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Home My WebLink AboutPermit Building 1985-01-29INSPECTION LINE 726-37 69 COMBI APPL I CAT T 72 Job Address .+q Hea Ran EIIERGY SOURCES: l,later HeaterLega1 Description I o Value of Uork:E.gtMo Ftg.11a n Sq. Ftg. Acce Owner bb-l. ngle Farn i sidence llith Attached Gara nq Re Addre s s qq q ara Construction Lender ALr/- lH/.rj- {aa a7. drrj 0 a/ \ N.s$. 0o Phone address''I ics . no.exDt res phone noDESGN TEAI'I name Structura I Pri ma El ectri cal Mechani ca l nhonp no - 'lACTORSnameaddres s I i cs. no.exDt res Genera l Plumbino El ectri ca I I'lecha n i ca'l ELECTR I CAL MECHAN I CALPLUIlB I NG CHARGF FFF l^HAPGFFFFNNFFFNHARCFNO Residence of FTSQ furnace/burner to BTU' sEach single fixture E Floor furnace and vent Relocated building (new fix. additional ) New circuits alts\".N"**s S. F. P,es i dence ( l bat.h)S ERV I CES Recessed wal I Soace heater and vent Duplex (1 bath) each Temporary Constructi on Apo) iance vent seDa rat-eAdditional bath Stationar.v evap cool er ge in existing dence C han res il,iater servi ce Indrrstrial multifamily, conrm. or Vent fan with sinole ductSewer 0f amps,Vent system apart from heatinq or A.C.Storm Sewer iQte 6t9t(eazz COMI.I./IND. FEEDERS Mechani cal exhaust hood and duct/ Instal I /al ter/rel ocate di sfri h fppdprs lJood stove/heater/7* I 'r&!7q7e7?*lkeS:0f ISSUANCF OF PFRI,IIT TOTAL CHARGES * TOTAL CHARGESTOTAL CHARGES rY?s. /2.n WHERE STATE LAI'I shal I not be valiC u REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit ntil the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apnlication for oermit, and do hereb.v certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City and the Laws of the State of 0reqon oertaining to the work described herein, and that NC OCCUPANCY will be made ssion of the Building Division. I further certify that m.y registration r,rith the Builder's ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in comcliance with 0l?S 701.055 wi llAt'lE (pl ease pri nt )S IGNATURE DATEl }!.!5r' ngfield structu t the permi and effect of Spriof any re withou Board is in full force as required by be used on this nroject its _ Sq. Ftg. l4ain x Value_ 5q s Flood Plain Storles / Occ.y Gro TOTAL VALUATION- Fire Zone Bedrooms 0ccy Load Val ue zone C??R tyDelconst . Ftg. Acces . Ftg. 0ther Plan Ck. Corm/Ind 65%/B1do Per Fee 4 tzt. sS tems Deverge (1.s7Svs Cha opmeot 7fu.toBUILOING PERI'IIT Charges and Surcharges __/a_z_: Plan Ck. Res 30%/B1dq Per Fee FencePLUI4BING PERMIT Charges and Surc ha rges _/o._=_ . '/d Dgmo Sidewal kELECTRICP.L PERIIIT Charges and Surcha rges ___/5_?__ .Gio A/C Paving Total Comb. Permit zw,aE Curb Cut u?#.8I,IECHANICAL PERMIT Charges and Surc harges ___/_a va- * TOTAL Sq. Ftq. 0ther _-1{ewl(4dd_AIteEneF. _Fence_Demo_C hange/ U se -other- Addres s ILs /A COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. elqqmple- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical cei I ino/o2. examEl-e- wa terFEETErlefftTFiEil*/orE. Square footage or valuation,-EIE.l. example- 1250 sq. foot house, 5002. example- if new project, check-iEw check add, etc. r forced air gas:el-cl- sq. foot garage , - if addition, F. Building permit information:l. example - construct single family house with an attached garage ?. example - remodel existing garage into family room3. example - convert single fam.ily residence iniorestaurant (change of use)G. Value of work as defined in Sect.ion 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriite persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Full P'lumbing, Mechanicai, and Electrical Schedulesare available 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 consult theful I schedulesC. BUILDING DIVISION STAFF I^IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for s.ignature by his electricalsupervisor. The generai contractor ii not authorizedto sign the electrical labelAppiicant to sign and date lJhenever possible, the initial application will be used asa.worksheet only. Where possible, Bui)ding Division Staffwill 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 thesefees. are paid. Al l other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY II III. IV V PERMIT VALIDATION -,h Pd t,,|fi I Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name'Laqpa Rq+'isnatu aut" /-//-t€ L CITY OF SPRINGFIELD COHBI NATI ON APPLI CATION/ PERMIT 7 Job Address I t{ Q Lesar Description I VOS-25-24 Og9Ob lJater Heater Ranqe EIIERGY SOURCES Heat -3<l0wnerSST Val ue of llork:d-QtM-o So. Fto. 0ther _Newl(Add-AriEil[ap. - _Fence_Demo Change/Use 0ther l'1a Sq Ftg 'e., Build SingleAddres s rtqq fru+t*.