HomeMy WebLinkAboutPermit Building 1989-6-27
I INSPECTION LIIIE CITY F SPRINGFIELD
726-3769 ' COMBIIIATIDN APPLICATION/PERMIT
J b Add S . f' 11 EIIERGY SOURCES:
o ress 3501 Olympic Street, pr~ng ~e lIeat None
Legal Description assessor 1 s map 17-02-30-43 l'later Healer None
Ran~e~, None
Valur of I-lark:
$45,000
BuihiinQ Permit Info: Descri'be 14ork(i.e.,
Filr.1ilv nes;dence l'lith Attached r.araoe)
'\
...
INFORllATION LINL
726-37S3
Sq. Ftg. J-Iain 1.000
~q. Ftg. Access.
Sq. Flg. Other
Ilel< Add Alter Pep.
--Fence Demo Change/Use
Other- -
Owner
r,,'; 1 (">r",' . 00100 "p(l 00101
Inc.
Address
6600 S.
Stor~n-Lok Warehouses,
Build Single
Chicago, 'IL
Construction LenderNone
^ddrc$5 none
OES I GN TEAr-1 {name I
c'entral Ave. Phone
(312)496-2800
Cit'lof Snrinn-Fipln 1()h .# ~A_('\7_'1"'7
Phone
{address 1
Addition of storaqe units at rear
of site
(lics. no.)
(exnires)
(nhone no.
2825 E. Main
ClR17? Ixn'PA1-?Cl1'i
Primary Johrmv Green" Mobile Mini StoraC'e
PuVR 111lD Wl\
Structural None
Electrical None
Hechani ca 1 None
CONTRACTORS (name)
Genera 1 Mobile Mini. Storaae
Plurnbino None
Electrical None
~lechilnical None
PLUlIBING
NO.
Each single fixture
(address)
II ics. no. \
(exoi res \
{ohonf' no.'
(same as above)
ELECTRICAL
MECHANICAL
FEF CHARr.F Jl[l
_EEL .GIJAIl!i.E. tlO.
'IL.GUl\J!liE.
Residence of
furnace/burner to
BTlI's
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(I ".ill1
Duplex (1 bath) each
Additional balh
~Iater service
Sewer
Storm Sewer
SERVICES
Recessed wa 11
Soarr br~trr ~nrl vp~.L--
Temporary Construct ion
Change in existing
rpsJ d~nce
multifamily, camm. or
Inrtu<;.triill
Appliance vent
sp.oarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood ilnd duct
Wood stove/heater
Of
amps.
COI~'1./IND. FEEDERS
Install/alter/relocate
rlio;.trih. fpprlpro;.
Of
amps.
ISSlIANCF OF PFR!IIT
TOTAL CHARGES
WHERE STATE L\I~ REQUIRES
shall not be vali; until the
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed hy an Electric(]l Supervisor and returned to the Building Division
I HAVE CAREFUllY EXNlINED the completed aprlication for fJermit. ilnd 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 fW OCCUrA!~CY will be made
of any structure without the permission of the Buildinfl Division. I further certify thot my registration "Jith the Builder's
Goard is in full force and effect as required by ORS 701.055. that if exempt the basis fa emption is noted hereon. and that
on ly subcontrac tors and employees who are in camp 1 i ance wi th OP.S 701.055 \'Ii 11 be used 1 S [Jroj ec t.
11Af.IE(please print)
Zone
Fire Zone
Flood Plain
BUILDING PER~IIT
Charges and
Surcharges
PLUt~BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERI~lT
Charges and
Surcharges
I1ECflANICAL PERMIT
Charges and
Surcharges
DATEl~j7-1SI
SI(.IIATURE
FOP orFICE USE
s(.' -1't~. Ila i n
Sq. Ft9. Access
Sq. Ftg. Other
x
Value
Value
Value
Type/Canst.
Gedrooms
Stories
Units
Occy load
Occy Group
x
x
I'L r _^ s::::> Plan Ck. COIlll1/lnd
__~.:._____ 6S%lBlsLo Per Fee
\""1.... 0 -:r... Plan Ck. Res
....) ~ ..,J 30%/UldQ Per Fee
Fence
ul~
TOTAL VALUATION
Syste~s Development 1_' -,~ l~. .:0
Charoe (1.5~\ V? . \.
\S-~-----
\ .
\3(\:;-----
-\~_cC-----
Dsmo'
Sidewalk
A/C Paving
Total Comb. Permit
I
I TOTAL
qL\B.~
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender .
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exam~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check. add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garl~ge
2. examPJ~ - 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 design or construction delays. Building
Division Staff must be able to contact appropriate
persons regard i 09 des i go i nforma t i on or job site
corrections. etc.
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. ---
Applicant to Sign and date
Whenever possible. the initial application will be used as
a worksheet only~,~Where possible. Building Division Staff
wi 11 prepare i1 type written copy and retutn it to the
applicant at the time the actual permit is issued for his
signature.
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.
tJ
.!
PERMIT VALIDATION
I'
fA.?JCA
~~I\rj)V
~
.'
Permit Clerk
(:j~
II.
111.
IV.
V.
FOR OFFICE USE ONLY
Permit applicant exempt from.regi'stration with the Builder's Board because:
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS
REVIEWED BY:
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