HomeMy WebLinkAboutPermit Building 1983-4-26
IINSPECTIOII LIIIE,
726,3769
Job Address
Legal De~cription
Owner
Address
Construction Lender
Address
DES IGIl TEAr.l
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbino
Electrical
~'echanical
NO, .
.
.
2040 Olympic
17 03 25 31
CITY OF SPRIrlGFIELO
COI1BIrIATION APPLICATION/PERMlT
E!IERGY SOURCES:
Heat
Hater Heater
Ranqe
ex>
IN
V1
'"
IN
INFORI1ATION LINE
726-3753
Sq. Ft9. ',lain
~q. Ftg. Access.
Sq. Ft9. Other
Ilew Add A Her Rep.
Fence_Oemo _Change/Use
Other
Street
07700
Troutman Investment
86766 McVay Hwy.
ValUE of Hork:
Corp. $10,000.00
Builri;no Permit Info: Describe Work(l.e.,
Phone 746-971 tamilv ~esidence Ilith Attached Garaoel
Build Single
Eugene, Oregon
Interior Remodle of Emporium Store
In the Springfield Mall
(name)
Larry N. Oliver
Phone
(address)
(exn;res)
,
(ohane no.l
747-4941
(lies. no.l
{namel
Empor i urn
r address 1
(lieS.M.l
(pxoi rpcd
(ohnnp no. ,
Reynolds Elect 2782 Central Blvd.
343-7297
Eugene
PLUllBHIG
ELECTRICAL
MECHANICAL
, FH 'CHARr.F NO
FFLI..cJJAIllil:JlQ.....'
. ~I='r rJ..l;RGL
Residence of
furnace/burner to
BTU's
Each Single fixture
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
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TOTAL CHARGES TOTAL CHARGES 15.00 TOTAL CHARGES
WHERE STATE L\l1 REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Water service
Sewer
Storm Sewer
x
New circuits alts.
or extens i ens
2 or more
SERVICES
Recessed wa 11
Sn~~~ hp~tpr ~nrl vpnt
15.00
Floor furnace
and vent
Temporary Construction
Change in existing
l"'P~ j d_pJ'lt"p
Imultifamily, COITl!1. or
Inrluc;.tr;i11
10f amps.1
ICO~1./IND. FEEDERS I
[Install/alter/relocate I
rli~tr;h fpprlpr~
IOf amps.!
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Appliance vent
seDarat~
Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatinq or A.C.
I Mechanical exhaust
hood ",nd dud
I Hood stove/heater
I
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ISSUANCF OF PFRmT
I HAVE CAREFUllY EXN1INED the completed application for ~ermit, and do hereby certify that all information hereon is 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 110 OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
Type/Canst. 5 I hr sor1Jnits
Bedrooms Occy Load
Stories Dccy Group
/ ,
Sir;II^TURF~l;1,~-
FO~ OFF I CE USE OIK y
Sq. Ftg. 11ain
DATE~ks
IIAI'IE(please print{"i2Ic.I<.. rn~Itl::s.T12."VY1
Zone c c
Fire Zone
Flood Plain
BUILDING PERmT
Charges anc
Surcharges
PLUt~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Value
Value
Value
TOT^L VALUATION
x
Sq. Ftg. Access
Sq. Ftg. Other
x
B-2
x
10,000.00
Plan Ck. Comm/Ind
52.00 65%1Bl do Por Foo
------------ Plan Ck, R'es
2.08 30%lBl dQ Per Fee
Fence
I ta67~/~!:!5-83
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Systems Development
Charoe (1.5~)
N.A.
Plan check fee .,diustment
[should have bee~ $33.80
I~fund "d ilJ<tm~nt - 7 F.n
!rotal Comb. rermi t I
I
I TOTAL
-
I Demo
12,.00 I Sidewalk
-------- ~~-I A/C Paving
I Curb Cut
------------
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$67.08
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B, Legal Oescription
1. example- Tax Lot 100, lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Spring'ield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam21e- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example' 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cneck 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 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.
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. BUILOING 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.
j- tJy08W
Lf~vt"
~o
~
I
,
\
I
Permit Clerk
(I~~
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
. '
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Permit'applicant exempt from registration with the Builder's Board because:
Additional Project Information:
D
PLANS REVIEWED BY:
name
LORNE PLEGER
signature
date 4-25-83