HomeMy WebLinkAboutPermit Miscellaneous 1989-3-17
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'I INSPECTION LINE -t-' CITY OF SPRINGFIELO
726-37<>9 _ CmlBlIlATlON APPLICATION/PERMIT
Shop R ~~g' AR Mohaw 1'larKe1:pa I ce E!IERGY SOURCES:
JO~}JIY~,S ~L__ h -I\)R. lqth St Heat Gas
l.eg.l0e,cription MaD 17-02-25-23 Ilater Heater Flpr.t.
I Ran~e___-.liLA....._~___
Tax lot, 00100. OQI01. 00102. 00300. 00400
AtJdrcss
IiiJJJnan Pronprti p,
900 North Tomahawk
Island Dr. I'hon'R,_411
INFORJIATlON LINE
726-3753
Sq. Ftg. "lain:2"'-"'~ r.,..
~q. Ft~. Access. - \J\}
Sq. Ftq. Other ~
flew Add Alter Rep. \'\
Fence_Oemo_Change/Use N
Valu, of Hork: _Other N
J505 ,440.00 II 6\
BUlh;lnQ Penn1t Info: Oeser be Work(Le., Build Single
Familv nesidence IIlth Attached Garaoel
.
Owner
Portland, OR 97217
Construction lender
unknown
fnn,trlJr.t ,trlJr.tural shell & enclosure for
Lease Bldg. Tenant improvements to be
U1lu~r :::'t:'l-'CUCll".t:' ,",t:'IIIIII.,~.
AJJrcss
DESIGN TEM1
(name)
PhonC"
(addrec;s 1
(1 ir:o;., no. 1
lexoiresl
lohone no. 1
Structural
R. A. Walker EnQ.
MFIA. Inc.
6775 S.W. 111th Ave. 1294
4440 S. ~1. -Corbett Ave., Ptl d.
2007 S.E. Ash. Ptld. OR
6/30/89
644-4222
Primary '~mann-Kl as Ass.Or..
(name)
(address)
flies. no.)
lI.
.~~
(exoires) ~i.1 (nhonp no,
,
Electrical
Hechanical
CONTRACTORS
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General LP R. A
717 M~rk"t Strppt Ptlrl nR
Pl umbi no
to be bin
to be bid
to be bid
Electrical
~1echanical
PLurm IIIG
ELECTRICAL
MECHANICAL
...1!!h
Ff f CIl^Rr,r Jln
~EL. J:1lAJlliE. NO
a::n r.llARG.E..
Each single fixture
Residence of
SQ. fT.
furnace/burner to
BTU's
Relocated building
(new fix.. additional)
v
New circuits alts.
or extensions
"7 d'~ ~~&;.
SERVICES
.7<.5e" '
Floor furnace
and v.ent .
Recessed wall
Soacp h~atpr anrl vpnt
I'S.F. Residence
11 bath 1
louplex (1 bath) each
jAdditional bath
7'19~ater service
37/1 Sewer
Storm Sewer
Temporary Construction
7:'r.'-' IChange in existing
;,/, l"p<:.irlpnrp
Imultifilrnily, COUIlI. or
~ =<> In",,"ri.!
L OfL~t!t;:>A
Cntfl./lNO. FEEDERS
I
I
.1
amps.1
1
2 IOf
I
/~
TOTAL CHARGES
WHERE STATE L.'II REQUlnES
shall n<?t. be vali'J"until.the
ISSUANCF Of PFRiHT
1'3:;: -, TOTAL CHARGES 1~9.-- TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical l1ortion of this rermit
label ~as been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXm1!tlEO the completed apfllication for permit, and do hereby certify that all infonnation hereon is true
and correct, and I further certify that any and all \'1ork performed shall be done in 'accordance wit.h the Ordinances of the CHy
of Springfield and the laws of the State of Orcl)on pertainin!} to the work described herein, and that ue OCCUPAIlCY ''1ill be made
of any structure without the permission of the Building Division.' I further certify that my registration "lith the Builder's
Board is in full force' and effect as required by Or.S 701.055, that if exempt. the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with Or.S 701.055 will be used on this project.
1lN-IE(please print) ~~-,,"-.J. ~~
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om ~/I ?/,s4l)
_SIr,IIATURF.
FO~ OffICE IISF. DIlLY
Zone_~~_. ...'_... Ty"oJ[onsL. ~-1(.JCr(.\i't"_n__..__._S~' Ft~. l10in ~,.~<>r x <Y.I/ Value_~~ ~{/~~....
Fire Zone_._......h.,..umHcdrooms..__.._..__._____'Occy Load...,..____..___.___Sq. Hf]. ^ccess ___x. Value .._____.
Flood Plilill__._____.__Stories..._.-L_--.:.Occy Gi'OUI~_~-2 Sf!. Ftg. Other x Value
T01AL VALUATION
BUILDING PERNIT
Charges anc
Surcharges
00 .' Plan Ck. Conm/lnd.
/"3<(2. .. 65%/B!do Per Fee
-------~-:-:---PTan n. R-es
t:; 7. 10 30UBl do Per Fe.
1"35"": --- Fence
--- --c6'~7?'-1 Demo
If'?-- I Sidewalk
----- i??-/.A/C Paving
I Curb Cut
I
S!:7Z '0
'Systems Development
CharQe (I. 5~)
-nJ5/'r;,o
PLUl1BING PERMIT
.Charges and
Surcharges
ELECTRICAL PERI:IT
Charges and
Surcharges.
ITota, Comb. Permit
/7.:P7, "PC>
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTI,L
lo/k:/: ZO
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COMBINATION APPllCATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
0., Legal Description
1. example- Tax lot 100, Lane County Map Reference
II oj 43
2. examele- lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
I. examele- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheaterlelectrlcal/or ~
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house. 500 SQ. foot garage
2. ~- if new project. check new - if addition,
CheCKadd. etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
J. example - 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 TEAfl 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.
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-available at the Building Division
1. To conserve space on the penmit fonm 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 electri'cal
supervisor. The general contractor is not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible. Building ~ivision 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 penmit is issued.
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Permit Cle~ ~JII (;
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V. FOR OFFICE USE ONLY
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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~ LFAl5e- 5~cC'5 ~CU:""/')N/c;... /.~;:::>/T/""A--.;rC. ,~Vh?N/~_
EL.p::./~//.4-c;.' ./?74Z'':'''~.,7'';'/~c .~1YD ~fr??/-"":H/:.EA .;q..#""~ ~~-.:;-
_ ;rG"&P/R~.~ ,h'e V/€~/~;:::>;:;>~~S .?,gq/.>?/ rs "-~7?c<.7/~h,..i_
, Permit appl i cant exempt from regi strati on wi th the Buil der 's, Board .because:
Additional Project Information: & ~A?/7S /0 "2?c:= hS?rC"Z> ~/7L
--:5? :L--:? 2)/3=f/6?~/77~/ ~K=-~=";:/Y /7'~<:::E"/v...r-.....>.; /;;/0
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6"'#4"dE~/~ 2J..V/W6/7' oA' ~-7'-8/
PLANS REVIEWED BY:
. '"
. ,. '.'
name
LG'h'.NE ?c&;;~
Signature/2~~.
// . "
date
'I- 2/-~'7