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Home My WebLink AboutPermit Signage 1980-10-23CITY OF SPRINGFIELD COMBI iIATI OI'I APPL ICATION/ PERI'4 IT -37 Job Address l-egal Description o llater H EIIERGY SOURCES Hea t Owne r ) varubE#thco Ftg. I'lain_Sq Sq Sq Ad Ftg. Access Ftg. Cha nge/ Use Addres s in ched Gara Pe rnr e eC IFami Bu lii thA conrt.r.-ti\n U["",\-.Qr\onT['] l . i-\\ n[\[q, [.Ct N \ Addre s s Phone ]oa> , DtSiGN TEAI.I nane address 1CS. nO.exD r res "lU I (phone no. Pri ma ry \J St ruc tura I Electrical ilechanical exD'r res (ohonp noCOI{TRA 'i n? "eci':n i Electrical PLUIlB I IIG ELECTR I CAL I,IECHAN ICAL ._"t i FEE CHARGF NN FFT CHA RG F FFF CHA RGF [acn singie fixture I Residence of SO. FT furnace/burner to BTU' S qelocated building (new fi x. addi ti ona I ) New ci rcui ts al ts or extensions FIoor furnace and vent I S. F. Residencel(t t,atn)SERVI CES Recessed wal I Soace heater and vent Duplex (l bath) each Addi tiona l bath Temporary Constructi on Apol iance vent seDa rat-e l,later servi ce ge in existing dencp Chan rpc i Stati onar.v evao coo I er Sewer I ndus tri a I multifamily, comm. or Vent fan with sinole duct Storm Sewer 0f c Vent systern apart from heatino or A.C. COI,lI.!./IND. FEEDERS Mechanical exhaust hood and duct- I ns ta I I /a I ter/ rel ocate di siri h fppdprs !'Jood stove/heater 0f ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LlH REQUIRES that the Electrical work be done byshall not be valil until the label has been signed by an Electri an Electrical Contractor, the electrical portion of th.is permit cal Supervisor and returned to the Building Division oertaining to the work described herein, and that NC 0CCUPANCY will be ding Division. I further certify that my reqistration r,rjth the Builder,s RS 701.055, that if exempt the basis for exemption is noted hereon, and that S lGNATURE a_L ,,tftt 2g&'l ty Boa r I HAVE CAREFULLY EXAMINED thc completed apnlication for oermit, and do here b.y certify that al'l information hereon is trueand correct, and I further certifv that any and a1 State of 0reoon 'I work performed shall be do ne in accordance with the Ordinances of the Ciof Soringfield and the Laws of the madeofastructure without the permission of the Builnydis in full force and effect as required by 0 onl_y s ubcontractors and employees who are in comol iance with 0l1S 701.055 rvilI be used on this Droject.r/to sl llAl.lE (pl ease pri nt o.ttr-/\e- C-r)d^Q. Fire Zone Bedrooms 0ccy Load Sq Tyoel Cons t X.Va lue So.lue Val ue Flood Plain Stories Occ.y Group. Uni tsZone TOTAL VALUATI Ftg. Access Ftg.Other_ Fto. l'lain Plan Ck. Comm/Ind 65%/81do Per Fee Svstems Deve Charoe ( 1.52 opmentBUILDING PERI{IT Charges and Surc harges 1-g-Oc: Plan Ck. Res 30%/Bldo Per Fee Fence Dgmo Sidewal k PL1,,I4BING PERMIT Charges and Surcha rges ELECTRICAL PERTIIT Charges and Surcha rges Total Comb. PermitA/C Paving Curb Cutl,1ECHANICAL PERMiT Charges and Surcha rges C)OIoTOTAL D-5L1C 1 \\t\ fi\Cr0' COMEINATION APPLICATION/PERMIT (CAP) Applicant to furnish A. Job Address B. Leqal Description 1. example- Tax Lot 100, Lane County I 17 03 43 2. example- Lot 1. Block 3, 2nd Addit Spr-i ngFi e1d Estates C. Name, etc. of owner and construction l, D. Energy Sources Map Reference ion to ender r forced air gas1. example- heat/2, example- water Square footage or electrical ceilin o r e ec ca or solar E vaiuat on, II 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exampTer if new project, check-new - if addition, check acid, etc.F. Bui lding permi t information: 1. examDle - construct