HomeMy WebLinkAboutPermit Building 1990-4-4
'1 INSPECTION LINE
1726-3769
.
CITY Uf SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
-, EIIERGY SOURCES:
Meat
I~ater Heater
.
tJ M- ~,. .-. _. -
Job Address
1477 Gatewav. Sorinefield. OR
Gas
INFOR/lATION liNt
726-3753
Sq. Ftg. Main~71 ~ ~
~q. Ftg. Access,
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other- -
.
1010 West 2610 South
S~lt Lake City. Utah
Constructio~ Lender
0%0,1'.' 4-<Due
Range
ValuE of Work:
$35.000.00
BuilriinQ Permit Info: Descr~be Work(i.e"
Familv nesidence With Attached GaraQe)
Build Single
~
02
legal Description S~ :lrt:lC'.hed warrantv deed
1!.1D~.Q M() () t4n()
'J.B.'s Restaurant, Inc.
Owner'
Address
84119-9990
Dinine room and cooler addition
..........
to the existine structure.
, ".
Address _ - . Phon~
OESIGN TEAI'I (name) --Taddre"l -
Robertson/Sherwood/Architects pc
Primary", 1:' E J _:'u JLt: T.'d. .....n n-rJ '"'1
7.,3, c. ~.;..::.. '9i~J .i _~ --o-u_, _., ...-.:,j
Structural John Herrick, 1684 Willamette. St.. Eugene.
Warner Engineering
Electrical
:UC4 :,-,...u;"~J :-:....:... :\J., :U5CUC, ~;-.. ::r74Z
fl ies. no.) {exniresl (ohane no.
1823 06-30-90 503-342-8077
OR 97401 5742 12-31-91 503-687-0129
8158 12-31-90 503-484-0620
Mechanical Lauch Mech. Enein.. 32373 Fox Hollow Rd..
CONTRACTORS I name I (addrp" )
General \\~~ 01'\7-10 'n\\l~iJL \~C~'d\~KW\~(rl
Plumbino ~ \N. ~~f'ffifuMU
EI octri cal ~ \ rtn \l)ll ftJ 1 ')
~'echanical \m~ ~ L'"
Eue.9740, J'101EPE l2-11-90 ,03-4R4-71Q,
(lies. no,) (pxo;res) (ohnnp nn \
'3S~DlD \Q ~Wlqn \~4;l(")i\1&
~\()~? (of;)4fq (
PLUI,IBING
ELECTRICAL
MECHANICAL
--1ill.:.1
FFF f,HARr,E Nn-"-
'IE-..cJiARliE. _Nn
t'~~ r.HARG.E..
I
Each Single fixture
Residence of
:7..-r...
SQ. FT.
I
furnace/burner to
?tI_~ BTU's
6,-
Relocated building
(new fix. additional)
~ Ne~ circu!ts alts.
orextenslons
"2~~6~
SERVICES
. :f.2.5Z:
Floor furnace
and vent
S.F. Residence
() bath I
Duplex (1 bath)
Recessed wall
Sn~cp hp~tpr ~nrl vpnt
I
I
I
I
I
I
I
I
TOTAL CHARGES /0$. /"5:.-::> TOTAL CHARGES ~-:sc:::> TOTAL CHARGES /Y'.lPJ?- /'3..---
WHERE STATE L,'I~ REQUIRES that tile Electr;cal work be done by an,'Electr;cal Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Storm Sewer
Of
amps,
/ kc~~~";"';"~-=<,
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi thO
s;nole duct
Vent system apart from
heatina or A,C.
Mechanical exhaust
hood ilnd duct
c..~
each
/'-
,
Additional bath
Sewer
Temporary Construction
Change in existing
rpc:, i dprH~p
multifamily, comm. or
Tndu",trial
~Iater servi ce
COMM./IND. FEEDERS
Install/alter/relocate
tii<:.tl"'ih f......rl...l"'<:.
Wood stove/heater
Of
amps.
~-~ ~~,.
,:s- /'. 44,. "-_'"
:<-......
a~TA'/~ ~~~,~~
~ ~~/.v ~:h.....~,,/=
~/r
ISSUANCE OF PFR!IIT
I HAVE CAREFULLY EXNlINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPArlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 wil be used on this project,
NAflE(please print)!.u.1Jfil:iVlCP W. :]":AJj}((?f SIGflATU (V. ~DATE cf-/Cf/qo
-FO~ OFFICE USE ONeY
Sq. Ftg. 11ainJ;~f~ ~ x~~~~Value
Sq. Ft9. Acces~u'_ _c.~-'/? Value
Sq. Ftg. Other x Value
_ )~QhCJ() TOTAL VALUATlON~_-
'J\ f'\ U'"6,...~^ LISyste. ms Development
ffi......I. \Ll~' J-'-tharqe (!.5~) , 5z:5: -
Zone
.c:.t;
Tyoe/Const. ~~
Bedrooms
Units
Occy Loa~ ..y<-
Occy Group~~~
Fi re Zone
Flood Plain
Stories
/
BUILDING PER/lIT
Charges and
Surcharges
Plan Ck. Comm/Ind
_ _ "7/.5::::::?:!2 _ _ 65%/Bl do ~pr Fpp
Plan Ck. Res
30%/Blde Per Fee
PLUllBING PERMIT
Charges and
Surcharges
/.0_ .?l!>
----~~-
_7.5
Fence
D~mo
I
I
ELECTRICAL PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
'Sidewalk
A/C Paving
_ n _ /~ ':":"n Curb Cut
_ 75"'
ITotal Comb, Permit
"2<)? ~
I
I TOTAL
7..8:2. 7!B
.
.
.
-
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examp.le- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc, of owner and construction lender
D. Energy Sources
1, example- heat/electrical ceiling/or forced air Qas
2. example- waterheater/electrical/or ~
E, Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F, Building permit information:
1. examole - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examole - 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 avoid design or construction delays, Building
Oiv;~;on Staff must be able to contact appropriate
persons regarding design information or jab site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Eleetrical Sehedules
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 sehedules
C. 8UIlDING DIVISION STAFF WIll FIll OUT All FEES AND
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. ---
Ill. 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 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.
I"
~?^ ~llqqo
I (0 (00 q
V. FOR OFFICE USE ONLY
Permit Cl erk
MJ)Q
)
---
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
"
,.
Additional Project Inform?tion:
PLANS REVIEWED BY:
. name' kN#,z j;;..~';;-/f'
~ ~-~
5 i gna ture z _ ~ - ~J"':>
r/ ,,.,
date2 -/';? -"7 c>
,