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)