single family house with an titafi-ed garage ?. exarnoie - remociel existing garage into famiiy room 3. damElE - convert s'ingle family residence into r"esTIITant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specia lty Code H. OESIGN TEAI{ AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or iob sjte corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Sxcept r.rhere blank spaces occur in the description :crtion of the Mechanicai and Electricai Schedules, tne appiicant need fill-in only the No. Boxes adjacent :c the appropriate item(s) to be instailed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the ful l schedules C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES Oi{ THE SCHEDULES0. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his eiectricai supervisor. The general contractoris not authorized to sign the electrical label. Applicant to sign and date Whenever possible, the initial application will be used as a rvorksheet only. l,lhere possible, Building Division Staff will prepare a type written copy and return it to the applicanc at the time the actual permit is issued for his s i gna ture. Fees and Charges P'lan check fees are due and payable at the time of the application, and no pians will be processed until these fees are paid. AII other fees and charges are due and payable r.rhen the permit is issued. iII IV V. FOR OFFICE USE ONLY PERMIT VALIDATION PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Perm'it applicant exempt from registratjon with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name S'I gnature date Permit Clerk PE -3 LII]E ' CITY OF SPRIITGFiELD COMBI |IATI OI.I APPL I CAT IONI PEP'I4IT 726- Job Address EIIERGY SOURCES Hea l,Jater Hea Ftg. l.la i n_ Sq. Ftg. Access._ Sq. Ftq. O*,.. IM Jlew_A.dd A]IEfffi. Demo Cha nge/Use DOa , Leqal Description Owne r ) varubEJEr\.oc Addres s e Builciinq Pernrit Info: Describe t^lork(i.e., Bui.ld Single Fani I y lles i dence l'li th Attached Garaqe ) constriltr\n fuF., t Addre s s Phone nane address exoi res ohone no. Pri ma Structura l El ectri ca l i'!ec na n i ca l li{A n aiie add res s l ics. no- )exor res ohone no. )<.q(J.L r n ) I C rical ,tl I ;LUl1B l:i3 EL ECTR I CAL I'4ECHAN I CAL trs:CHARGI i\0 FFF I CHARCF ilo. I FFF I'HAPIIF t iacn singie fixture i I I I Residence of )t,at furnace/burner to BTU' S lelocated 5ui.l ding (new fix. additional ) Nerv ci rcu'i ts al ts or extensions Fl oor furnace and vent S. F. P.esidence(l bath)SERV ICES Recessed wa'l I Snacp hpatpr and vpnt Duplex (1 bath) each Additional bath Temporary Constructi or Apoi iance vent seDarate l,la ter serv i ce Chang res i rl e in existing ence Stationary evap cool er Sewer multifamily,comm. or Tndrrstr.i a'l Venj fan with sinole duct Storm Sewer 0f amps. Vent systenn apart from heatinq or A.C I I COI,lI.!. /IND. FEEDERS Mechan i cal exhaust hood and duct Instal I /a l ter/rel ocate distrih- feeders 0f arTrp s. I ISSUAI!CF OF PFRIIIT TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES l,lHERE STATE LllJ REQUI|IES that the Electrical work be done by shail not be valil until the labej has been signed by an Electric an Electrical Contractor, the electrical portion of th'is permit al Suoervisor and returned to the Building Division t,anddohereb.ycertifythatallinformationhereonistrue and correct, and I further certif-v that any and all rvork performed shall be done in accordance with the 0rdinances of the City of Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that tl0 OCCUPAI'ICy will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exemot