HomeMy WebLinkAboutPermit Building 1984-12-11IISPEC
26-37
COHBI II!AP ,TI IT
OF RI IE
Job Address !
Lega l Description
c
Phone
Phone
Owne r
Address
Construction Lender
Addres s
re., Bu Sing e
tl IERGY SOURCES I
sAccesl,Jater Heater
Hea t
Ran qe
Val ue
nera
Hechanical
EI ectri cal
Structura I
Prima
'lectri
PLUIIBI NG ELECTR I CAL
6 Each single fixture f*30.-
Residence of
SQ. FT
furnace/burner to
BTU' s
Relocated bui lding
(new fix. additional)New circuits alts
\^Ehlion)qaae
Floor furnace
and vent
s . r. Res iainiE-1l lattr)SERV I CES Recessed wal I
Space heater and vent
Duplex (I bath) each /lzr*< Du.zu ,dD@.
Additional bath Temporary Constructi on ApoI i ance'verit
sepa rate
[^later service ge in existing
dence
C han
resi Stationary evap
cool er
Sewer Indrrstrial
multifamily, conrm. or /Vent fan with
sinole duct 3i?
Storm Sewer 0f S.Vent systern apart from
heatinq or A.C.
coHH./IND. FEEDERS Mechanical exhaust
hood and duct
Instal l,/al ter/rel ocate
di stri h- fpedprs Hood stove/heater
0f s
ISSUANCE OF PFRIlIT
IIHERE STATE LAN REQUIRES that tlre Electrical work be done by
shall not be valiC until the labe'l has been signed by an Electri
jrc TOTAL CHARGES
an Electrical Contractor, the electrical portion of this permit
TOTAL CHARGES
ca1 Supervisor and returned to the Building Division
a|D
I HAVE CAREFULLY EXAHINED the completed appljcation for permit, and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and al1 work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Oregon oertain'ing to the work described herein, and that NC 0CCUPAI'ICY will be made
of any structure without the permission of the Buiiding Division. I further certify that my registration vrith 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 ORS 701.055 wil1 be used on this project.
Ly'7liAl'lE(piease print)S I GNATUREoqih-I ,
. Fto. Access x Value.rri.o*uWr*"@
.4/tEffist Irain Y
1Ftg
Fire Zone Bedrooms 0ccy Load
Flood Plain Stories Occ.y Group
Zone dhP nst
TOTAL VALUATION
AI VC
51,
o
1 /u.,4 .
Plan Ck. Conm/Ind
65%/Bldo Per Fee ll-9l\V}
BUILDING PERI'IIT
Charges anC
Su rc ha rges
___34 --
Plan Ck. Res
30%/81dq Per Fee
Fence
v- ir I
PLUI4BING PERMIT
Charges and
Surcha rges
__se::_.2d Demo
Sidewal k
Tota'l Cornb. Permi t
ELECTRICAL PERI|IT
Charges and
Surcha rges
___t_*=_
,60 A/C Paving
Curb Cut ?{.6/TOTAL
I'ECHAIIICAL PERMIT
Charges and
Surc ha rges
a
.ro
n,9
Sq.Ftg.
Ftg.
r
=a
R
HECHAN I CAL
,?*
TOTAL CHARGES r?|t*.
COHBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal DescriPtion
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot l. Block 3, 2nd Addition to
SpIIn-ETield Estates
C. Name, etc. of owner and construction Iender
D. Energy Sources
l. iiample- heat/electricll ceilir=rqlor fgrced air gas
2- effi'51e- waterhEITEi.zelectricaI/or solar
E. Square foofage or valuation' etc'
1. example--1250 sq. foot house,.500 sq..foot.garage
2. A[mtTe- J-f new project, check new - if addition,
EIEEE-6dd, etc.
F. Building Permit information:
1. exampie - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examplE - convert single family residence into
Estaurant (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 biink spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
PERMIT VALIDATION
III.
to the appropriate item(s) to be installedB. Full Plumbing, Mechanica), and Electrical Schedules
are available at the Building Divisionl. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbrev'iated schedu'les you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.
App)icant to sign and date
Whenever possible, the initial application will be used asa worksheet only. Where possible, Building Division Staffwili prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesetees are paid. All other fees and charges are due andpayab'le when the permit is issued.
FOR OFFICE USE ONLY
IV
v Perm'i t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Informatjon :
PLANS REVIEWED BY:
name /^ant<ta ft&8 sisnature date