HomeMy WebLinkAboutPermit Building 1980-09-12ECTION LII.IE
37 69
CTTY OF SPRINGFIETD-
COMBI NATION APPL ICATION/PERMIT 726-37
Structura I
E'l ectr i ca l
I'lechanical
Genera I
PI
cal
'tc
Job Address
liater Heater
Ranqe
EIIERGY SOURCES
Hea t
3z
l-egal Description
102'
0wn
Yalue of l.lorkfr or<
Sq. Ftg. Access.--
Sq. Fto. 0ther__
l{eur Add Al ter P.eo.
-FeiEl Demo chanqeTuse
Other -
Ftq. I'la
Addres s PhoneS Buileinq Pernrit Info: Describe llork('
Farni 1y Res idence l,li th Attached Garaqe A
e., Build Single
Construction Lender -{\l na p ,
Addre s s Phone I
QC
E
oaJ
t ,\)
DES i GN TEAI{name (address lics. no.exDI res (phone no.
Primary
n
CHARGF NO FFF l.HARGF
Each single fixture furnace/burner to
BTU' s
Rel ocated bui I dinq
(new fix. additional )
New circuits alts
or extensions
S . F. P.es i dence(l bath)SERVI CES
I
Floor furnace
and vent
Recessed wal I
Soace heat-er and vFnt
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa ra te
[,later service ge in existing
dence
C han
res i
Stationary evao,
coo l er
Sewer multifamily,
I ndus tri a I
comrn. or Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
cor.lr.,r. / rND. FEEDERS Mechanical exhaust
hood and duct-
I n sta I I /a I ter/ rel ocate
di stri b. feeders l'Jood stove/heater
.amp s.0f
]SSUANCF OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l,lHERE STATE LAI'I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshal'l not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Divisio4
on oertaining to the work described herein, and that NC 0CCUPANCY will be maDivision. I further certify that my registration urith the Builder's
llAl'lE(please pri S I GIJA
Dermi t
rfo rmed
0reo
the B
ty
de
g
0
ect
I HAVE CAREFULLY EXAHINED the completed application for , and do hereb.y certify that all information hereon is trueand correct, and I further certify that any and all work pe shall be done in accordance with the Ordinances of the Ciof Springfield and the Laws of the State ofof any structure without the permission of uildin
Board is in full force and effect as required by ORS 7 1.055, that if exempt the basis for exemption is noted thatonly subcontractors and employees who are .in comcliance with 0l?S 701.055 vrill be used on this
Val ue
TOTAL VALUATIO
x(n Ftq. l'lain
Group Sq . Ftg. 0ther
Acces sFtg I ue-Fire Zone Bedrooms 0ccy Load
x Val ue
Cons t Uni ts
Flood Plain Stories.
Zone Tyoe/
Plan Ck. Conrn/Ind
55%/81do Per Fee 1e
VE
5q"
opmentternsBUILDING PERNIT
Charges and
Surcharges
Fe e
Plan Ck. Res
30%/BI dq Per
FencePLUI4BING PERMIT
Charges and
Su rcha rges Dgmo I
SidewalkELECTRICAL PERI1IT
Charges and
Surcharges A/C Pavi ng Tota'l Comb. lermi t
Curb CutI,IECHANICAL PERMIT
Charges and
Su rc ha rge s toDTOTAL
PLUI1B I NG ELECTR I CAL MECHAN I CAL
1
anF
Residence of
sQ. FT.
I
COMBINATION APPLICATiON/PERMIT (CAP)
Applicant to furnishA. Job AddressB. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition to
Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
r forced air gas
sol ar
PERMIT VALIDATION
I
1. example- heat/electrical ceiling/o2. example- waterheater/electrical/orE. Square footage or valuation, etc.
example- 1250 sq. foot house, 500 sq. foot g
example- if new project, check new - if addi
check add, etc.F. 'Building permit information: l). _etrggpl,-e_ - construct singie, fami ty hoLrse wi
attached garage i?. _example --remocle t existing. qarage into faih," . exJmplE -'convert single lami iy residencei
restauiant (change of use) .i; Ita'l rre o-i r^rork as def i ned i n Sect ion 303 (;r ) of
2
ara9e
ti on,
th an
ily room
i n i:,.1
the
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iitruc.lura I
r)t-sIGN 1'El\i'I
r o at,o id des
Di r.r'is ion Sta
Specia l ty Code
AND CONTRAC IORS
j
ignff or construction deIays, Bui'iciing
must be able to con'tact appro P3"i a te
si Le
rI
IlI
persons.iegarding design informatlo;: or job
correr-tions _ ctc.
