HomeMy WebLinkAboutPermit Building 1983-06-08IIISPECTION LIIIE
726-37 69
CITY
COHBI i{ATI ON
OF SPRiNGF
APPL I CAT I
I ELD
ON/PERI1IT
INFORI1ATION LiNE
726-3753
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Job Address / yoz Mz>* wr ,Blv>EIIERGY SOURCES:
Hea
l,later Heater
Ranqe
So . Ftq. l'1a i n_
Sq. Ftg. Access._
Sq. Ftg. 0ther_
_l.lew_Addal ter_Rep.
_Fence_Demo Change/Use
0thertupca4T-
\Legal Oescription
Owner wa Val ue of tlork:7;z*.-r
Address Phone le Work(i.e., Build SingleI Garaqe)
/*srl<c- Ttvo ,k*s ,Yb--z
Construction Lender a1 ?s,-.
Addre s s Phone
DE5 I GN TEAt{name addre s s tcs. no.exDl res ohone no.
Pri ma ry
Structura I
E I ectri ca I
l'lec ha n i ca I (6
lCTORS n ame addres s 'I i cs. no.exDt res ohone no.
Genera I
Pl umbi nq
El ectri ca I
e a €u 2).D /
PLUIIBI IIG ELECTR I CAL HECHANICAL
N0.FEE CHARGE NO FFF . HA PCF t't0 FFF THARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' S
Relocated bui Iding
(new fix. additional)x New circuits alts.
or extensions2 <t?<atfS /f,.--
Floor furnace
and vent
S.F. Residence(l bath)SERV I CES
Recessed wal l
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
<Pna rate
Ilater servi ce Change
res i den
in existing
CE
Stati onar-v evap,
coo l er
Sewer multifamily, conrn or
Indrrstria I
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systen apart from
heatino or A.C.
coMr.r./IND. FEEDERS
Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
distrib. feeders ['lood stove/heater
0f amps /2q,rofi1tOat 7 ,--GD.
/db,*BZory ,7 6 *
ISSUANCE oF pFRHIT /2,o-
TOTAL CHARGES TOTAL CHARGES /fr"TOTAL CHARGES ??,tF
UHERE STATE L,1t,l REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valil until the label has been signed by an E'lectrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication for permit, and do hereb.y certify that all infonnation hereon is true
and correct, and I further certify that a ny
of
and al'l r,tork Derformed sha'lI be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State 0rego
the Bu
n oertaining to the work described herein, and that N0 OCCUPAHCY will be madeof any structure without the permission of 'it di ng
701
Division. I further certify that my reqistration with the Bui'lder's
Board is in full force and effect as required by ORS .055, that if exempt the
wi th 0l?S 701 .055 tti lI be
basis for exemption is noted hereon, and that
only subcontractors and er:rployees who are in comcliance us I S proJec
,r\\wbfftl,lAl.tE (please pri nt)OUrx* (D.
S IGNA
FF
Zone TyD e/Cons t._Uni ts Ftg
Ftg
Ftg
l'la i n Value
Fire Zone Bedrooms Occy Load Access x Va
o the r /?E Z t?.ft?a Ct? 1 u a
lue
Flood Plain Stories Group Sq lue
BUILDING PERNIT
Charges anC
Su rcha rges
Plan Ck. Conm/Ind
65%/B1do Per Fee
Svstems Deve
Charqe tl.51
opmmt
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERI,IIT
Charges and
Surcha rges
Fence
Dgmo
ELECTRICAL PERIIIT
Charges and
Surcha rges
Gr-
b
Sidewalk
A/C Paving Tota'l Comb. Permit
I1ECHANICAL PERMIT
Charges and
Surc ha rge s
??. .. a
,3E
Curb Cut
TOTAL 5e,va
iur'arn cln'lv
TOTAL VALUATION
COMBINATION APPLICATION/PERHIT (CAP)
I. Applicant to furnishA. Job Address8. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. ellamole- Lot l. Block 3, 2nd Addition to
SpFl-ngfield EstaresC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
bD=ry
l. examol e-2. examol e-E. squaET66-tae
heat/electrical r lorcqd air gas 8 g3wa te a ter e or soTar
e or valuation,l. examole- J!!q sq. foot house, 5OO sq. foot garage2. @J?-new project, check-i-ew - ir aaaitioi,
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. examp]e - remodel existing garage into family roomJ. examDIe. - convert single fam.ily residence into
EsTi'ur-ant (change of "uie)
G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blink spaces ociur in the description--portion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be insta'lledB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Buiiding Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be instaljed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF l,tILL 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 his electricalsupervisor. The general coniractor il not authorizedto sign the electrical labelIII. Applicant to sign and date
I'lhenever possib)e, the .initial application wil.l be, used asa.worksheet only. Where poss.ible, Building Division Staffwill prepare a type written copy and returi it to theapplicant at the time the actual permit is issued for his
s i gna ture.IV. Fees and Charges
P'lan 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.
V. FOR OFFICE USE ONLY
ud,l
Permi t C]er
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Bu'ilder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name
LhcrJ s1 gna tu r date 6*aF
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