HomeMy WebLinkAboutPermit Building 1982-5-18
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INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
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Address
Collins Food International
511 NE 123rd Avenue Phone
7,500.00
Sq. Ftg. Main
Sq, Ftg, Access.
Sq, Ftg. Other 32 I
_New _Add. XAlter _Rep.
._Fence_Demo_Chonge/ Use
_Other
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Job Address 514 Q Street
Legal Description 17 03 26 24, TL 5503
ENERGY SOURCES:
Heat
Water Heater
Range
Value of Work:
Owner
252-5556
Building Permit Info: Describe Work (i,e" Build Single
Family Residence With Attached Garaqe)
Portland. Orp.gnn
q7?2~
Construction lender
Drive up window addition
Address
phone
DESIGN TEAM
(name)
(address)
(lies. no.)
(expires)
(phone no.)
Primary
C.D.C.
Reagan, Cramer
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(expires)
(",hone no.)
620-7990
General
I PrtgjE'lrl COllstr'lction Co 18085 S!.J. Lower Boone~ ~9rrJ' ~-d, P~rtl:m8
Plumbing
Electrical
Mechanical
Chase Company
PLUMBING
ElECTRICAL
MECHANICAL
NO.
FEE
CHARGE NO.
FEE
CHARGE NO.
FEE CHARGE
Each single fixture
Relocated building
(new fix, additional)
S.F. Residence
(1 bath)
1
". ft.
New circuits, alterations
or extensions 2 0 r mo r ~
15.00
furnace/ burner to
llTU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Residence of
SERVICES
Duplex (1 bath) each
Temporary Construction
Additional bath
Amps.
Water service
Sewer
Wood stave/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10.000 CFM
Amps.
ISSUANCE OF PERMIT
TOT Al CHARGES
TOTAL CHARGES
15. 00 TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portioil of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
/
I HA VE 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 performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregan
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division. I further
certify that my registration with the Builder's Boord is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
SOONATU" A~L~O/J/
FOR OFFICE USE ONLY c:: t/ /
Basis for Builder's Board exemption:
NAME (please print)
/fA <LHo N f)
.I.. <::-I1C'Jl"..c.l....D
DATE ..:r-/O-d".
Zon'"
Fire Zon'"
Flood Plain
l,-If
1l1-N AOO
Type/ Const.
Bedrooms
<; tori", ,
1
Units
('lecy load
()ccy Graup----B.=2
C;q. Ftg. Main
<;q. Ftg. Access
Sq. Ftg. Other
x
x
Value
Value
Value
1,0UU.UU
,\?'
x
TOTAL VALUATION
BUilDING PERMIT
Charges and
Surcharges
44.00
1. /6
Plan Ck. Comm/lnd
65%/ Bldq Per Fee
Plan Ck. Res
30%/ Bld~ Per Fee
28. 60 PO 6-17- (> ':;ystems Development
( ) tharCle (1,5%)
f!>Sl7t./.4
112.50
PLUMBING PERMIT
Charges and
Surcha rge s
Fence
Demo
I Total Comb. Permit
I
I
61. 36
ElECTRICAL PERMIT
Charges and
Surcharges
15.00
.60
Sidewalk
j>./ C PavinCl
MECHANICAL PERMIT
Chorges and
Surcharges
Curb Cut
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
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 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air ga! (
2. example-water heater / electrical/or solar
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot garag (
2. example-if new project, check new-if addition, cl
add, etc.
F. Building permit information:
1. example-construct single family house with an a (nf
garage
2. example-remodel existing garage into family rOl
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 Div
Staff must be able to contact appropriate persons rE
design information or job site corrections, etc.
I
CITY OF SPRINGFIELD
~/
City Hall
Springfield, Oregon
Department of Public Works ('
OFFICIAL RECEIPT
No. B 59061(
Date .....5 -I A 19 R ~
( Rec'd Fr~m ~a q,ie~d (' 1)Y'h~. ()n. C
Address /808 ~ ~ (J). in.perS (Y)rP S
r::. P r rei j/ n{] rJ /W}2.. ,LA II ) () (
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Received For:
(
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41(;
LJ4C6
l. 7 f.o
15.{j()
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/ / Q , 50
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II. Abbreviated Plumbing, Mechanical & Electrical Schedul
A. Except where blank spaces occur in the description I
of the Mechanical and Electrical Schedules, the appl
need fill-in only the No. Boxes adjacent to the appn
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 schedu
have been abbreviated
2. If the item(s) to be installed are not covered on tl
ated schedules you should consult the full sched~
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES,
CHARGES ON THE SCHEDULES
'190
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III. Applicant to sign and date
Whenever possible, the initial application will be used I
worksheet only. Where possible, Building Division Staff
prepare a typewritten copy and return it to the applica
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 ~n,
and no plans will be processed until these fees are paic
other fees and charges ore due and payable when the (mi
is issued.
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AUTHORIZED SIGNATURE
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BRIGGS PRINTERS/LITHOGRAPHERS. EUGENE. OREGON
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V. FOR OFFICE USE ONLY
Permit Clerlr
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY:
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7-10-81
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