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
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