HomeMy WebLinkAboutPermit Building 1982-7-14
CITY Of SPRIIIGflELD
COtIBI ;IA T I ON APPLI CA TION/PERMIT
E!IERGY SOURCES,
Heat
\.Ja ter Hea ter
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IIlISPECTIOtI LIIIE.
726-3769
Job Address 3115 Industrial Avenue
Legal Description
~?-11-?1- nn7nn
TI
Ranqe
ValuE of Hark:
Owner Future Logging
Address 3114 Industrial Avenue
Springfield, OR 97477
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INfORlIATION UNt
726-3753
Sq, Ftq, 1,lain
~q. ~t9. Access.
Sq, Ftg, Other
)lrlew_Add_AI ter _~ep,
. Fence Demo Change/Use
Other - -
,1
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Phone None
$lP,(1{l(1
Buildino Permit Info: Oeser be Work(i..e.. Build Single
Familv nesidence With Attached Garaoe)
Construction Lender
One 10 Bay Truck Garaae 10 5' X 24
Metal Pole Building
Address
UESIGrl lEAl'
(name)
Phone
(address )
Primary
Structural Brackman & Associates
Electrical
Hechanical
CONTRACTORS
(name)
(address)
General Youno Wil de & Sebrino
2790 Baker. S.Pi.l,L
Plumbinq
Electrical
~'echan; ca 1
PLUIIBIIIG'
ELECTRICAL
NO,
(lies. no.)
(exo;res)
(ohane no.)
8449
(lics. no.)
(exo;res)
(ohone no. )
1.3.3.lS
Ik3D-A1
747-0040
MECHANICAL
Each single fixture
FEE CHARGE NO I='~~ rl-l;&G.E. NO_
Residence of furnace/burner to
SQ, FT, BTU's
~H r~ARtiE.
/
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
!1 bath)
Duplex (1 bath) each
SERVICES
Additional bath
Temporary Construction
Change in existing
re$ j d~J1o,>_ .
multifamlly. COnJl1. or
Industrio'l.l
IOf amps.
ICOffi1,/IND, FEEDERS
I Install/alter/relocate
di..trih_ fppdpr..
IOf amps.1
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~Iater service
Sewer
Storm Sewer
TOTAl CHARGES
WHEnE STATE L~W REQUIRES
shall not be va1ij until the
TOTAL CHARGES
that the Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Floor furnace
and vent
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Recessed wall t"
SOo'l.~P hpo'I.tpr o'I.nrl vpnt
Appliance vent
",poaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart
heatina or A.C.
I Mechanical exhaust
hood and duct
I Hood stove/heater
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from
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I TOTAL
ISSUANCE OF PFRrHT
CHARGES
1 HAVE CAREFULLY EXN11NED the completed application for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed 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 UO OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard 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 subcontractors and employees who are in compliance with OPOS 7Q1.055 will be used on this project.
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IlAr,IE(please print)1{\, ~ R K: N, 'S:E~R I ~\ 6- SIGII^TURE "'i'f'r::M~ ~ ~~~ OATE7 J)Lj l'l ~
FO~ OFFICE USE O!IL Y ---;~,\ , . i
Zone~-1 Type/Const, S-N Units Sq. Ftg, nain x '\--....... Value
Fi re Zone Bedrooms Occy Load Sq, Ft!J. Access-2.52D x Value
Flood Plain Stories Occy Group B-1 Sq, Ftg. Other x Value
TOT^L VALUATION 10,000,
BUILDING PERI,HT
Charges anc
Surcharges
Plan Ck, Comm/Ind
__!2.2..."QQ.______ 65%1Blda Per fee
2 08 Plan Ck, lies
. 30%/Bl dQ Per Fee
Fence
I"t 1,1 An
7-1-82 L,P,
PLU!1BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERr~IT
Cha rges and
Surcha rges
Sidewalk
------------
[ A/C Pavi ng
I Curb Cut
/1ECHANICAL PERMIT
Charges and
Surcharges
Systems Development
Charae (1,5r,)
l~nnD
Total Comb. rermit
54,08
$204,08
TOTAL
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COMBI~ATIO~ APPLICATIONIPERMIT (CAP)
I. ,Applicant to furnish
A, Job Address
B, Legal Oescription
1. examole- Tax lot 100. Lane County Map Rei
II 03 43
2, examole- Lot 1. Block 3, 2nd Addition to (
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examo 1 e- hea tie 1 ectri ca 1 ceil i ogler forcel l!:..
2. examole. waterheater/electrical/or s~
E. Square footage or valuation, etc. ------
1, examole- 1250 sq. foot house, 500 sq, foot
2, example- if new project, check-new - if ad 101
cneck add, etc.
F. Building permit information:
1. example - construct single family house Wil
a ttacned garage ('
2. example - remodel existing garage into fami
3. examole. convert single family residence i'
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of. ....
Structural Specialty Code I"
H, OESIGN TEM1 ANO CONTRACTORS
To avoid design or construction delays, Buildins
Division Staff must be able to contact appropria (
persons regarding design information or job site .
corrections, etc.
II, Abbreviated Plumbing, Mechanical, & Electrical Schedl
A. Except where blank spaces OCcur in the descripti( (
portion of the Mechanical and Electrical Schedul~
the applicant need fill-in only the No. Boxes adj
to the appropriate item(s) to be installed
8. Full Plumbing, Mechanical, and Electrical Schedul (,
are available at the Building Division
1. To conserve space on the permit form the schet
have been abbreviated
2, If the item(s) to be installed are not coverec ("
the abbreviated schedules you should consult t
full schedules '
C, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO ,
CHARGES ON THE SCHEOULES I
0, As noted on the CAP, the label must be delivered t, \p
electrical contractor for signature by his electric
supervisor. The general contractor is .not authoriz
to sign the electrical label. ---
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
signa ture.
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.
Ill.
V, FOR OFFICE USE ONLY
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CITY OF SPRINGFIELD
CltyHall II
Sprlngtlald, Oragon
Dapartmant 01 Public Works
OFFICIAL RECN~: B 59424(. I
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- AUTHORIZED 's&G~ATURE
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. . GENE OREGON
/ 8RlGGS PRINTERS/LITHOGRAPHERS. EU '
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCblPI',IICY: ISSUANCE,
Owner to Sign improvement aqreement for Industrial Avenue,
t
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY: ,
,,,~~()'(Y\f A1 E (:,<' (2- 'i9"'-~" . ,J{}v '\(JD FUfJ "t. '18-69--
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