Loading...
HomeMy WebLinkAboutPermit Building 1985-12-26 Jl~\m"" UNE COMBI "m6" O:'lrmmi7~ERMIT J /!. ~ __ J A / !. /: /1 ENERGY SOURCES: Job Address -3 c;2 {o ~/' ~~V Heat Legal Description I ^7 (),'~ .:)0 <-'3 L/ 0 !J;;}O!7 Hater Heater Range ValuE of l'lork: Construction Lender Address DES I GN TEAt,1 (name) Phone (address) . Primary , Structura 1 Electrical : r1echanica1 . CONTRACTORS , Genera 1 (name) , ()wV1!l ^ ) (address) P1umbinq i Electrical gjplWJ ~'echanica1 PLUr1BING ELECTRICAL NO. FEE CHARGE. NO, Each single fixture Residence of SQ. FT. Relocated building (new fix. additional) New circuits a1ts. or extensions S.F. Residence (1 bath) Duplex (1 bath) IAdditiona1 bath IHater service Jsewer Istorm Sewer I I I 1 I I each I I I I I I I I I 1 I I SERVICES ITempOrary Construction, IChange in existing residence 'I multifamily, comm. or .,; I Industrial 10f ICOMM./IND. FEEDERS I Install/alter/relocate, distrib. feeders 10f amp~1 I I I 416 1 I I I , TOTAL CHARGES I TOTAL CHARGES WHERE STATE l!l,\~ REQUIRES that the Electrical work be done by an shall not be'va1id until the label has been signed by an Electrical amps.1 I I Zone Fire Zone Tyoe/Const. Bedrooms Units Occy Load Occy Group Flood Plain Stori es BUILDING PER~1IT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldq Per Fee Plan Ck. Res 30%/BldQ Per Fee . ___~_fQ,-o:Q_ Iro PLUI1BING PERMIT Charges and Surcha rges ___________-' Fence I Dt/mo I (j)r 00 I Sidewalk - --- - - --:Lj'V-' A/C Paving I, Curb Cut I ELECTRICAL PERMIT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges #~ INFORtfATION liNt. 726-3753 Sq. Ftg. I.fa i n ~q. Ftg. Access. Sq. Ftg. Other Ne\'~ Add Alter Rep. --Fence Demo Change/Use --Other -- -- (lies. no.) (ex[)ires) Owner fJ/tPm1l:a J7liIrite ~{ ~h# ~ - /7 ~L Buildinq Permit Info: Descrbe Work(i.e., Build Single Address :3 ~&, ('//M (t/..4J/2//2Y Phone C ?o Family Residence I~ith Jlttached GaraQe) 3;;2. ~L} dl/i.v.ap~ I~ #M /1PA2fJ~ ~r()dc IJ /0 ()lJ' I I I I I I I .1 I I I 140 I I I ISSUANCF OF PFRllIT 10 1'0 I TOTAL CHARGES El~ctrical Contractor, the.electrica1 portion of this permit Supervisor and ,returned to the'Building Division I HAVE CAREFULLY EXNlINED the completed apfll i cati on for permH, and do hereby certify that a 11 i nformati on hereon is true and correct, and I further certify that any and all work performed sha11,be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO 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. rW.fE(please print) WOtuA R-D M'f\T\OO~ SIGN^TURE~ FO~ OFFICE USE ONLY Sq. Ftg. r1ain Sq. Ftg. Access Sq. Ftg. Other (1 i cs. no.) (exoires) " MECHANICAL FFF rHARGF NO. furnace/burner to BTlI's Fl oor fu rnace and vent I J I I I Recessed wall I Soace heater and vpnt ' I I ; I : I I App 1 i ance vent seoarate I' Stationary evap. cooler I Vent fan with sina1e duct I Vent system apart from I heatina or A.C. I Meehan i ca 1 exhaus t hood and duct I Wood stove/heater I I I ~~ ......... x Value Value Value x x TOTAL VALUATION 'Systems, Development I Charge (1.5%) I 9f2u~O~ I ~()q/5 BI 1 -, ITotal Comb. Permit TOTAL ex) ~ ............. ............ ~ ............... (ohone no.) (ohone no.) FFF rHApGl: ., I ,I ,I I DJI,TE (2:'2lo- ~S- c 20 21. (f6 I 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 1. Block 3, '2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electricalior solar E. Square {ootage 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 permit information: 1. example - constru~t single family house with an attached garage 2. example - 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 regarding design information or job site corr'ections, etc. ' ' , II. Abbreviated Plumbing, Mechanical, & Electrical Schedules 'A. 'Except wheri blank spac~s o~cur in ~he descripiio~ ' portion of the Mechanical and Electrical Schedules, the applicant need fill-in only th~ No. Boxes adjacent to the apprOpriate iiem(s) to be installed ' ' , B. Full Plumbing, Mechanical, and Electrical Schedules are available at Jhe Building Division 1. To conserve s'pace on the permit form the schedul es have been abbreviated 2. If the item(s,) to 6e 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 'ele~trical contractor for signature by his electrical supervisor. The general contractor iscnotauthorized 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 will prepare a type written copy and return it to the applicant at the time the actual 'permit is issued for his signature. Fees and Charges " P'lan 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. II I. IV. V. FOR OFFICE USE ONLY , f PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: PERMIT VALIDATION \) ()();\o, \V ' y Permit Clerk rv L./ Permit applicant exempt from registration with ~he Builderls Board because: Additional Project Information: PLANS REVIEWED BY: name signature date .' ,. - ~ - . .! ] ~ ~ J I ~ . A ~j ~