HomeMy WebLinkAboutPermit Building 1984-12-09IilS
726
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COHBI iIATI ON APPL ICATION/ PERMIT
Job Address b EIIERGY SOURCES:
Hea t
tlater Heater
Ranqe
Sq. Fto. l.lai n_
Sq. Ftg. Access._
So. Fto. 0ther
l{ew Add l(l ter Peo.
-FenE offi Cnanqeluse
0ther
N
-t-
J
Nt
Legal Description 2
varue offllorffl}@
0wner c
Address U Phone BuiIcii
Fami I v
ngTerlrit Info: Describe Work(i.e., Build Single
llesidence l,,li th Attached Garaqe)
Construction Lender
Addre s s Phone
DESIGN TEAI.I ^name addre s s 1CS. nO.exDl res phone no.
Primary IIT I !rmrl
Structura l v
EI ectri ca I
Hechani ca l
name addres s 'I irs n6 PYnl req nhonc nn
JftI r I tTtrr qgJ-q>//
Pl umbi nq \
E l ectri ca l
ttechanica l
PLUIIBI NG ELECTRICAL HECHAN I CAL
FEE CHARGE NO FFF .HA PNF NO FFF .HAPGF
6 f,:30.'
Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)r New circuits alts.
\exBf'*baae
FIoor furnace
and vent
S.F. P.esidence
( l bath)SERV I CES
Recessed wal I
Snace heater and vent
Duplex (l bath) each I lLrfR Drazu ,Qlh -
Additional bath Temporary Constructi on Apol iance'venl
seDa rate
|later service Cha
rpq
nge in existing
i dence
Stati ona r.v evap.
coo I er
Sewer multifamily, corm or
I ndus tri a I /Vent fan with
sinole duct 3 G
Storm Sewer 0f s.Vent system apart from
heatino or A.C.
COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct
InstaI I /a'l ter/relocate
dictrib. feeders Hood stove/heater
0f amps
ISSUANCE OF PFRI1IT
TOTAL CHARGES c ?d.nn TOTAL CHARGE5 fr rSZ rorAL CHARGEs t?ha, 8/d.*
WHERE STATE L]\t.I
shall not be valiC
REQUIRES thatuntiI the labe
tlre El ec tri ca 1 w0r k be done by
an Electric
an EI ec tri ca I Contractor the e I ectr 'I ca 1 port I on this permit
I has been S 1 9 ned by I Su pervi s0 r and returned to the Bu 1 I di n9 0i v'l sl 0n
mxAHINEDthecompletedapplicationforpermit,anddoherebycert.ifythatallinformationhereon.istrue
and correct, and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that t.l0 OCCUPAI'ICY will be made
of any structure without the permission of the Building Division. I further certify that my registrat'ion vrith 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 that
only subcontractors and employees who are in comoliance with ORS 701.055 wi'll be used on this Droiect.
l{A}.lE(please print -l ,g 4-{h TURE TE /ty'?
F
Zone ChR t ts Ftg /l,ruin u .I
Fire Zone Bedrooms 0ccy
Flood Plain Stories 0cc.y Grou
. Ftg. Access x Value.rri.*n""Wu*"-ZMT
TOTAL VALUATION
BUILOING PERNIT
Charges anC
Surcha rges
___3G_,-__Plan Ck. Corm/Ind
65%lB1do Per Fee //.,/ .
Plan Ck. Res
30%/Bldq Per Fee tl &(,.1hvt
PLUI{8ING PERMIT
Charges and
Surcha rges
___3 o.oo
2A
Fence
vv l, I I
Demo
ELECTRICA.L PERI1IT
Charges and
Surcha rges
___/_*=_.3
Sidewal k
A/C Paving Tota'l Comb. Permit
',IECHANICAL
PERHIT
Charges and
Surc ha rges ----/a 6
/o
Curb Cut ??.6/TOTAL
- nrtn*.vttgil1 Ib)
hP_- t ift
Each single fixture
,?*
Svstems ueve
charqe (1.52 opmentL3A()
C CITY OF SPRINGFIELD
City Hrlt
Springficld, Oregon
Drpertmcnt ol public tf,orkt
OFFICIAL RECEIPT
No. BCOMBINATIOI{ APPLICATION/PERI,III (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Referenc,17-0'3:-3Z. exaTp-lg: Lot l. Block 3, 2nd Addition tospringfield Estates
9. Name, etc. of owner and construction IenderD. Energy Sources
(640L1
(Rec'd From
?3ac>ar*lrNah),/Address
Received For *l. example- heat/glSs..!!l!gl ceiling/or forced air rs_ ?. EfiEiTre- waf,ernearer/erectrical/0" saffi 3
L. square footage or vaiuation-,fEl-
l. _g+P]€=]p. sc. foot house, 500 sq. foot sari.. exampte_ if new project, check-new _ if additir /_ EhEEF-aad, etc. (F. Building permit information:l. g}amp.le - construct single family house with ar_ attached garage
1. +=Blg --rem6del exisrins sarage into famity r (r. examDte _ convert single family residence inioFETi-iFant (change of "uie)-""' '
: i!iiir:i,iliielqi:J'3;:.in section 303 (a) or the (H. OESIGN TEAI{ AND COII1RACTORS
]:..::::9 g::ig^ or. construction derays, Bui.tdinsulvlslon Staff must be ab.le to contallpersons.resardins desisn information ;.t53itlill" fcorrections, etc.Abbreviated prumbing,.Mechanical, & Erectrical SchedurrA. Except wnere blSnk ,p;;;;-;;;r; ;;';;;portion or ine'Mechanicar ano Electric.i:il:ili:l (the app't.icant need fi.ll_in onii ir,e r,ri. aoi;a-idjl,_ to the appropriate item(s) to -Ue insiittea8. Ful'l PIumbing, Mechanicii, i.a-er".i.iare avaiiabt6-at the Building Diris,ionttl Scheduler (1. To conserve space on the-perrnii iorm the schedt \
have been abbreviated2. II tt'g item(s) to be instal.led are not coveredthe abbreviated scheduies you siroulJ-*.irii-if (fu l I schedulesC. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANDCHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to theelectrica'l contractor for signaiur" 6, ni, electricalsupervisor. The general coniractor ii not authorized- to sign the electrical label.Applicant to sign and date
llheneyel possible, the initial application w.ill be used asa.worksheet only. Hhere possibti, Autiainq Oivisio;-a;ai;wil) prepare a type written .opy-unJ-."tr". it to theapplicant at the iime the u.a;;i ;;;rii-ir'trrr"a for hissi gnature.
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II.
III.
IV
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Amount Received
(
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AUTHORIZED
Ftlttcts? susrrrs FoaMs. rNc.193)X2.Eta9
Permit Clerk
d}B
v
Fees and Charoes
Plan.check feis are due and payable at the time of theapplication, and no plans wiil'oe p"oieisJo until thesefees are paid. All btner fees ana'ctri"S.r'.". due andpayable when the permit is issued.
FOR OFFICE USE ONLY
PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAIICY:
eP 'lrm at I anc et xpp romfempt .I ts ra i o wn t'l hreg t Bhe 'lu 1 de sr rdBoa ubeca es
Additional Project Information:
PLANS REVIEWED BY:
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