HomeMy WebLinkAboutPermit Building 1986-5-2
~ IIISPECTIOII LitlE
~ 726-3709
/
..... Job Address 1396
l.e9al Oe~criDtion
.
CITY Of SPRIiIGFIELO
COIIBIilATION APPLICATION/PERMIT
EIIERGY SOURCES:
tiea t None
~Iater Heater ~lnnp
,
~"iL
(1&1
,
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\1-(1~.t.--:'~:,1.4"'..":~> - -:::::::.:O!
Ranqe
ValuE:
None
of Hark:
{NFORltATlO:-l 1l;1~
725-3753
So, Ftq, I,\.in 168 sf.
~Cl. ~tl). Access.
SQ. Ftg. Other
llewX,l..dd Alter ?ep.
--Fence Demo Change/Use
Other- -
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no. )
Main St.. Springfield. OR
Owner Southland Corporation
AJJrcss 1035 Andover Park W.. Tukwila Phone
54000
[Iuilc;ina Permit, Info: Describe \~ork(i.e.. Build Single
FJ~ilv Residence Ilith Attached fiaraae1
WA
98188
(206) 575-6711
Add re ss
ut.::'ILirl n.AIl
lnameJ
Phone
(address)
Addition of 4 Rottle Stora~e Enclosure
to the side of an existing 7-~leven
Food Store
{l ics. no.l
(exnires)
( ohane
Construction lender
None
Primary HnN Architects.
215 NW Park Ave.. Portland. Or. 97209
~'4-0"O
Structural
Electrical
Mechanical
COIllRACTOR5
(name I
{address)
(1 its. no.'
(e:.:oi rp(,)
(Dhon~ no,
Gene"l G.A. Bentlev Construction. P.O. Box 363. Gresham. Or. 97030
661-2103
Plumbino
Electrical
I ~lechanic'al
PlUlIBlIlG
ELECTRICAL
MECHAN I CAl .
~IO_ I
I FEr ! CHARGE Iln
~~~ I ('H~Rr.r tin I
I F;:r rH~pr,r
SQ, fT,
furnace/burner to
BTU',
Each single fixture
Residence of
Relocated building
(~ew fix. additional)
V Ne..... circu~ts alts.
or extenSlons
I!UY;; ~,lfU l-r
SERVICES
IS"
Floor furnace
and vent
S.F. P.esidence
(I bathl
Duplex (1 bath) each
Additional bath
Recessed .....a 11
~n~rp hp~tp~ ~nrl vpnt
Storm Sewer
Of
amps.
Apoliance vent
~pn,:l",:ltP
Stationaryevap.
cooler
Vent fan wi th
"inal~ ~1_lct
Vent syste~ apart from
f,po'itina or A.r..
MeChanical exhaust
hood il nd duc: t
Water service
Temporary Construction
Change in existing
rf'drl~nrp
multifamily, comm. or
fnrlllc;tr; ~ 1
Sewer
COI'V'l./lIlO, fEEDERS
Install/alter/relocate
r1ic:tr;h fpprlprc;
\Io0d stove/heater
Of
amps.
I
I TOTAL CHARGES I TOTAL CHARGES t'!i. - I TOTAL CHARGES
I WHERE STATE L.\tl REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical flortion of this pemit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
1 HAVE CAREFULLY EXN'lItlED the completed application for r>ermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all .....ork oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of OreC)on pertaining to the work described herein, and that IIC OCClJPArlCY will be made
of ,)oy structure .....ithout the permission of the Ouilding Division. I further certify that my registration~lith the Builder's
Ooard is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is ncited hereon, Jnd that
only subcontractors and e~ployees who ar)e~~AClo\m~li.nce with ORS 701,055 Will. be u~ on t,hi~~/'ect.
<'IIINIE(ple"e print)~II,", ( <4."' "- SIGilATVRE ~ # ; OATE 5-2-5"_
I FO~ OFfiCE IIsr Oill Y / /-'
Zone /;(1~ Tyoe/Const...r"3-N Units So. Ftg. 11ain ~. x Value
Fire Zone Bedrooms Occy load Sq. Ftg. Access x .Value
flood Pl.in Stories / Occy Groupir~~ Sq, ftg, Other ,/}:;PP''''/<'H x /6E?v.lue I,I~.-
TOTAL VAlUATIOl1
F"'J"6-.esw '~syster:ls Development
:R,.<;'~~?7-"-icharqe 11.5~)
#
ISSUArICE or PfR!1!T
I,
OUllOlliG PERflIT I --__'t!l:$:t?__ I Plan Ck. Conrn/lnd
Charges an::: 65%10 I do Ppr Fpp
SurCharges /.7$ Plan Ck. R-es
JO:/Oldo Pp.r fee
PlUIlBING PER,'IT Fence
Charges and ------------
Surcharges DC""
ELECTRICAL PERr~IT _u_{S:.~_ S1dew.lk
Cha rges and
Surcharges .bO AIC Paving
t1ECIlMlICAL PERMIT Curb Cut
Charges and ------------
Surcharges
t::t'J _ eo
TOTAL
(;1. &8
.---. -
I Z/' B&
Total Comb. rermit
I'"
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
11 03 43
2, exampJe- Lot 1, Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2: example- waterheaterjelectrlcal/or solar
E. Square footage or valuation. etc. -
1, example- 1250 sq, foot house. 500 sq, foot garage
2. examole- 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. examole - 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, OESIGN TEAl,' AIIO CONTRACTORS
To avoid design or construction delays. Building
~ivision 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
f6 ~~; 1)3 d-
f) ~(5 -ft?,
]
Permit Cl erk
cc
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name Latwt!=' R. ~ ~
Signature,d-.....,;. -a .P J
'/ . ",
date 5-1~~
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