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Home My WebLink AboutPermit Demolition 1984-02-07INSPECTION LINE 7?6-37 69 CI-TY OF-SPRINGFTETT COMBI I1ATI ON APPL I CATION/PERMIT Job Address EIIERGY SOURCES Hea t l.later Heater Ranqe Sq . Ftq . l'1a i !q. Ftg. Access._ Sq. Ftg. 0ther_ -l'lewJddJl ter-'eP. _Fence_Oemo_C ha nge/ U se _other- 3 l-egal Description \Value of tlork Address n n Descr l^lork nce l,lith At ,€., Build Single I I t Construction Lender Xtl Addres s Phone -\ DtSt(iN TEAI,I name rcs. no.exDl res phone no Primary Structura I EI ectri cal Mechani cal AcTo[s/\ _ . (name I i cs. no.exD r res ohone no- I umb i I \T -7 T E l ectri ca l l'lechanical PLUI1B I NG ELECTR I CAL MECHANICAL FFF CHARGF NN FFF CHARGF NO FFF . HA PGF Each single fixture Residence of SQ. FT furnace/burner to BTTI' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. Residence(1 bath)SERV I CES Recessed wal I Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seDarate [,la ter s erv i ce Change in existing res i dencp Stati onar.v evap cool er Sewer multifamily, comn. or Tndrrctria l Vent fan with sinole duct Storm Sewer 0f Vent systern apart from heatino or A.C. coMr.r./IND. FEEoERS Mechanical exhaust hood and duct Insta l I /al ter/re1 ocatedistrih- feeders ['lood stove/heater 0f ISSUANCF OF PFRI.IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L.{tI REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernitshall not be vali:l until the labe'l has been signed by an Electrical Supervisor and returned to the Building Division and I HAVE CAREFULLY EXAMINED the completed aprrlication for Dermi rforme t, and do hereb.y certify that all information hereon is truecorrect, and I further certi fy that any and al I work De State of Oregon oertaini d shall be done in accordance with the Ordinances of the Ci tyof Springfield and the Laws of the ng to the work described herein, and that HC 0CCUPAI{CY will be madeof any s Board is tructure without the permission of the Building Division. I further certify my registration with the Builder'sin full force and effect as required by ORS 701.055, that if exempt the basis exemption is noted hereon, and thatonly su bcontractors and employees who are in compliance with ORS 701.055 wi"l used ect. I'lAl'lE ( pl ease pri nt )5 IGiIA Zone e/ Const ts So Fto. l4ain Val ue Flood Plain Stories 0cc.y Group Sq. Ftg. 0ther x Value TOTAL VALUATION- BUILDING PERNIT Charges and Surc ha rges Plan Ck. Conrn/Ind 65%/B1do Per Fee Svs Cha terns Deverqe f1.57 opment Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo I ELECTRICP,L PERIIIT Charges and Surcha rges Sidewalk A/C Paving Curb Cut Tota'l Comb. Perm.i t I,IECHANICAL PERMIT Charges and Surcha rges TOTAL lB,6 Fire Zone Bedrooms 0ccy Load Sq. Ftg. Access x Value_ COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Descriptjon l. example- Tax Lot 100, Lane County Map Reference 17 03 43 ?. example- Lot 1. Block 3, Znd Addition to Springfield Estates C. Name, etc. of owner and construction IenderD. Energy Sources 1. 2. Sql. 2. example- heat examp.l e- wate uare footage or /e1 rt 'li or forced air gas r a r or solai E valuat oll , exampl e- examp i e- check add 1250 sq. foot house, 500 sq. foot garageif new project, check new - if addition,I, etc.F. Building permit information:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. exampie - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Divis'ion Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechan'icai and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractolis not authorizedto sign the electrical label Applicant to sign and date lrlhenever possible, the initial application wilI be used as a worksheet on1y. Where possible, Building Division Staffwill prepare a type wrjtten copy and return it to theapplicant at the time the actual permit is issued for his s i gnature. Fees and Charges PIan check fees are due and payable at the time of theappiication, and no plans will be processed until thesefees are paid. Al l other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY II III. IV V PERMIT VALIDATION rl I Permi t Cl er PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY: Permit applicant exempt from reg'istration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name !ign atu re date \qsL{