HomeMy WebLinkAboutPermit Building 1991-1-30
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,nm~~mON LINE-q.r;"'2 / t$9r",,"w-.lCOHBlrJmNU~~m~m~~~ERMIT ~~~~~7~~ION LIN~
.. ..'.."".. ' , ' EIIERGY SOURCES: Sq. Ftg. f4ain 2.6% "f
" i~ob"Address N.E.C. Beltline Rd. & Gateway St. Heat-Elo~.d~ >>o~. Pl1rrp ~q. Ftg, Access, 1.8<;6
" !Legal Oescription (f}rP..~ ^ n f"\ ~_' . ) Hater Heater Rl prtri r Sq. Ftg,' Other
rl rH ) EI -t ' _X Ilew Add Al ter Rep.
,;. '1' - ~ DO \ () Range ec nc __ Fence Oemo Change/Use
~ d~IU~2OS0HOtl'!I, bt~g~2gg, O( 0 Other-
~,,' ("Owner 'Atlantic Richfield Co., c/o Barghaus,e,n Enf oan8qy-,...l.'j'5 ,000 '
~j , BUlfoino Permit InfO: Describe Workll,e., Build Single
ll1' iAddress 18215 72nd Avenue So., (206)'. 251-6222 Family Residence llith Attached Gar'!.oe'
" New ARea AM/PM Mini-Marfet C9nsist~~g ot a 2,655 sf
~.1 !:' Kent, Washington 98032 conven~ence store, a JL x 5ts pump ~sland,anoI r
'.~ IConstruction Lender N/A ~nu~~nHon~~l!~~k~~lN~w ~~!;~a~g~tg~l~~~ (~~g~ i-
r s~gns ~nclud~ng a new h~-r~se sign, I
:Address Phone
r jUt.:>J.t:iN It.Ar" (name) (address) ';1J~~~ no \ (exo1res\ ~k~n~ nn.- ~J
.' [primarv Barghausen Consulting Engineers 18215 72nd Ave S. Kent 012466-85 11/27/91 251-6222
" I Jane tollins (lOU'
~:.Stru~tural Chalker Engineers 950 S. Fawcett 11301 Tacoma, Wa 98402 13900 \~71!1~! 838-327?S-: 3)
lElectrical J & S Consulting Engineers 201 N. Hollyw()()~_~y 11212 Burbank;1~~5 E11075 6-30-91 841-( 303
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15 S. Grady Wy 11628 Renton 8206 12-31-91 (206) 235-5190
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: IHechanical Spurgeon & Assoc
_CONTRAcrORS Inamel
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, lGenera 1
': 'P;umbino To be selected
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, 'Electrical To be selected
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~ ?Mechanic'al To be selected
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To be selected
PLUlIBING
ELEcrRICAL
MECHANICAL
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ruJ\BG.E. .Jill
SQ. FT.
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furnace/burner to
<:/~ ..."..;.. BTU's
Floor furnace
and vent
i:t'L .t&B.G.E.
Each single fixture
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Residence of
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Relocated building
(new fix, additional)
S.F. Residence
11 bath\
Duplex (1 bath) each
New circuits alts.
or extensions
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SERVICES
, Recessed wall
C:l"\:l("O hllU+illolfO ;Inri IIillont
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" Additional bath
'; 11d Water service ;:i:>,o'"
~ 9&,' Sewer '25. -
~ ~ Storm Sewer I'I~-
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I ;>>" ' ISSUANCE OF PFRtm /et?.",
'1.; '(TOTAL CHARGES 'I'?P.~ rOTAL CHARGES rOTAL CHARGES !i~. $'0::,
lC' r ' WHERE STATE LAII REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit,
; jhall not be valid until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
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~ i' I HAVE CAREFULLY EXAMINED the compl~ted application 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 accordancewjth the Ordinances of the City
''j of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO',OCCUPAIICY will 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' ORS 701.055, .that, if exempt the basis for exemption h noted herepn" and that
,~ only subcontractors and employees'who'are'in compliance with ORS 701,055 will be used on this project.
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;.: lwiE(PleaSe print)a~ JUI.. &"'_4'.?S'f SIGNArURE~ $. ~ DArE 1-~t)-'7/
7" FOR OFFICE USFAlIILV "7~'" ..r;..c;>_~
Type/Const, 57V~ ~/\Jnits Sq. Ftg. Hain~ y Value.tf/?t?J.,~
Bedrooms Occy (oad "')"b .Sq. Ftg. Acces~ x Value -=3r ~
Stories / Occy Grou~">>-/Sq. Ftg, Other .~~alue 7.o_~ .\-
TOTAL VALUATlON-.:3~ e>t:;C,
1-'30-9/ ~z:r/9/~ ~
C"2<t> _0 Plan Ck, Conmllnd / Systems Development I ~..,L:!.-..
___tP-.'-'J2..___ ~/RJ.~o p.rr Fpp ~~ Charoe tl.5~l' '/.....~
U Plan Ck. Res
7/'?C> 30%/Bldo Per Fee
___Jl...3~~__ Fence
-:< J ..<;" ~ Demo
remporary Construction
Change in existing
I"'P~1tf~p
multifamily, comm, or
Tnrtlldl"'i"l
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6
Appl lance vent
H:':'~,rat,Q
Stationary evap,
f.nn]~!"
Vent fan with
~i~S'l~ l'iL'rt.
Vent system apart
heatinq or A.f..
Mechanical exhaust
hnn/'i ,:I n/'i Ifllrt
7(;)<> 9:' I>
~..... I$!~,p
Of : 600
amps.
from
COMH.lIND, FEEDERS
Install/alter/relocate
tfi~tl"ih_ f~jlotfjlo~~
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Wood stove/heater
Of
amps.
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, tBUILDING PE~IIT
I ~~:Charges and
~~'Surcharges
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"'] \PLUflBING PERMIT
~ ICharges and
;l>Surcharges
TELEcrRICAL PERIUr
:'Charges and
, ;;'Surcharges
-k ;,~., "6:\':"\~'
lid, " k,'ic~L PERMIT
, es'and
u...:harges
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S i dewlllk
'A/C Paving "?>"I'5. -.!!!> rotal Comb,
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- rOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B. Legal Description
I, examp,le- Tax Lot 100, ,Lane County Map Reference
1/ oj 43 :
2, examele-' Lot I. Block 3, 2nd Addition to
~prlngtjeld Estates
C. Name, etc. of owner and,construction lender
O. Energy Sources
1, examele- heat/electrical ceilinq/or forced air qas
2, examele- waterneater/electr,caJ/or ~
E, Square footage or valuation, etc, _ ,
I, example- 1250 sq. foot house, 500 sq. foot garage
2, examele- l1rinew project, check new - if addition,
cneck add, etc,
F. Building permit information:
I, exa~le - construct single family house with an
attacned garage
2, examole - remodel existing garage into family room
3, exame,e - 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'ANo CONrRACTORS
ro 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, & Electrical 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 avail~ble at 'the-Building Division
.. I, 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 OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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, -
HI. Applicant to sign and date
Whenever possible, the initial ,application will be used as
a 'worksneet 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,
PERMIT VALIDATION
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V, FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE 'OCCUPANCY:
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Permit applicant:exempt from registration with the Buil~er's\Board because:
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. Additional Project Information:
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PLANS REVIEWED BY:
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,~:,_-,"date 7-2&-9/
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