--h-YEt b ?,ot-',,.-o Fami I dence n rDescAtthedac aG (S*or")a-Qr{O d,"1 / Construction Lender A.(rl- -!zr-tj-tn- {aa pl. d"r/ a a/ \ No$- 0o Addres s Phone uLStGN tt.At"t name address exoi res 10nP no-rcs. no.. Primary M*zr; funsuJ,*sa-- /2./O *a:pa. Po f,7,>4snp 97lcl ?y2A9// Structura I El ectr i ca l Mechan i cal CONTRACTORS name addres s I ics. no.'exDr res ohone no- Genera I Pl umbi nq E l ectri cal Itechani ca l ELECTR I CAL MECHAN I CALPLU14B I NG CHARGFFEE NN FFF CHARGF N FFF CHARGF Each single fixture Residence of FTSQ furnace/burner to BTU, s ENew circuits alts or extens'ions2 ***E Floor furnace and vent Relocated building (new fix. additional) S. F. Residence(l bath)SERV ICES Recessed wal I Soace heater and vent Duplex (1 bath) each Temporary Construction Apoi iance vent seDa ra teAdditional bath Change in existing res i dence Stati onar-v evap. cool erblater servi ce Indrrstrial multifamily, comm. or Vent fan with sinole ductSewer Storm Sewer 0f s.apart from .c. Vent systen heatinq or Albse 6t9t?e.62.*,Mechanical exhaust hood and dtrctICOI4I'l./IND. FEEDERS /Instal I /a1 ter/rel ocate di stri h- feeders l'lood stove/heater 0f amps I ffi!7 qaa qllv,.ltrAB: ISSUANCE OF PFRI1IT TOTAL CHARGES *TOTAL CHARGESTOTAL CHARGES lfirs. /2,* WHERE STATE l-Al'l REQUiRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed apnlication for oermit, and do hereb.v certify that a and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the Cityof Soringfield and the Laws of the State of 0regon nertaining to the work described herein, and that NC OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my registration urith 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 employees who are in comcliance with 0l?S 701.055 wi oarc /-t?- 15l,lAltE(please print)S I GNATUREr' 'll information hereon is true be used on this Droject. Fire Zone Bedrooms Occy Load Flood Plain Storles / }cc.y Grou . Fto. Access x Val.rri.orn""ffiru, TOTAL VALUATION- 5q x Val ueits So. Ftg. l'laizone C)4R Iypelconst Svsterns Develoomext Charqe (1.52) 'Plan Ck. Conrn/Ind 65%/B1do Per Fee 4 tzt. sS OO7fu.BUILDING PERI'IIT Charges and Su rc ha rge s __/a_z:_ Fee Plan Ck. Res 30%/Bldq Per FencePLUI'4BING PERMIT Charges and Surcha rges e-, /aa_ Dgmo Si dewa I kELECTRICAL PERI,IIT Charges and Surcha rges ___/5_-_ .Gio A/C Pavi ng Tota'l Comb, Permit 2?O,aE Curb Cut u?#,*TOTAL IlECHANICAL PERMIT Charges and Surc harge s ___/a=_,ro /t * C0MBINATT0N AppLICATIoN/pERMrT (CAp) I. Applicant to furnishA. Job AddressB. Legal Description l. exampie- Tax Lot 100, Lane County l,lap Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. 2.L. 5qua examoi e- examp I e- re foota heat,/electrica l cei forced air gas wa ter ter EC or soJar ge or vaiuati ofl, I examp]e- 1?50 sq. foot house, 500 sq. foot garage exampie- if new project, check new - if addition, check add, etc. 2 F. Building permit information:1. example - construct single family house with anattached garage ?. example - remodel existing garage into family room3. example - convert single fam.iiy-residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding des.ign informat.ion or job s.i tecorrections, etc.II. Abbreviated p)umbing, 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 adjaient _ to the appropr.iate item(s) to be installedB. Fu11 Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the scheduleshave been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF WiLL 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 contractor ii not authorizedto sign the electrical iabelIII. Appi icant to sign and date l.Jhenever possibie, the.i nitial application w.i I] be used asa.worksheet on1y. Where possib)e, Build.ing Div.ision Staiiwill prepare a type wr.itten copy and return it to theappiicant at the time the actual permit is issued io" tissignature.IV. 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. Ali other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY a ,|fi I Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit app'licant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY na,ne LAD- frE#r?sisnatu date 0 V,{ Pt