Al-rhrevial:rri' Plumbing, Mechan'ical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptiorr- 'pbri:ion oi'ttre l,iechanical a;id Electrical Schedules,
the applicant need i=iIl..in only the I'lo. Boxesiadjar:eiii
, to the appropriate 'item(s) to be inslalleii iiB. Ful.l .P'l'umbing., Mechanical., aird Electrical SchedLrles
are avai-lable at the Building Division t'1. To conserve space on the permit. form the schedu'lcs- havc been abbreviated- 2" If ttre item(.s) to be installed are not covered orr
the abbreviated schedules you shou)d consiilt theful l schedulesC, BUILDING DTVISION STAFF WILL FI[.L OUT ALt. FEES AND
CHARGES ON THE SCHEDULES iD. As noted on the CAP, the I abei must be'de'l 'ivererl to the'elecErical contractor for signature by his el'bctr.icalsupervisor. The gener'al contractor is not authorized
1:o sign the electrical label
Applicant to sign and date
Whenever possibie, the initial applicat'ion will be used as
a worksheet only. Where possible, Buiiding Division Stai'fwill prepare a type r^rritten copy and return it to theapplicant at the time the actlral permit is issued for his
s i gna ture.IV. Fees and Charges.
Plan check fees are due and payable at the time <l.t theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due and.. payable'when the permit is issued.
V. FOR 0FFICE USE 0NLY E:".'
v-6Et ll
PRO.]ECT C()NDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY:
I
rrni t Cl ci'k
I
Fermit.appl icanrl exempt from registratjon with the. Bu'ilder" s .Board because:
PLANS REVIEWED BY:
da tenamesigna tu re
Add'itional Project Information :
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SP ECT I
6-37 69
IILL
-
C{]IIBl i]ATION APPL ICATION/PERMII
N RIlATI ON
726-37
Job Address
l-egal Description
EIIERGY SOURCES
Hea
l.later Heater
Ranqe
a uE of l.lork
Sq. Ftg. Access.---_-
Sq. Fto. 0ther--_
l,ler"r Add Al ter P.ep.
-reiEl oeilo Chanqe/Use
0ther -
Ftq. l.la n_
Address PhoneS Builc.inq Pernrit Info: Describe l,lork(Family llesidence l{ith Attached Garaqe
.e., Bui1d Single
A
Constructi on Lender -{11 n),a ,
Addre s s Phone
:*t
t=CialtJce
-Ju
DESIGN TEAH name addres s I ics. no exo i res ohone no.
Primary
JStructura I
El ectri cal
l4echanical
CONTRACTORS n ame address )lics. .no. ) (expires
Genera 1
Pl umbi
CI.,1ARG F NO FFF
anic
PLUI1B I NG ELECTRICAI MECHAN I CAL
c
CHAAGF i
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional )
New ci rcui ts al ts
or extensions I
Floor furnace
and vent
S. F. Residence(l bath)SERV i CES Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Construction Apol'iance vent
seoarate
[,later service ge in existino
dence
Chan
res i
Stationary evap.
cool er
Sewe r Tndrrstrial
multifamily, comrn. or Vent fan with
sino l e duct
Storm Sevrer 0f s Vent systern apart from
heatinq or A.C.
COI4H./IND. FEEDERS Mechanical exhaust
hood and duct
Instal l /a1 ter/re1 ocatedistrih- fpeders lJood stove/heater
0f s.
