HomeMy WebLinkAboutPermit Building 1986-06-06I a>o
9,
MLD
COHBI NATION APPLI CATION/ PER}IIT
Job Address t:& Uotrawk Btvd.
Legal Description
EHERGY SOURCES:
Heat
Value of l.lork:.{ /,f/rD
Sq. Ftg. Access._
So. Ftq. 0ther
-HewJddJlt-e-P€p-._Fenc e_Demo_Cha n ge/ U s e
-other--
5q.n_
Owner C.J..Brown , SyI Smith J* Eaaurt ,e., Build Singletn
am'l AAddress 1385 gak SL Eugene wLu Phone485-15
e>
U UcoKsfiu"tion t{daer none
Addres s Phone
OESIGN TEAI,I name I ics. no.exot res phone no,( addre s s
Primary
Structura I
E I ectri ca I
Hechani ca l
:ONTRACTORS name ( addres s lics, no-exol res ohone no.
Er ectri cal Sma7z ra/ €'<ez,
ilechani ca l
ELECTRICAL MECHANICALPLUI{B I NG
FFF CHARGF NN FFF CHAAGF N0_FFF CHARGF
Residence of
SQ. FT
furnace/burner to
BTU'sEach single fixture
22 <A
Relocated bui lding
(new fix. additional)
New circuits alts.
or extensions2 ae )bbrqd
FIoor furnace
and vent
5.F. Residence
( I har,h )SERV I CES Soace heater and vFnt
Recessed wall
Duplex (l bath) each
Temporary Construction Apol iance vent
scnaratpAdditional bath
ge in existing
dpnrp
Chan
rp< l
Stationary evao.
coo l er'a'ater service
Sewer mul ti fami ly, corrm. or
I ndu stri a I
Vent fan with
sinole duct
Storm Sewer 0f _ amps.Vent system apart from
heatino or A.C.
COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct
I nsta I I /a I terlrel ocate
distrih- fppdprs IJood stove/heater
0f amps.
ISSUANCE OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES Z?.SO TOTAL CHARGES
WHERE STATE Lltl.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perflit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Oivision
I HAVE CAREFULLY EXAHINED the completed application for oermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State oi Oregon pertaining to the work described herein, and that N0 OCCUPAHCY will be madLof any structure without the permission of the Building Divis'ion. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and employees who are in compliance with (tRS 701
tlAtlE(please pri *41 '-6
wil l be used on this project.
6baGa7 /6.2g Systerns Develoommt
Charqe f1.57)'N3.
Fire Zone Bedrooms 0ccy Load Sq
Flood Plain Stories ^/ Occy Group B-Z Sq
TOTAL VALUATI
Pl an
l,la
0ther
Acce
Ftg
Ftg
Ftg
zon" C4__Jypelcon
ue,"w_
BUILDING PERI'IIT
Charges and
5urcharges
6aZ
6a
Plan Ck. Res
31%/Bldo Per Fee
FencePLUI,IBING PERMIT
Charges and
Surcha rges Deno
SldewalkELECTRICAL PERIIIT
Charges and
Surcharges
.Sa
A/C Paving Total Comb. Permit
Curb Cut
HECHANICAL PERHIT
Charges and
Surcharges TOTAL 4?.?o
l,later Heater_
ts
T*
COMBI NATI ON APPL ICATI ON/PERI{IT
I. Applicant to furnishA. Job AddressB. Legal Description
(cAP)
le- Tax Lot 100, Lane County Map Reference
PERI'IIT VALIDATION
4
.n
1
c.
0
I
2 I
r n9 1e
etc. of owner and construction lender
hea ceili forced air gas
wate or solar
e or valuation,
Lot l. Block 3, znd Addition to,l d Estates
Sources
{E Squa
I
examol e-
examo'le-
re footag
example-
.
examp I e-
check add
1250 sqif new
, etc
foot house, 500 sq. foot 'la rageproj ec t ,,check new.- if add 'ition,2.
F Bui Iding permi t information:1. example - construct single family h,Irse wiilr anettached qarage
?. examole -""em6del existing garage into frrn,.,y roomJ. exampte - convert single family residence i,rioFEi6ur-urant ( 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 delays, Building0ivision Staff must be able to contait'appropr.iitepersons.regarding design information or job iitecorrections, etc.II. Abbreviated P1umbin9, Mechanical, & E.lectrical SchedulesA. Except where btink spaces ociri in the aar.;i;ai;;--portion of the Mechanical and Electrical Schedu.lei,the applicant need fill-in only the No. Boxes iajiient_ to the appropriate item(s) to 6e instal.led8. Full PIumbing, Mechanical, ana E'lectrical Schedu.tes. are available at the Building Division1. To conserve space on the-permit form the scheddleshave been abbreviated?. If the item(s) to be installed are not coverod onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES0. As noted on the CAp, the label must be delivered to theelectrical contractor for signature by his etectriiai -
supervisor. The general contractor ii.not auttrorizedto sign thF elect..ical IabelIII. Applicant to siqn and date
tlhenever possibie, the initial application will be used asa.worksheet oniy. l,lhere possible, Building 0ivision Staiiwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued io" f,issi gna ture.IV. fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans wiii be processed until these. fees. are paid. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registratio'i with the Builder's Board because:
Additional Project Information:
nu*u LaBA€ 71 6 E* risnature
PLANS REVIEWED BY:
date 6:?'86
l