HomeMy WebLinkAboutPermit Building 1990-10-1
CITY U~ SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat Gas
liater Heater
Range
ValuE of Hark:
9,750.00
BuiltiinQ Permit Info: Describe Work(;.eo.
Familv nesidence With Attached Garaoel
I INSPECTION LINE
726-3769
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Job Address
1968 Marcola Road. Sorin2fie1d. OR
legal Description
Owner
Hillman ProDerties Northvest
Address
900 N. Tom~h~wk Tql. nr.
9l\'~"-li,1 1 1
Portland. OR 97~17
Construction lender
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INFORllATlON UNl
726-3753
Sq. Ftq. i,lain
~q. Ftg. Access.
Sq. Ftq. Other Rn 1
.-tlew_AddXAl ter .Jep.
Fence Oemo Change/Use
Other- -
c9
-
-
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-
Buil d Sing 1 e
MR. /=tpA?/11?At~
T~n~n~ Vil1-Tn _ ~o~~;l
, <$""-
/0
TOTAL CHARGES :?~. - TOTAL CHARGES TOTAL CHARGES :z~ -
WHERE STATE LAH REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this penoit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Address
Ul~ I uN IlAl1
Phone
(address 1
flics. no.)
(name)
Primary Dave Hickman Associate Architect, 700 N. Hayden Island Dr.,
Structural
Electrical
Mechanical
CONTRACTORS
tname I .
taddressl
CliC":<:;, no.)
Genera 1
Hillman Properties Northvest, 900 N. Tomahavk Island Dr.
Twin Rivers Plumbing, P.O. BOX 2477, Eugene, OR
Plumbino
Electrical L.R. Brabham, Inc., 10-D West "Q" Street, Springfield
flechanical Harvev & Price Co., P.O. BOX 1910, Eugene, Oregon
PLUllBING
ELECTRICAL,
NO.
FEF rHARr.F NO
FFF rH~ NO.
:<
Each single fixture
Residence of
I~ .:ao.-
SQ. FT.
Relocated building
(new fix. additional)
. 'New circuits alts.
or "extensions
S.F. Residence
(l bath)
Duplex (1 bath)
SERVICES
, .'
I
I
I
I
I
I
I
I
,6 ~cr. ~~~,.~L:
t!?2~AY4 ~A~R~
;q,;t:;'~{7: I
each
Additional bath
Temporary Construction
Change in existing
re<;.jqrftcP
multifamily, camm. or
Indllc;trial
Water servi ce
Sewer
Storm Sewer
Of
amps.
COMi,l. II NO. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
(exo;res)
(ohane no.
Suite 350, Portland
*
(pxr:lirpc:.i~' ~ (ahnM nn.)
MECHANICAL
n~ nl~
furnace/burner to
/ ?'j-.-:e> BTU' s
Floor furnace
and vent
~,-
Recessed wa 11
~n~rp hPnter ~nrl upnt
/
Appliance vent
c;enarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatinq or A.C.
Mechanical exhaust
hond and duc,t
Wood stove/heater
"f.-
from
~ ,71~~
~~
~A/.
ISSUANCf OF PFRrllT
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon ;s 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 OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board ;s in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subco~tractors and employees who are in compliance with OP.S 701.055 will be used on this project.
HAHE(please print)
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I./J-u../ ..d/~4a. )
DATE
9-19-?O l
SIGIIATURE
FC~ OF:n CE ,USE~orll V L
Type/Const.~~nits Sq. Ftg. t1ain x Value
, '
Bedrooms Occy Load Sq. Ft9. Access x Value
Stories I Occ'y Group fl-~Sq. Ftg. Oth~rI43~r-...-",," s:;i!'. Value~~
Q-SI-qytt/%39l.P TOTAL VALUATION
J:=::.t \ ":::l':i 1'0 _ syste, ms Oevelop_t
: ~)r(\x:-. Charqe (1.5~) ,
Zone-L /
Fire Zone
Flood Plain
BUILDIflG PERt,1IT
Charges an~
Surcharges
Plan Ck.
65%/Bldo
Plan Ck.
30%lBl do
Conm/Iod
Ppr Fpp
R"es
Per Fee
~s~_
.y. ~ ::r
_u_~~_
/. _eo
PLUt1BING PERMIT
Charges and
Su rc ha rges
Fence
Demo
ELECTRICAL PERtHT
Cha rges and
Surc~arge.s
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
AIC Pavi ng
~ ~ ~ I.C:rb i:u~
------;--;~rl
"-
-
[.1/6.2-z>
To~~l Comb. rermit
j ?/-../8
TOTAL
"<7e.e:>?
Ii
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100, lane County Map Reference
11 03 43
2. example- Lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources . ~. . . .. ,~,
'I. exa~le- heat/el~ctriCal' cei1 ina/orfforced air Qas
2. example- waterheater/electrlcal/or solar
E. ,Square footage or valuation. etc. -
1. examole- 1250 sq. foot house, SOD sq. foot garage
2. "example- 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 - remodel existing garage into family room
3. 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 TEAM AND CONTRACTORS
To avoid desfgn 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 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
D. 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. ---
III. 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
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.
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V. FOR OFFICE USE ONLY
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-Permit
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PROJ~CT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:' .'.
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PERMIT VALIDATION
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clerkcJicu.
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Permit applicant exempt from registration with the Builder's Board because:
Addi,tional PrQject .~l}fQr:I1).a:tion::.
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