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HomeMy WebLinkAboutPermit Sidewalk 1983-10-23I 7 L COI1BI IIAii ON APPLICATION/PERMIT 72 s C,)N 6 t/ Job Address EIIERGY SOURCES Hea t Ftg. l'Ia Sq. Ftg. Access.- llater Heater Ran Val ue of l,lork Legal Description vTv Owner Address Phone n t be l,lor Fami I .e., Build Single O 7 Q1z ;71 Construc er D<.t Addres s Phone name address lcs. no.exD res phone no Pri mary Structura I El ectri cal Mec han i ca I CONT ACTORS name addres s 'l i cs. no. )exDt res nhnne no- ) Ge PI I'lechanical PLUIIB I NG ELECTR I CAL MECHAN I CAL FEE CHARGE NO FFF CHAEGF I'10 FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to tsTLI' S Relocated building (new fix. additional) New circuits alts or extens ions Floor furnace and vent S . F. P.es i dence ( i bath)SERV I CES Recessed wal Iqnace heatFr and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sepa rate l,later servi ce Chan res i ge in existing dence Stationary evap cool er Sewer multifamily, conun. or Industrial Vent fan with si nol e duct Storm Sewer 0f Vent systern apart from heatino or A.C. COI.III./IND. FEEDERS Mechanical exhaust hood and duct- I nsta I I /a I ter/ re1 ocate distrib. feeders lJood stove/heater 0f ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAt, REQUIRES that tlte Electrical work be shal] not be vali'l until the label has been signed by an done by an Electrical Contractor, the electnical portion of this permit Electrical Supervisor and returned to the Bu'ilding Division EXAM I NED t he comp e ap l-)ca on for .oermi t, and performed shall ining to the wor do he re b.y ce rt a t a I I 'I n fo rma t 'I on he reon 1 S true and correct,of Springfieof any struc Board is in and I further certr'fy'ld and the Laws of the ture without the permis ful l force and effect a that any and all State of Oregon sion of the Buil work be done 1 n acco rd ance wt th the 0rd 'I nance s o f the L I ty pe rta k descr 'I bed he re 'I n an d tha t NC OC CUPANCY !vl I I be ma de d i ng D'iv i 701.055 s 'I on I fu rthe r ce rt 1 fy tha t m.y reg i s tra t -,1 on vJl t h the Bui I der s requ t red by ORS th at f exempt the ba s 'I s for e xempt t o n 'I S noted hereo n and th at o n I v subco ntrac to rs a nd ernp I oyees who a re 1 n comD I 'I ance w1 th 0tls 7 n 1 05 5 w1 'I I be us ed 0 n thi s proj ect t'lAl'!E (pi ease ITIEI rGNATURE ?nu/a^/rdr/,r,ffi DArE/ FOP. OFFIC : USE OI.I LY Zone Tyoel Cons t Uni ts Ftg Ftg Ftg . l'lain I Ilp Fire Zone Bedrooms Occy Load Sq. Flood Plain Stories 0cc.y Group Sq. . Access x Vai ue 0the r x Val ToTAL VALUATT0N-- BUILDING PERI'IIT Charges and Su rcha rges Plan Ck. Comm/Ind 65%/81do Per Fee Sys Cha terns Deve'iqe tt.sZl opment Plan Ck. Res 30%/B1da Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICAL PERIIIT Charges and Surcharges Sidewal k OO A/C Paving Tota'l Cornb. Permi t I4ECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL r-\oo hlr.l- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. gClP.]_g- Tax Lot 100, Lane County Map Reference17 03 432. exampie- Lot 1. Block 3, 2nd Addition toSpringf.ield Estates 9. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION L exampie- heat/electrical ceilino/o - l. exampte- waterheater/electrical/orE. Square footage or valuation,-eTc.-1. example- 1250 sq. foot house, 500t. example- if new project, check new check add, etc. r forced air gas sol ar sq. foot garage - if addition,l.r6F II F. Building permit information:1. example - construct s.ingle family house with anattached garage ?. examp]e - remodel existing garage into fam.ily roomJ. example - convert single family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construct.ion delays, BuildingDivision Staff must be ab'le to contalt appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanicai , & Electrica l SchedulesA. Except where blank spaces occur in the descr.iptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaient - to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedujesare availab'le at the Building Division1. To conserve space on the-permit form the schedules have been abbreviated2. If the item(s) to be instailed are not covered onthe abbreviated schedules you shou)d consult thefulI 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 thee'lectrical contractor for signature by his electricai - supervisor, The general contractor is.not authorizedto sign the electrica'l labelApplicant to sign and date Hhenever possible, the .initial application wi'll be used asa.worksheet only. Where possible, Building Division Staffwill.prepare a type written copy and returi it to theappiicant at the time the actual permit is issued for his s i gna ture. Fees and Charges PIan check fees are due and payable at the time of theapplication, and no plans will be processed until thesetees are paid. Al l other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III. IV V Permi t Cl PROJECT CONDITIONS TO BE SATiSFIED BEFORE OCCUPAI{CY: Perm'it appl icant exempt from registration w'ith the Builder's Board because: Addit'ional Project Informat'ion: PLANS REVIEWED BY: name S1 g nature date q)