HomeMy WebLinkAboutPermit Building 1989-1-17 (2)
MrKpn7;p rnmmprr;.1 rnnt 1365 \-lest Second ~'1'Jene 1t~~10
2050 West Broadwav Euoene 20-96PB
12-C W.O. Street SDrinafield 20-B7C
POBox 1910 Euaene 77
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jINSPECTlON LIlIE
726-3769
Job Address 1879
Pioneer Parkway
Legal De'criPtion..(7.4'S".#.~ /.d16.""~_ ;;Z./dt:>
. .
Owner Hilll main ProDerti es
Address 900 N TOM HAWK ISLAND
PORTLAND OR 9721~
DRIVE
Construction lender
Address
DESIGr. Il:.N1
(namel
Phone
(address)
Primary Davi d Hi ckman
12200 N Jantzen Drive
Structural
Electrical
Mechanical
CONTRACTORS
(nalr.el
(addrpssl
General
Plumbino Twi n Ri vers
Electrical
l. R Brabham
Harvev & Price
Hechan1cal
PLUIIBIIIG
ELECTRICAL
NO, FEF CHARGE 1'n
Each single fixture Residence of
~ 7.!0 15:- so. FT.
Relocated building "./ New circuits alts.
(new fix. additional) or extensions
':2 d< M~n;
Is.F. Residence SERVICES
(] bathl
IOup1ex (1 bath) each
IAdditional bath Temporary Construction
I ~Ia ter servi ce Change in existing
rp~ j qe.ncp
I Sewer multifamily, COITI'n. or
Tnrludrial
Storm Sewer I Of /00 amps.
COMfI.IIND, FEEOERS
').0 \ LJ\ LI Install/alter/relocate
ctic:trih (ppnpr"
Of amps.
~L-U
/
(Hcs. no. 1
0'r,
\ ~ 'llt;~'& -/
flies. no. \
,rr CHARGE....llil.....
'2'2 ~
I
I
I
I I
12:7&
r
./ ..Iv; fi.t;;j__
I ([
(exnires\
(ohonp- no."\
?A~-???56
11'"1, ~),~
lexniresl
(ohone no.)
7~lla
06-01-89
10-89
10-89
~d..3..:..71 d~
683-1414
747-661A
746-16?1
MECHANICAL
.fEL J:IiARliL
/
furnace/burner to
~"'e.!> BTU's
J
Floor furnace
and vent
tb. o~
,
Recessed wall
S~cP heater ~nrl vpnt
Appliance vent
sfo",ratp
Stationary evap.
r..oo]er
Vent fan with
sino1l:~ duCt
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond and duct
9.-
Wood stove/heater
~ .?J ,p........-::=.
-z.......
::)2,1 '),1, \.0,
C\ / /,,' I I I
:::10, ),.,,~ &) . t.. ~ I ICl I SSUANCF OF PFR!IIT
TOTAL CHARGES 4'S- -- TOTAL CHMGES '1"5: -. TOTAL CHARGES ~-'V. /5--
WHEnE STATE L,\\/ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMIINEO the completed application for permit. and do hereby certify that all information hereon is true
and correct. and 1 further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Sprin9field and the Laws of the State of Ore90n pertaining to the work described herein, and that 110 OCCUPAllCY will be made
of any structure without the permission of the ~uilding Division. I further certify that my registration wfth the Buflder1s
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.
SIf,IIAT~ O-v
FOP. OFF t CE ~Sf Dill.. Y I
Sq. Ftg. lIain x
Sq. Ftg. Access x Value
;t:J-2.. Sq. Ftg. Other..::"'_..-..L....72!lt/J"?.... Value q~-
( -, TOTAL VALUATlDrI
?.c'5(~
~(),'3
(1)
llAf.IE(please print)
James Coates-Chaney
Zone_/' r-:
Fire Zone
Flood Plain
Tyoe/Const.222"~ ~>>nits
Bedrooms Occy load
Stories / Occy Group
Plan Ck, Comm/lnd
_____Z'_Z.~CZ_~/BldO ~pr rpp
~ LI Plan Ck. Res
7'6~ 30%/Bldo Per Fee
PLUt~BING PERMlT de" 40<> Fence
Charges and < - - - - - Z..i2~ ---
Surcharges ' -;Z>.75' DtIRlo
ELECTRICAL PERr:lT L/.s:~ Sidewalk
Charges and '1 _____J. .
Surcharges, ~ .'2-5' A/C Paving
2~~~:~~C~~/ERMlT _n__L5.!.~'!_ Curb Cut
Surcharges V . 7~
BUILDING PERfIIT
Charges an~
Surcharges
~ '~ATF 1-17-A9
/'
/Value
l 11 Cd Syste~s Development
- -0 I CharQe (1.5~)~,
l-....
:"),-? ~ /:)
Total Comb. Permit
'2&>7. '38-
Z-'S? 78
TOTAL
..
COMBINATION APPLiCATION/PERMiT (CAP)
i. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map Reference
17 03 43
2, exa~le- lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. ------
I. 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. exam~le - remodel existing garage into family room
J. examyle - 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 TEAfI 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 whe,'e 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
fu 11 schedu 1 es
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. ---
ill, 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,
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
.
~ 1
~
,
~
PERMIT VALIDATION
\~()1d--
~_/ ~ q
~ 1- VI
Ci/
Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
name~",,;J3..v~
~t!?:~ signature~_
//
Additional Project Information:
,. ~ I ,,,'.J
PLANS REVIEWED BY:
_ ~ _ date /~ ':2 3'-8 '7
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