HomeMy WebLinkAboutPermit Building 1984-02-10PL I CATI ERMIT 37TION
69
NE COIlBI T \\At
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Value of t'lork
0wner
Address /{aC
Addre s s
'I
Desu ra'I
Phone
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ng eernl't
Construction Lend er
l'1a n
Job Address
EIIERGY SOURCES:
Heat eLQ<.?,
f,tater Heater €1€17.
Sq. Ftq. Access.._--
name a
Mechan i ca I
E l ectri cal
Structura I
Pri
MECHAN I CALELECTR I CALPLUI.IB I NG
FFFNOFFFCHARGENNFEECHARGE
(o /8.4furnace/burner to&o,ods BTU's7Residence of
FTSQ.$"/tb.-oaAO Each single fixture
Floor furnace
and vent
New circuits alts
or extens ions
Relocated bui lding
(new fix. additional )
Recessed wai l
Soace heater and ventSERV I C ESS. F. P,es i dence
( I bat-h )
Duplex (1 bath) each
Apol iance vent
separateTemporary Constructi onAdditional bath
Stationary evap.
cool er?a.o'ge in existing
dence
C han
res i
,75 l.later servi ce
?Vent fan with
sinole duct 3a?5,4 I ndustri a I
multifamilyn comm. or?o'Sewer
9.n ftsa
7"
2fro./of droo amps.I apart from
.c.
Vent systern
heatinq or A/&'Storm Sewer
v,*B*9c0r,1r.1. / IND. FEEDERS 7 Mechanical exhaust
hood and duct
tr'Jood stove/heaterInstal 1 /al ter/re1 ocatedistrib. feeders
/0,4 €.x ootT<afi ,5a zszIof lAA S
t?ald.{a*z . Orytr ,c-EII/sb /
A 2ac^tr ?S
ISSUANCE OF PFRI{IT
5E.SaTOTAL CHARGESTOTAL CHARGES ?@,€TOTAL CHARGES /64
WHERE STATE LAl'l REQUIRES that the Electrica'l work be
sha]] not be vali,l untiI the label has been signed by an
done by
E l ectri
' an Electrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon'is true
and correct, and I further certify that any and al'l work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that I'lC OCCUPAI,ICY will be madeof any structure'without the permission of the Building Division. I further certify that my registration r,rith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption'is noted hereon, and that
only subcontractors and ernployees who are in comcliance with 0l?S 701.055 will be used on this Droject.
t,lAt'lE(please pri IGIIAT
).,.r-l=IJ '/0dur
Fire Zone Bedrooms 0ccy Load
Fjood Plain Stories / 0cc.y Grou
Ftg. Access x Value_
r t s . otn
" " -zrr-W-d-g-* -------y a1 u e ?O, ) a?. -r,Yrar.COTOTAL VALUATI#<zt=z
t 2?t sq
Ftq . l4a i
y'-3
Zone const.S./r/rt, untts uatueZ$Q,??/.1ttl-
Pl an Ck. Cornm/ Ind
65"1/81rlo Ppr Fpc ?r9,4 P.J Rr*&S opment 9065,'oBUILDING PERMIT
Charges and
Surcharges
ttz. f,o
/?.vy Plan Ck. Res
30%/Bldq Per Fee n4,/,/ ffryrau, I -€e
Fence Alasz>te;T 27,2tPLUI4BING PERMIT
Charges and
Surcha rges /o .ra
260.'o
D6mo
Sidewalk ??O'2A.&ELECTRICA,L PERIlIT
Charges and
Surcha rges --l?S.-a--.?o A/C Paving /60 ,a Tota'l Comb. Permit // q/.26
Curb Cut Q!'t,/.88 5 z36. ofI1ECHANICAL PERI4IT
Charges and
Surc harges 2./r TOTAL
Legal DescriPtion
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. examole- Tax Lot 100, Lane County Map ReferenceI7T5T32. example- Lot l. Bjock 3, 2nd Addition toSpFingField Estates
!. Name, etc. of owner and construction lenderD. Energy Sources
I e l ectri ca I eili or forced a2teresoarE. Squa valuatIexamp I e-
examp l e-
check add
O['c
2
1250 sqif new
foot house, 500 sq. foot garageproject, check'
etc.new - if addition,
F, Buil
I
ding perm
example -;ttaaTA
it information:
construct single fam.ily house with an
2
gara ge
3.
exampl e
examp I e
. restaura
lue of wor
- remodei existing gara ge into family room- conve rt single famil y res'idence i nto
G. Va
nt (c hange of use)
kas defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI{ AND CON1RACTORS
II
To avoid design or construction delays, Build.ingDivision Staff must be able to contatt appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated P)umbing, Mechanical, & Electrical SchedulesA. txcept where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appiicant need fill-.in only the No. Boxes adjacentto the appropriate item(s) to be instajledB. Full Plumbing, Mechanicil, and Electrical Schedu'lesare availab1e at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consu'lt thefulI schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theeiectrical contractor for signature by his electricalsupervisor. The general contractor is not author.izedto sign the electrical label
Appiicant to sign and date
Whenever possible, the initial app)ication wi'll be used asa worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return 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 time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III.
IV.
PERMIT VALIDATION
QhoM,
L-to-%
laL4OZ*'tdH0a
Permit Clerk
PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
Permit applicant exempt from registration with the Builder's Board because:
Add'iti onal Project Informati on :
PLANS REVIEWED BY:
name s i gnature date
1