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HomeMy WebLinkAboutPermit Building 1984-08-08ON LINE CITY OF SPRINGFIELD COMBI NATI ON APPL ICATION/PERMIT 726-37 Job Address EIIERGY SOURCES Heat !,later Ran 5q. Ftg. Access.--- Sq. Ftq. 0ther_ _l,lew-AddrAl ter_Rep. _Fence_Demo Change/Use_other- CE.9o $ l-egal Description ""l1,Rb):o0wne Address Phone Builciin Fami I y g'Pernrit Info: Describe l^lork( Residence l,lith Attached Garaqe .e., Build Single ( I \ Cons tructi der --\C\nA *f\o Fr N r Ah t,}.Jc.O Q - Addres s Phone \ name address exDl res phone no. Prima Structura I El ectri cal l'|echani cal S name addres s lics. no-exoi res )ohone no. Genera I I ,{Y, Pl umbi 0 EI PLUI.{B I NG ELECTR I CAL MECHAN ICAL FFF CHARGE NO FFF CHA PC F NO FFF CHARGF Each single fixture Residence of SQ. FT furnace/burner to BTU' S Relocated buildinq (new fi x. addi ti onal )\ New ci rcui ts al ts or extensions rr \S@ Floor furnace and vent S,F. Residence ( I uattr)SERV I CES Recessed wal I Soace heatcr and vpnt Duplex (l bath) each Additional bath Temporary Constructi on Apoi iance vent sepa rate l.later servi ce Chan res i ge in existing dence Stati onar-v evap cool er Sewer multifamily, comm. or Industrial Vent fan with sinole duct Storm Sewer Vent system heatinq or A apart from .c. COMI"I./IND. FEEDERS Mechanical exhaust hood and ductInstal I /al ter/re1 ocate di stri b. fppdprs l'Jood stove/heater 0f s. ISSUANCF OF PFRI.IIT TOTAL CHARGES TOTAL CHARGES \s.oo IOTAL CHARGES WHERE STATE LAIIshall not be vali.l REQUIRES that the Electrical work beuntil the label has been signed by an done by an Electri Electrical Supervi cal Contractor, the electrical portion of this pernitsor and returned to the Building Division I HAVE CA INED the comp eted apnl cat on for Dermit, and do here b.v certi fy that al I rmation hereonand correct, and I further certify that any and all work oeriormed shali be n s true of Springof any st Board is field and the Laws of the Sta te of 0regon oertaining to the work den of the Building Division. I further done in accordance with the 0rdin ances of the Citywill be maderucture without the permi ss io scribed herein, and that N0 OCC UPAI,IC Y in full force and efifect as required by ORS 701.055, that if cer tify that m.y registrat.ion vrith the Builder's only s ubcontractors and ernployees who are in comoliance with 0l?S 701. ' exempt the 055 wilI be basis for exemption is noted hereon , and thatused on this Droject l{At'lE(please print (t,n I GNATURE 0-4 Y\'3y BUILOING PERI'IIT Charges and Su rcharges c>c) BO P lan Ck. -onxr/ In-a- 65%/8ldq Per Fee Systems Deve Charqe (1.52 opment PLUI4BIN6 PERMIT Charges and Surcha rges Fence I Dgmo / ELECTRICAL PERIIIT Charges and Surcha rges oc> _ __\r= G(> Sidewalk A/C Pavi ng Total Cor',rb. Permi tMECHANICAL PERMIT Charges and Surc ha rge s Curb Cut TOTAL &e40 0f amPs t,la TOTAL Load jO sg.eroupBl sq.Ftg 0therain - Stor.i a, __ 0cc.v Fi re ood PI --?<)--an t#Yt U(--)-____\/-____ PERMIT VALIDATION Perm'it Cl erk lu33% COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 C. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical ceiling/o2. exarTrp fe- waterheateEETdETIItilTorE, Square footage or valuation, etc.l. example- 1250 sq. foot house, 500 sq. foot garage 2. exampie- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage ?. example - remodel existing garage into family room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated?. If the item(s) to be instal led are not covered on the abbreviated schedules you should consult the ful I schedulesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrica'l contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label.III. Applicant to sign and date Whenever possible, the initjal application wil'l be used as a worksheet only. Hhere possib)e, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna ture.IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. r forced air gas sol ar 2 V. FOR OFFICE USE ONLY Lot 1. Block 3, 2nd Addition to eld Estates exampl e- SFffisTi PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: S a-E permit appl.icant exempt from reg'istration with the Bu'ilder's Board because: Additional Proiect Information: PLANS REVI EI,JED BY dateS1gnatu re ,b0