HomeMy WebLinkAboutPermit Building 1984-10-03'i
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COMB I TIATI APPLI CATI T
Job Address
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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
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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:
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