HomeMy WebLinkAboutPermit Building 1989-1-17
CITY UF SPRINGFIELD e: INFORllATION L1N<
COMBIiIATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq. Ftg. I,'ain
Heat ~?"'" '\t~ :q. Ftg. Access.
Hater Heater 6Z:.~7-. Sq. Ftg. Other J<?
Ran~e K!lew_Add~1terJep.
Fence Demo_Change/Use ~
Valu€ of Work: YOther~jp, p~ I
12,000.00 , ?::?~~~~ ~
Phon 2B9'11IJlu1I(jlno Perm,t Info: Oescrlbe Work(Le,. Build Single ,I. \...
e ~.. ~amilv Residence Hith Attached Garaae) ~ .. j V-
!::t;Vl/~j / /.It;;fi./;;i=- ~I\J)
/;;rn..l~...-/ I (
I
ELECTRICAL MECHAN I CAL
_n t"~L. ...c..tiARG..E. Nn <<< r'JAllllE.
Residence of furnace/burner to
SQ. FT. / ~,.,~ BTU's , ~-
I
/' New circuits alts. Floor fu rnace
or extensions and vent
'2 "", N'J~J;; '72.&
SERVICES Recessed wa 11
Sn~rp hp~tpr ~nrl vpnt
,
IINSPE.rION L!'fIE
726-3769
'.
,
Job Address IB79 Pi oneer Parkway
Legal De"ription.t'7."""',~.~ ".~,?_, :1/dt!:>
~ . ,
Owner HjlllniBJO Prooerti es
Address 900 N TOM HAWK ISLAND
PORTLAND OR 9721~
DRIVE
Construction lender
Address
U<,IGII I <AI"
(name)
Phone
(address)
Primary Da vi d Hi ckma n
12200 N Jantzen Drive
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addressl
Genera 1
M,..I('~n7ijQo r.nmm~)"'("i.:!l' r"n+ A'5.5-W.o~+ cOC'Qod E"94?ne
2050 West Broadwav Huaene
12-C W "0" Street Sorinafield
POBox 1910 Euaene
Plumbino Twin Rivers
Electrical
L R Brabham
Harvey & Price
~'echanical
PLUllBING
, NO,
FEF rHARr.F
~
,
Each single fixture
7.~ t'~-
Relocated building
(new fix. additional)
S.F. Residence
11 bath 1
Duplex (1 bath) each
IAdditional bath
I ~Iater service
I Sewer
I Storm Sewer
I
I
I
I
J
Temporary Construction
Change in existing
rp'iidJ'Jlt'"p
multifamily, camm. or
TnrllJc;tr;ttl
Of /00 amps.1
COMM,/IND. FEEDERS I
Install/alter/relocate I
rlictrih f",p,riprc;,
Of
amps. I
flies. no.)
(lice;, no.'
/11::::1:::':10
20-96PB
20-87C
77
I
1 /
12:?~
I
I
I
I
(exnires)
fohane no.
?R'i-?2.2.,'i1i
(pxnirpc;.l (OhMP M \
7_~1_S,\' ~43-714~
06-01-8Q IiR,-1616
10-RQ 767-lin~R
10-8Q 761i-11i;11
Appliance vent
s..f:o!'r:atp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechan;cal exhaust I
hood and durt
Wood stove/heater I
~.h::~,,_
9,-'
I
i
I
12......
I
I
I SSUANCf OF PFRrHT
TOTAL CHARGES ~~- TOTAL CHARGES ~5:-' TOTAL CHARGES ~N, /.5:--
WHERE STATE L,\\/ REQUIRES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this pem1t
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. 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 UO OCCUPAr~CY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IlAI"E(please print) James Coates-Chanev SI"NAT~ O-v (1JA '~ATF 1-17-RQ
FOR OFFICE lISE DilLY' /'
Sq. Ftg. !lain x /Value
Sq. Ftg. Access x Value
;1&$-2.. Sq. Ftg. Other~=-L87Zl1i' /.r:;>~ Value ~-
, .., TOTAL VALUATION
\ 70"(~
(10./3
Zone
cc.
Type/Const.~~ ~~nits
Bedrooms Occy load
Stories J" Occy Group
Fire Zone
Flood Plain
BUILDING PERIIIT
Charges and
Surcharges
~ Plan Ck. Comm/Ind
_____'7..:?...?_<2_ 65%!~lo~ P.. F..
'" Plan Ck. Res
7,630 3D%/Bldo Per Fee
_____~5:' - Fence
Z.7$' Demo
_____!/S,<:Id> Sidewalk
~ .'Z'S' A/C Paving
_____/5~~~_ Curb Cut
.75
PLU11BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Cha rges and
Surcharges.
MECHANICAL PERMIT
Charges and
Surcharges
(-'1 c.c syste, ms Developmen~,.
\ -0 I Charoe (1.5~) ;.,0;
51'? ~o
Total Comb. rermit
207. "3~
;2??' 78
TOTAL
,
..
-
..,-
,
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VAll DATION
I. Applicant to furnish
A, Job Address
B. Legal Description
1. examole- Tax Lot 100. lane County Map Reference
1/ 03 43
2, exa~le. Lot 1. Block 3, 2nd Addition to
>pr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. exalllP'Ie;. waterheater/electr;ca(/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,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole' - remodel existing garage into family room
3. example - conve~~ single family resjdence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM~ 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 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
O. 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, Buildi~g 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
Permit Clerk
, 'PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permi t appl icant exempt from registration with the Buil der' s Board because':
Additional Project Information:
PLANS REVIEWED BY:
~'_ . ,date /~ ':2 ~-8""7
( , .P'
name Ld;13~d=' ~~~ signature~-~:
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