the basis for exemption is noted hereon, and that onl_y subcontractors anci ernnloyees who are in comcliance with 0lls 701.055 will be used on this nro.ject. L/\O S( l,lAllE(please print o-fi-,-r\s- O-Dd*Q-,a-L m\e--L DATE[fr|S IGi.IATURE Zone e/ Const.Uni ts (a Ftq. l'lain x.lue Fire Zone Bedrooms 0ccy Loa d Sq. Ftg Acces s. 0ther X Val ue x Value TOTAL VALUATI on^j--55().aD BUILDING PERT1IT Charges and Su rcharges 1-g-Oo Plan Ck. Comm/lnd 65%/B1do Per Fee Svstems Develocment charoe (1.5q.) Plan Ck. Res 30%/81dq Per Fee PLL"18ING PERMIT Charges and Su rcha rges Fence Dgmo ELiCTRICP.L PERIlIT Charges and Surcha rges Si dewa I k A/C Pavi ng Total Comb. Permit IlECHANICAL PERMIT Charges and Surc ha rge s Curb Cut TOTAL ico(o ( -I\IILAIl I L l'Jood stove/heater Flood Plain Stories Occ.y Group '. Sq. Ftg. \ PERI4IT VALI OATION :ITY OF SPRINGFIETD City Hol! Springfiold, Oregon Deporlment of public WorksOFFICIAI RECEIPT No. B 54979 I9 i (n ived For.: ( ( (unt Received SIGNATURE 3HCltOt.tuRNEULL plrNtEiS - €u6EXE OR 97aot !a!tt.a Permit Clerk coMBINATI0N AppLrcATroN/PERI{IT (CAp) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map ReferenceITTTTS2. example- Lot-l. Block 3, 2nd Addition toSffiffiietd Estatesq. Name, etc. of owner and construction lenderD. Energy Sources 1 examo.l e- examo I e- re tOotag hea t,/e I trical li or fOrced air oasr sofi7..-tva ter e oE. Squa e or vaiuati on, etc. examol e- examp I e- EIEEI-acia 1250 s q. foot house, 500 sq. foot ga ra ge2.JF-new Project, check new - if addit ion, r trLLF. Bui Idihg pemi t information:l. exarnp.le _ construcr single family house rvith anai!acnec garage2. exanDlg _ remocie.l existing garale into family room3. exarroie - converr sing.le i#iit";";;i;"n.""'i,ito'""resraurant (change of use)G. Value of work as defined in-iection 303 (a) of theStructural Specialty CodeH. OESIGil TEAIi AND COII1RACTORS To avoid design or construction delays, BuildingDivision Staff must be ab.le to contact aooroDri:rppersons re-oarding design information o" ibU-!it.--corrections, etc.II. Abbreviated piumbing,. i,lechanica.l, & Electrical SchedulesA. lxcept r.,,here blink spaces o.iu. in-tne ;;;.;;;;;;;-':crtion of tne Mechanica.l and E.lectricai Scirearies,tne applicanr need fiil_in only the No. eoi;i-iljui.nt_ :o--:he aDprcDriate item(s) to be installedB. Fuil piurnbing, Mechanicit, ana-itectricai-s.hedulesare available at the Building DivisionI. To conserve. space on the permit form the schedu.leshave been abbreviated2. If the .item(s) to be installed are not covered onrhe abbreviated schedules you shouid .onirit-ti,"full schedulesC. BUILDING OIVISION STAFF I^JILL FILL OUT ALL FEES ANDCHARGES Oi{ THE SCHEDULES0. As noted on the CAp, the label.must be delivered to theelectrical contractor for signaiure by his eleciricai'supervisor. The generar conlractor ii not urirrJrii"a ^ .fo sign the electrical iabel.rrl. App ncant to sign and date Hhenever possibie, the initial application wi.ll be used asa.r'rorksheet only. Hhere possibti, auitaing o.iriri"n-iialiwil'l.prepare a typg written.opy-ina-".turn it to theapplicanc ar the time the actui-t peimit is lsiuei ior" r,i,signature.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and-no prans wilt-ue processed untir thesefees are paid. All other rees inU'ciarges are due andpayable rvhen the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY: P e trml iI ac tn ft rompap S'l rtemp ta oI Winreg h+L Bthe iu dI re S oB rda be c ua es Additional project Information : PLANS REVIEWED BY: name dates'l gnature ( ( { I