HomeMy WebLinkAboutPermit Building 1982-04-15INSPECTION LINE
726-37 69
CITY OF SPRINGFIELD
COMBI NATION APPL I CATION/PERMIT 726-37
//Job Address €42
Lesat Description t7_or_ 3€-23 5-0rlo
'i.,
Ranqe
EIIERGY SOURCESHeat ?-
l,later Heater 4/ct
Sq. Ftg. Access._
Sq. Fto. 0ther_=-*-
_New Add AITeEIREE. -
_Fe n ce_Demo_C ha nge/ U se
-other-
Ftg . t'lain
Value of tlork:Zze:e0wn r
.€., Build Single.Bui lr'inq Pernrit Info: Describe [nlork('/FarniIy Residence trlith Attached Garaqevhonfi4i--*t,Addr6ss tq? .A,.,// t/
on LenderConstruc
b
N
o
\Al
rd
aAddres s Phone
ohone no.exn i resaddressDESIGN TEAI.I name
Ytn -nlan,O)Pri mary
Mechanical
Structura l
El ectri cal
umbi
PLUI,IB I NG ELECTR I CAL
I
MECHANICAL 1
furnace/burner to
BTLI' SEach single fixture
Floor furnace
and ventxRelocated building
(new fix. additional)
Recessed wal l
Snacp hpaf.pr and vent
New circuits alts.
or extensions -1 )73 t\f oR<
Residence of
SERV I CES
SQ. FT
S. F. Residence(l bath)
Duplex (1 bath) each
Temporary Constructi onAdditional bath Apol iance vent
seDa rate
Stati onar-v evap.
cool er
ge i n exi sti ng
dence
Chan
rps il^later servi ce
Vent fan with
sinole duct
multifamily, comn. or
TndrrstrialSewer
Vent system apart from
heatinq or A.C.0f .amps.Storm Sewer
Mechanical exhaust
hood and ductCOMH./IND. FEEDERS'4L1r,=h(Wsrffi ,*re. h
l,Jood stove/heaterI nsta I I /a I ter/ re l ocate
di<trih. feederst$lraya / P*ry
-ampi0f
ISSUANCE OF PFRIlIT
TOTAL CHARGES
aa
TOTAL CHARGESTOTAL CHARGES froo
be done by an Electrical Contractor, the electrical portion.of this pe
an Electrical Supervisor and returned to the Building Division
S IGT{ATUREI'lAt'lE (p lease pri nt 4,
rmi t
Ci ty
made
fyany
rd
perm
ffect exempt
055 wi]
t ru'I sathatIIn'I tforma onI re0nhermltdoandcertonhereb.yaetedIcIcomppapLHAVEI of thenwlcetthOrdihencenasshrmedIabeInedo'I ccordana'I workIandfuhertcerrtitthaaaandIndnyacorrec t fy
wl II be'I an td Lha OCNC CUPANCYnttow0rthedescrkbed1hererta0nrl'If I ad nd ofLaws Sthe teta of soeethe0regofSpng I SBuiItraS'It uJlon ht derthefutherrc'Irt tthaIvlon'I reg imys11s00nthef'IBu diI Di Sruttheng+L ctu wlre thouofs
n th atndon'I s tedno hereoba'Is forS exemptthethat'I fa'I nI Ifu e a s red'I b 7010Rs 0 55BosforceIandrequv I usbe 0ned 'Ith s ect7o1projIwhoreaIIan'I wlce th 0r?sIonSUonbcandtractorscomovernpoyees
12
WHERE STATE L/\l,l REQUIRES that the Electrical work
shall not be valiC until the label has been signed by
Valu
Val ue
Flood Plain
x
x
'i ts
lueto ri es
Fire Zone Bed rooms
Ftg. l{ain
ToTAL VALUATI0N_
Sq. Ftg. Access
Group Sq. Ftg. 0ther
Occy Load
Zone____Type/Cons t
opmentSvstems Deve
charqe ('1.51Plan Ck. Conm/Ind
65%/Bltlo Per Fee
Plan Ck. Res
30%/Bldq Per Fee
BUILDING PERI.IIT
Charges and
Surcha rges _t6
za,oe
Fence
Dgmo
PLUI4BING PERMIT
Charges and
Surcha rges
a-(>
za
Si dewa I k
Total Cornb. Permit
ELECTRICAL PERI,IIT
Charges and
Surcharges
a6
. 4,.4
/
Curb Cut q/.1TOTAL
I,IECHANICAL PERMIT
Charges and
Surc harges
f
A/C Paving
COMBINATION APPL I CATI ON/PERMI T
I. Applicant to furn.ishA. Job AddressB. Legal Description
(cAP)PERMIT VALIDATION
1. glample- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield Estates
Name, etc. of owner and construction lender
Energy Sources
r ?a
c
D 1. example- heat2. EiamF-f-e- wate
Square footage or
/el ectrical iti forced air gas
er sol ar
E va l uation, etc
l. examp-le- 1?50 sq. foot house, 500 sq. foot garagea. elampte-.if new project, check new _ if addition,check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. examp]e --rem6del existing garage into farm.ily roomJ. exampte - convert single family residence into_ restaurant (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 construction deiays, BuildingDivision Staff must be able to contait appropriitepersons_regarding design information or job sitecorrections, etc.
Abbreviated Plumb.ing, Mechanical, & Electrica.l SchedulesA, Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electrica.l Schebulei,the applicant need fill-in only the No. Boxes iajaient_ !0_!hg appropriate item(s) to Le insta.l.ledB. Full PIumbing, Mechanical, and Electrica.l Schedulesare available at the Building Division1. To conserve space on the-permit form the scheduleshave been abbreviated2. ff the item(s) to be installed are not covered onthe abbreviated schedujes you shou.ld consult thefull 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 theeiectrical contractor for signature by his e.lectriiai'-supervisor. The general coniractor ii not authorizedto sign the electrical iabelApplicant to sign and date
Whenever possible, the jnitial app)ication will be used asa.worksheet oniy. Where possibli, Building oiv.islon iiaiiwill.prepare a type written copy ind return it to theappiicant at the time the actuai permit is issuea io" tis
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiil-be procesied until theserees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit appl i cant exempt from registration with the Builder,s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s'r gna tu re date 1-t-* e \
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