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HomeMy WebLinkAboutPermit Building 1984-10-03'i N NEL COMB I TIATI APPLI CATI T Job Address r-esar Descriptio\\ (\fr t53L\ CBqC() EIIERGY SOURCES Hea t liater Heater Ranqe 0wner d4Value of l,lork:.1.*)D. 5q. Ftg. Access.-- Sq. Fto. Other_ _r,lew_AddJlTEEIeE.-_ _Fence_Demo Change/Use -other- . Ftg .l.lain Address o vhone z/f,f-:€. t'i 'l S e F nq Re s dence t Descr Attac I.lork Gara Au/P-r^l-, ?z<1r'/- / 47// Construction Lender 'Tro', b?r, a<', ) \) l,./f ..s c ] O(7 I Addres s Phone DES I GN TEAI'I name ad<res s I ics. no.'exoi res V I ohone no. Pri mary Structura I El ectri ca l l''lechan i cai rFq sCONTRACTORSname oO -V Genera I Plumbin El ectrica l l,'lechani cal MECHANICAL \ NPLUtlB I NG \u ELECTRICAL\N FFFN0.FEE CHARGE NO FFF CHARGF NO Each single fixture Residence of FTSQ furnace/burner to BTLI' S New circuits alts or extens i ons Floor furnace and vent Relocated building (new fix. additional) Recessed wal I Snacp hpafpr and vcnt S.F. Residence ( I bath)SERV I C ES Duplex (l bath) each Temporary Constructi on Apol iance vent seDarateAdditional bath ge in existing dence Chan req i Stati onar.v evap cool er["later servi ce ormultifamily, comm Tndrrctrial Vent fan with sinole ductSewer Vent system apart from heatino or A.C.Storm Sewer 0f Mechanical exhaust hood and ductc0Mr.1./lND. FEEDERS Instal I /al ter/re1 ocate di stri h- feedprs I,Jood stove/ heater 0f amps. ISSUANCE OF PFRI,IIT TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES WHERE STATE Llll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shail not be vali,l until the label has been signed by an Electrical Supervisor and returned to the Building Division and correct, and I further certify that any and all workof Springfield and the Laws of the State of Oregon oertai of any structure without the permission of the Building D Board is in full force and effect as required by ORS 701. DATEtlAl'lE(please print)lGNA for oermit, and do hereb.y certify that all i rmation hereon s true Ci ty made exempt 055 wi l f hetshabenedonccaordancetth0rdhen0ancesperformed n n to eth kwor scde r hbed ere n thand NOat OCCUPANCY beg tra t uJt0n tth Buhe de r ssonfucrtherertthatfym.y ba S forsthe t on noteds and tthahattf055 sn t701tOPSh comp cati oneap r)H only subcontractors and er,'rployees who are in comoliance wi FI Ftg Ftg Ftg Val ue TOTAL VALUATI F x 6 ilpLoad Sq c.orp$l-sq al sCon te/ni ts SoZone Fire Zone Bedrooms Flood Plain Stories Acce s s 0ther l,lain x Value_ Plan Ck. Cornm/Ind 651"/B1do Ppr Fep ?.zS fu.q/tq/n Svstems Develooment'Charqe (1.52) '\\.\.BUILDING PERI'IIT Charges and Surcharges --\GO PIan Ck. Res 30%/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges DEmo Sidewalk Total Comb. PermitA/C Pavi ng ELECTRICAL PERI1IT Charges and Surcharges Curb Cut \5 c,oTOTAL 14ECHAIIICAL PERMIT Charges and Surcharges CHARGF I I I I I hereon, 3JA* COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot I00, Lane County Map Reference 17 03 43 PERMIT VALIDATION 2.examp l e- Spri ngfi Lot l. Block 3, 2nd Addition toeld EstatesC. Name, etc. of owner and construction lenderD. Energy Sources l. example-2. *rElE Square footag heat/electrical 'I 'I or forced air gas WA e e or soTar E or va I uat O[, 1. example- 1250 sq. foot house, 500 sq. foot garage2. elample- if new project, checkrre-w - if additio;, check add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?. examp_le - remodel existing garage into family roomJ. example - convert singie fam.ily res.idence 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 construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur .in the descriptionportion of the Mechanical and Electr.ical Schedules,the applicant need fill-in only the No. Boxes adjacent - to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the perm.it form the scheduleshave been abbreviated2. If the item(s) to be insta'lled are not covered onthe abbreviated schedules you should consujt theful l schedulesC. BUILDING DIVISION STAFF t'lILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by h.is electrical - supervisor. The general contractor .i! not authorizedto sign the electrical labelApplicant to sign and date Whenever possible, the initial app)ication will be used asa.worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and returi it to theapplicant at the time the actual permit is.issued for hissignature. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no p)ans wili be processed until thesefees are paid. All other fees and charges are due andpayable when the perm.i t is .i ssued. FOR OFFICE USE ONLY A \D-5 II III. IV. V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information PLANS REVIEWED BY: Si gna tu re aateQ-tt-8*\