INfORlIATION LI'," '
726-3753
Sq. ftg. 1.lain 90B
~q. Ftg. Access.~A
Sq. Ftg. Other
X flew Add Alter ~ep,
-Fence Demo Change/Use
-Other- -
\)()
'J
~
~
I~
I
ValUE of Hork:
$500,000
Builoina Permit Info: Descr,be Work(i~e.. Build Single
Familv I'lesidence Hith I".ttached Garaae\
ConstIuct a new autorrobile fuelina
facilitv with a ronvenience store
(lics. nn.
I
(ohane no.
( exo;res)
Structural
Primary Billy Ray Strite, Architect P.A. 2660 Grover Court
Boise, ID 83705
6-30-88
Temporary Cons~ruct;on
~~:i~:~~~~J~~!~~~?~~~
mult;fami'y~or
Tnrl,,"triitl
COffi1./IND. FEEDERS
Install/alter/relocate"
rlic:.trih fpprlpl"c'
Electrical
Mechanical
CONTRACTORS
Inane'
(address)
Genera 1
Plumbina
Electrical
Hechanical
PlUllBlNG
-.llih
. Each single fixture
17
Relocated building
(new fix~ additional)
FEF CHARr.F Nn
Residence of
7.:)~ t27.~
New circuits alts.
or extensions
S, F. Resideme
(] bath)
Duplex (1 bath) each
SERVICES
Additional bath
g;r:/ Water service 75.'.
~ Sewer 7'~~
, q'f.j Storm Sewer ~-
/ /;3?J~A-7/""N'~";'~' 7.5<:::
/gAC.....~'o~.../CF7.">&
I
I
Of t.,<'t:>O
I
/
Of -;;::'2:5"
(:2S
TOTAL CHARGES
:::33''7. Sa TOTAL CHARGES
;;t6 y 58
WHERE STATE L'\~ REQUIRES that tile Electrical work be done by an.'Electrical Contractor, the electrical portion of this pemit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
1983
(208-336-8370
l1ies. no.)
(~xnirp,,)
(ohon~ nn )
"
ELECTRICAL
MECHANICAL
I:IL J:HARIiE. NO
I
furnace/burner to
'-;;>4.= BTU's
,
~. c>C
ccc
ru'JlG.E.
SQ, FT.
(
Floor furnace
and vent
Recessed wall
Sn~rp hp~tp~ ~nrl vpnt
amps.
Appliance vent
seoarate
Stationary evap.
cooler
/' Vent fan wi th
(L) sinolp rlu("t
Vent system apart from
heatina or A.C.
I Mechanical exhaust
hoorl ~nrl rjll(.t:
I I Hood stove/heater
157-9' 5' I~/R o/.m:F7Y. I
~-~ 1 I
I 1 I
I
/::27.50 TOTAL CHARGES
/Sl
1
1>?-:2
1
5'", l/il-
I
I
f-z .)0
I
I
amps.
ISSUANCE OF PFR!IIT
, I HAVE CAREFULLY EXM1INEO the completed aprlication far permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all _wo~k De~formed shall be done in accordance with the Ordinances of the City
of Spri ngfi el d and the laws of the Sta te of Or~(]on' pertai ni ng to the work descri bed herei n, and that UO OCCUPArKY wi 11 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontr~ctors and employees who are in compliance with ORS 7nl.055 will be used on this project.
IWIE(please print)
Zone C,c; Tyoe/Const. ~~N
Fire Zone Bedrooms
Flood Plain Stories I
\Jf,NATURE ___ ___ , DATE
FOr. OfF I CE USE OIlL'Y ,
So, Ftg. Ilain ~/L.p/n>::;,..X) Value :2 S-ce:::>. <>D,,"_-'-
Sq. Ft!J. Access x Value
e:.. /' -'"
Sq. Ft9. Other-",,/~ //?>'~V6'_ VaIue_":::~c..--.""""""
TOTAL VALUATION ~~,~.o-~"
Units
Oeey Load / '7
Occ,V Group ~-?
BUILDING PERHIT
Charges and
Surcharges .
2 --?/l c-o Plan Ck. Co","/lnd
___ Lc:::::-:-q-.:__ 65%/Rldo Pj'r Fpp
c<" Plan Ck. Res
~~_ -' ~ 30t/BIdo p.., Fee
____'737S9 Fe, nee
j ~_ ~.81 D~mo
1'27~5;::/ 1 S1dewalk 7'"/2.
- --- - - G~3-8-1 AIC Paving
;;6, 5" p 1 Curb Cut j=rs;/
------(~"jj-I
PLUt~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
'tPJ!l>-t?-a? lystems Development
~. 41<;" ir,LJ----;;: tharqe (1.51,)
I,.::,;",~,,'/'~ J>,,",
I"'"
1
7-s-" 6'""'. """"
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/~'? .v,/,~.::-":':-_
...... -~::: ./~ (" ?
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1
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1-
":"!.",;.:;::~..y/-,r.::
I
Irotal Comb. Permit I
72'03. 3'2.
7/-80
77". Sc>
/6. /.Y
l"9j.~
I
I TOTAL
"
93'37. (;,?
-
,-
..
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':.":7~}
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION,
I. Applicant to furnish
A, Job Address .
B, Legal Oescription
1. example- Tax lot 100. lane County Map Reference
II oj 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exa~le- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project, check new - if addition, .
cnecK add, etc.
F. Building permit information:
1. example - construct single family house with"an
attached garage
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. OESIGN TEAM AND CONTRACTORS
To avoid 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, & Electr;cal 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 adjacent
to the appropriate item(s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2, If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL DUT ALL FEES ANO
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The. general contractor is.not authorized
to sign the electrical label. ---
III. Applicant to sign and date
. ~henever possible, the initial application will be used as
a-worksheet only. Where possible, Building Division Staff
will prepare a type written 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 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. '
V: FOR OFFICE USE ONLY
I
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFOREOCCUPAtlCY': 1.55~-1"'d L c'
77?- '/0 T /~~C-"d.~
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~6/?,~r..;~/?/r./77 /~ ;7/c-CE/V~?'_ OK i.iS-gfS
Permit applicant exempt from registration with the Builder's Board because:
, . . ~ .
.... .
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..,Additional Project Information:
/:"
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'.,
PLANS ,REVIEWED BY:
:;name~R"",,~ .?2~~7?
si'gna~ure4""",,,: -.;:?..........:~ ,-'"' date //../3-2$?
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