ISSUANCF OF PFRI1IT
TOTAL CHARGIS TOTAL CHARGES TOTAL CHARGES
I,lAi.1E(please pri IGiIATU DA
by an Electrical Contractor, the electrical portionrical Supervisor and returned to the Building Divis ton
I,JH ERE STATE LAl,l REQUIRES that the Electrical r{ork be done
EX At,1 I DNE the e tedI a II ac t rfocomp I t an d hedo rtce I hat at I1
Ipl-)n-Derm reb.y rma t0 on.I h Ireo n Ls rUfy e
a Ind fu rt rc0trrecndahe cer It t Lha a nda Ia \{oI krfyny rfo rmed ha5 lI ncco rda wlacn,]edonbeDE e t thh 0rde na1 esnc theof Ll tyf1itIeadndoSprngtheofLa vrs het taS ofte 0re n'Ioe rta I n thto deswork crl n!on g bed he 'I nda ath ilct CCUPA0 t,lL ,l
1Ire madebefosructturet houwi thL 1ss n of ianypermitheBu dI I D I 'Is no furt r 'Iinghecert t tha re I tras 'It no thv|t het 1
'Ifyn.y g de su'I fun Is'IrdBoa I afo rce efnd ctfe sd u I h tat ,l fredORS0170s5 the ba 'Is fors .l
1on nos tedreqbyexemptexempt tLhaIonsuontbctorsracdanIesawhovernpIren'II cean th 70l?s 0oyec0mD 1 05 5 t{1 I I be US ed on t Ih s ect
shali not be vali:l until the label has been signed by an Elect
D r v
Ftg
Ftg
Ftg
Zone Uni ts
Value
ToTAL VALUATI0N.-------------.-.- '-
X
S q
y Load
Cons t
Stori es c.y Group
l''la i n Val ue
Val ue
FIood Plain
Access
0t her
Fire Zone Bedrooms Occ
Plan Ck. Comm/ind
65%/Bldq Per Fee
Svstens Deve
charqe ( 1.52
opmentBUILDING PERI'IiT
Charges and
Su rcha rges Plan Ck. Res
301t"/B1dq Per Fee
FencePLUI'4BING PERMIT
Charges and
Su rcha rges Dgmo I
SidewalkELECTRICA.L PERIlIT
Charges and
Surcha rges A/C Paving Total Cornb. l'ermi t
Curb CutI,IECHAIIICAL PERMIT
Charges and
Surc ha rges TOTAL
'-1(
( nhonp no
of this permit
tcD
Add'itional Project Informat.ion :
PLANS REVIEWED BY:
datenameSIgna tu re
COMBI NATI ON APPL I CATI ON/PERMIT
i. Applicant to furnish
A. Job Address
B. Legal Description
(CAP)
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpfiiqfield Estates
Name, etc. of owner and construction lender
Energy Sources
1. examol e- hea?. ffi wat
SquaiE-Tootage o
t,/electrical ceilin or
r valuation, e
PERMIT VALIDATION
CITY OF SPRINGFIELD
Ciry Holl
Springfield, Oregon
Deporlmenl of Public Works
OFFICIAT RECEIPT
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e ec
forced a'
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1. examole- 1250 sq. foot house, 500 sq. foot gt
2, example- if new project, check new - if addil
check add, etc.B
Buitding permit information :1.. example- - construct single, family house. attached garage2, exarnole - remocie'l existing, garage into fafii11
3, . exaffilE -,convert single iamil.v-resicience;ini
iestauiant (change of-use) iG. Vcrlue o-i r,rork as defined in Section 303 (a) of tl
Struc[uia] Specjal'ty Code iH. DtSIGi\i TtAi.r ANo corllnRcrons i't'o a'.,oid ciesign or construction delays, Bui'l ding
Dirrision Staff must be able to contact approp4ia'''persons .r egarding design .information or job s.ite. corrections. ctc.
Abbreviat.ed Plumbing, l'lechanical, & Electrical SclredrA. Except vrhere blank spaces occur in the descriptir- 'pbrtiorr r.r'i" the I'iechanical and Electrical Schedulr
the a:pplicanl need Fill..in only the No. Boxesiad.' to the appropriate itenr(s) to be inslal leci i;B. Ful.l .Plumbing., Mechanical., and Electrical Schadu
are avai-lable at the BLrilding Division :.
1. To conserve space on the permit: form tlre schr- 'have been abbreviated' ?. If the item(s) to be installed are noL cover(' the abbreviated schedules you should consiiltful l scheduiesC, BUILDIiIG DIVISION STAFF I,IILL FII.L OUT ALL FEES AI
CHARGES OI'I THE SCHEDULES ..;
D. As noted on the CAP, the label must be'deliverecl'elecLrical contractor fo-. s-ignature by his electr
supervisor. The general contractor is not authoto sign the electrical label.
Applicant to sign and date
l,,lhenever possible, the initial application will be u:
a worksheet oniy. l^lhere possible, Bui)ding Divisionwill prepare a type !^/ritten copy and return it to th,
app)icant at the time the actr.tal permit is issued fo'
s i gna ture.
Fees atrd Charges.
Plan check fees ane due and payab'le at the time o't t,
application, and no plans will be processed until th,
fees are paid. Ail other fees and charges are due ar
payable-when the permit is issued.
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P.e:r'mi t Cl tii-k
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Rec'd
Add
Received For
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Amounl Received
BY
AUTHORIZED SIGNATURE
RN6ULL PFINTERS EUCENE OR g7'OI
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V. FOR CFFICE USE ONLY
PRO"IECT CONDITIONS TO BE SATiSF IED BEI'ORE OCCUPAI'ICY :
" :'- '-H
H-::5=Er::::a5eE-
Fermit.applicant exempt from registrat'ion with thc Buildev''s.Board because:
7,.OO ('E-.