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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