HomeMy WebLinkAboutPermit Building 1982-04-19Job Address
Legal Description -2 l.later Heater Gi S"
SOURCES:
G a-rEIIERGY
Hea t Sq. Ftg. Acces-,
Sq. Fto. Other_
-l'lewJddT-AlIilfieE-_Fe nce_Demo_C ha nge/ U se
-other-
. l.la
Val l,lork: cR)
Owner
it I 0 Wobe
d e
Desc ,l S e€. tAdd16ss
u, -/,u0,tr,OLdA-lLytu ,
Construction Lender
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b)
N
Address Phone
Prima
Structura I
5).er*-
C.uu-r/
E'l ectrica l
Hcchani ca l
t10 FFF
El ectri ca I
ELECTR I CAL MECHANICAL
FFF {:HARGF NN CHARGF
PLUIIB I NG
furnace/burner to
BTU' s
CHARCTf.
AE-7 Each singie fixture Fa6,.
Floor furnace
and vent
New circuits alts
or extensions
Relocated building
(new fix. additional)
Recessed wal l
Soace heatpr and ventSERV i CES5. F. P.es i dence(l bath)
Duplex (l bath) each
Temporary Constructi on Apol iance vent
se Da ra teAdditional bath
Stationary evap.
cool er
Cha
res
nge in existing
i denceIlater service
7.-,eb.2 Vent fan with
sinole ductI ndustri a I
multifamily, comn. orSewer
Vent system apart from
heatino or A.C.0fStorm Sewer
Mechanical exhaust
hood and ductCOMTI./IND. FEEDERS
Instal I /al ter/relocate
di cfri h fpedprs lJood stove/heater
0f S
Pax 'M/7llofa: lAOrrra,*tc
R4 V??&c>rREP frt
/opr ISSUANCE oF PFRlrrr /a-€eacrvt<i1 h
TOTAL CHARGES l6.nTOTAL CHARGESTOTAL CHARGES I a<-?1_
2n^A.-c
TOTAL VALUATI
a
x
x
Oc cy Val
Val
l'la i
2ru2.'''
Ftg
Ftg
FtgFlood Plain Stories / 0ccy
Val uezone €.2 ryoe/const.!31fulR--lnits
t-oad 2 ?89 Sq
e"oup A-3 sq
Fire Zone Bedrooms Access
0ther
/./.4.
'Jvstems Development
Charqe (1.52) 'Plan Ck. Conm/Ind
65%/B1do Per Fee ?Le. P'r a't7'a
Plan Ck. Res
30%/Bldo Per Fee
BUILDING PERI.IIT
Charges and
Su rcharges
___ye._-__
.12
Fence
Dgmo
PLUI4BING PERMIT
Charges and
Surcha rges
t:l--- -I .ya____7_
S'idewa I k
A/C Paving Total Comb. lermit
ELECTRICAL PERI1IT
Charges and
Surcharges
t)!.8€P_
Curb Cut
/ a 2."6
lOTAL
I.IECHANICAL PERHIT
Charges and
Surc harges .4'{
110
ilL CITY OF SPRINGFIELD
COI1BI IIATION APPL ICATION/PERMIT
WHERE STATE LlIi REQUIRES
shalI not be valiC untiI the
that the Electrical work be done
Iabel has been signed by an Eiec
7?
by an Electrical Contractor, the electrical portion of this pernit
trica'l Supervisor and returned to the Building Division
Y EXAPIINED the ca on for oermit, an certify that al1 information
and correct, and I further certify thatof Soringfield and the Laws of the State
any
of
al'l work performed shall be done in accordance with the Ordinances
oertaining
ission of
app
and' 0regon
the Bui
of
to the work described herein, and that f'lO 0CCUPAI{CY wil
is true
the City'l be made
ilder's
and thatfI di ng Division.
701.055, thaas required by ORS
only subcontractors and ernployees who are in compliance with ORS 701.055 wi ll be used on this Droiect
t{Al'lE (p lease pri nt
any structure without the perm
rd is in fulI force and effect
I further certify that my registration vrith the But if exempt the basis for exemption is noted hereon,Boa
o
pxni rec )(ohone no.DL51GN I LAI4 I name (address
:TORS ( name
Err
Residence of
sQ. FT.
ue----
8pz,zE
\
COI.4BINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition to
SpFTn-ETietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
E.
F. Bui I ding permit i
example - con
attached gara
exampie -
example -
res tauranG, Value of work as
Structural SpeciH. DESIGN TEAM AND
nforma ti on :
struct single fami)y house with an
ge
remodel existi rage into family roomng ga
famiconvert si ngl e ly residence intot(change of use)
defined in Section 303 (a) of thealty Code
CONTRACTORS
1
2
3
II.
III.
IV.
To avoid design or construction delays, BuildingDivision Staff must be able to contalt appropriitepersons regarding design information or job sitecorrections, etc,
Abbreviated Plumbing, Mechanica'1, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electricai Schedu.les,the applicant need fill-in only the No. Boxes aOjiientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the-permit form the schedu.leshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF t,lILL 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 etectriiai"-supervisor. The general contractor is not authorizedto sign the electrical IabelApplicant to sign and date
I'lhenever possible, the initial application wi.lI be used asa.worksheet only. l,lhere possible, Building 0ivisio; Staiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued iJ. f,is
s i gna ture.
Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans wiil-be processed until thesetees are paid. Al l other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLYV
/7u / qe
PERI,IIT VALI DATION
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
<4L /t
a Oaqu
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
name Ladat€ P<* + s;gn
PLANS REVIEWED BY:
-82:dateature
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