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
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each
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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
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I 416 1
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, 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
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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
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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
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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)
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MECHANICAL
FFF rHARGF NO.
furnace/burner to
BTlI's
Fl oor fu rnace
and vent
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Recessed wall I
Soace heater and vpnt '
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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
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.........
x
Value
Value
Value
x
x
TOTAL VALUATION
'Systems, Development I
Charge (1.5%)
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9f2u~O~ I
~()q/5 BI
1 -,
ITotal Comb. Permit
TOTAL
ex)
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(ohone no.)
(ohone no.)
FFF rHApGl:
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DJI,TE (2:'2lo- ~S-
c 20
21. (f6
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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
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
PERMIT VALIDATION
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y
Permit Clerk
rv
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Permit applicant exempt from registration with ~he Builderls Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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