HomeMy WebLinkAboutPermit Building 1984-10-24INSPECTION LINE
7?6-37 69
CTTY OF SPRINGFIELD
COHBI I{AT1 ON APPL I CATION/PERMIT
I^IHERE STAshall not be
726-3753
ra1 Description fg1 Iot #1000 t7 .0)25
TE !11{ REQUIRES that the Electrical work be done by an Elvali'l untiI the label has been signed by an Electrica1 Su
ectrical Contractor, the electrical portion of this pern.itpervisor and returned to the Build.ing D.ivision
CAR INED the comp eted apnl ication r oermit, and do hereb.y certi ata I information is true. correct, and I further certi fy that any and all work performed shall be done in acc
fy
of Springfield and the Laws of t he State of Ore !on
Buil
oertaining to the work descr.ibed
ordance with the 0rdinances of the Ci ty
of any structure without the permission of the herein, and that NC 0CCUPAI{CY wili be ma deding Division. I fLrther cert.i fy that my registration vrith the Builder,sBoard is in full force and ef fect as required by ORS 701.055, that if exempt the basi s for exemption is noted hereon, and thatonly subcontractors and empl oyees who are in comcl i ance wi th ed on this project.Terneo by /-{-tr
l.lAl.lE ( pl ease pri nt)IGNATURE
BUILDING PERI'IIT
Charges and
rrcharges
PLUI4BING PERMIT
Charges and
Surcha rges
Job Address 1 5 Mohawk Hi iel-,w t_
Address 3800 N. vV. St . Helens Rd . Phone
Portland, Oregon 97270
owner rexaco Inc.
Building Face-Lift & Canopy enl-ar
r Heater
n
lgt"Sq. Ftq. Othe'
_rlewl(AdQflFence Demo
r
Chan
IteFlReF
ge/Use
-0ther-
n Pernit In d ingle
t't i Attac
2B 800 .00
Ranqe
5Cr
Value of l,lork:
EIIERGY SOURCES
Hea t Sq. Ftg. Access.--
Construction Lender Same aS "Oryne1. ,'IllslI t oc Ilew J- iLUU-Lir, o I'lE W UJ- BIllj aI-eas shown on the drawi-ngs.
Address Phone
(wo interior work is included)
N.C
sF
I]I5I GN TEAI'{name address exDt res ohane -no -11r_cnarcl.
Texeeo -
!. weDutw
lens Rd. . Portland. Ore 226-i5?5Pri ma ry .HeTne - - 3BOO N-W- St
Structurar Madison, fnc., 27OO S. 11th Ave, phoenix, Arizona B5OOT (5OZ)25?-3083
Electricat Sub-contractor d.esigned (canopy onfy - other electrical exists.)
Hechanicar None required for the pro ject.
CONTRACTORS name add res s 'lics. no- )(pxn I rpq ohone no- )
Pboenix, Arizona B5oo? (6oz) zSZ-toBGenera i !lMa.dison. T 2100 S. 11th Ave
Pl umbi Contractor
Co
l_rel-ocation work o
.llectranicat None reouired for the oro.'iect.
PLUIIB I NG ELECTR I CAL MECHAN ICAL
FEE CHARGF N0.FFF CHARGF NO FFF IlHARGF
Each single fixture Residence of
FTSQ
furnace/burner to
BTLI' s
Reiocated buildinq
(new fix. additional)Floor furnace
and vent
S. F. Residence
( l bath)SERV I CES
New c'i rcui ts al ts.
or pxtensions
Recessed wal I
Soace hcatpr nnd vpnf
Duplex (l uath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
[.later service Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily, comr. or
I ndus tri a I
Vent fan with
sinole duct
Storm Sewer 0f _ amps.Vent system apart from
heat'inq or A. C .
coMf.r./IND. FEEDERS Mechanical exhaust
hood and duct
Instal l /al ter/re1 ocatedistrib. feeders I'Jood stove/heater
0f amps
€/a<n G.erts P.7 a
=? rf&t7a*un ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
x
x/x
a st
Grou
Uni ts Val ue
IC
Flood Plain Stories
Zone
Load
. Ftg. 0ther
Val ue
Ftg. l,lainFire Zone Bedrooms occv Ftg. Access
r vatu"?4_@,2
TOTAL VALUATION-
S.tcO",t-Systens DeveloomEnt -
Charse (1.5r)'/yl -q.?6?y.ta
1
an
P lan Comm/ I n
. Res eL'w'7-6rf,cAL,z-
Fence
Demo
Sidewal k
ELECTRICP.L PERTIIT
Charges and
Surcharges A/C Paving Total Comb. Permit /z8.zc
Curb Cut
I,IECHANICAL PERMIT
Charges and
Surc ha rges TOTAL //zate
c
PERMIT VALIDATIONp
4-95'd
#udfl
Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Biock 3, 2nd Addition to
S[Fin-!-field Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
l. example- 1250 sq. foot house, 500 sq. foot garage
2. exampie- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remode'l existing garage into family room
3. example - convert single family residence into
iestauiant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN 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.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. 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 installedB. Full Plumbing, Mechanical, and Electrical Schedules
are avai Iable at the Building Division
1, To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be instal1ed are not covered on
the abbreviated schedules you should consult thefulI schedules
C. BUILDING DIVISION STAFF I'IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be de'livered to the
e1ectrical contractor for signature by his electrical
supervisor. The generai contractor is not authorized
to sign the electrical label.
Applicant to sign and date
l,lhenever possible, the initial application wilI be used as
a worksheet oniy. 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
s i gna ture.
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.
II.
III.
IV.
air gas1. exampl e-2. example-
E. Square footag
coMBINATT0N AppLICATI0N/pEp.t4rT (CAp)
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY:
permit applicant exempt from registration with the Builder's Board because:
Add'itional Proiect Information:
7l^
nane L*/e€ k€TR sisnatur
PLANS REVIEWED BY:
C-
date ^a_erel
Permi t Cl e
,a