HomeMy WebLinkAboutPermit Signage 1980-11-23L
::CIT''-, iPRTNGFiELD
COIlBI IIATI OI'I APPL ICATION/PERMII 72
EIIERGY SOURCES
Hea t
liater Heater
Ranqe
Job Address Uc rYI)Sq
. Ftq. l.1a i n_
. -tg. Access
. Ftq. OtherSq
_llew_Add_AtGr1_!en -
_Fence_Demo_C ha n gel U se
_other--
ls€j
_a5su
)
Legal Descri ption l1
Va
Owner ,J )o
Addres s Phone Builciino Permit
Farn-ily Residence
Info: Descri t
tli th Attacher Ga ra
.e., Build SingIe
I I
Construction Lender DDoYr-A-it ,m.l-t 6
Addres s Phone o-0^txi , Lt
L]L5iGN TEAI.I name address exD res ohone no-
Pri ma ry
Structura I
El ectri cal
llechanical
CON TRACTORS n ame (addrecs )lics. no.exor res ohone no-
i
Electrical
rlechanical
PLUIlB I IlG ELECTR I CAL MECHAN I CAL
I FEE CHARGE NO FFF rHA RGF i'10 _FFF rHA PGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New ci rcui ts al ts
or extensions
Floor furnace
and vent
S. F. Residence(I uailr)SERV I CES
Recessed wal I
Snace hpafpr and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
sepa rate
l,later serv i ce Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily, comrn. or
Ind'rstrial
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent system apart from
heating or A.C.
c0Mr.1./iND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
di strih^ feeders l,lood stove/heater
0f amp s.
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L1N REQUIRES that the 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 Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State of 0reoon oertaining to the work described herein, and that NC 0CCUPAI,ICY will be madeof any structure without the permission of the Building Division. I further certify that my reqistration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemDtion is noted hereon, and that
only subcontractors and ernnloyees who are in comcliance with 0l?S 7n1.055 vilI be used on this nro,ject.
tlAmE( pl ease o',^r&0-y' /-f7d*/SIGNA ome ,t/-r/r$ '5O
Zone Const. Uni ts So Ftq
Ftg
Ftg
t4a i Val
Fire Zone Bedrooms Load Acce s s
0ther
al ue
Flood Plain Occ.y Group'Sq I
TOTAL VALUATION
Stori es
BUILDING PERI'1IT
Clrarges and
Surcha rges
Plan Ck. Comm/lnd
65"1,/Bldo Per Fee
Svstens Deve
Charoe ( 1.5c
Opf,rent
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICP.L PERtlIT
Charges and
Surcharges
5idewalk
A/C Paving Total Comb. Permit
I,IECHANiCAL PERl',lIT
Charges and
Surcha rges
Curb Cut
TOTAL
1
IIY-Q ;-lV t -lt
oo$
COMBINATION APPLICATION/PERMIT (CAP)
i. Applicant to furnishA. Job AddressB. Legal Descriptjon
1. example- Tax Lot 100, Lane County Map Reference
17 03 432. exampie- Lot 1. Block 3, ?nd Addition to
SEl.irigfr'ei d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. example- heat/electrical ceiling/2. exampIe- waterheaTerTElEcIrlcalToE. Square footage or valuation, etc.
or forced air gasr sofar
1. examole- i250 sq. foot house, 5O0 sq. foot garage2. .*.plg- if new project, check-i-ew - it aOOition,
check add, etc.F. BuilCing permit information:1. example . construct single family house uith an
;atacEed garage
2. example - remodel existing garage into family roorn3. examole - convert single famiiy residence into
iElTEuFant (change of-use)G. Value of work as defined in Section 3C3 (a) of the
H
Structural Specialty Code
DISIGN TEAI,I AND CONTRACTORS
II
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. E.\cept r.rhere blank spaces occur in the description
Dortion of the llechanical and Electrical Schedules,the applicant need fill-jn only the l,lc. Boxes adjacentto the appropriate item(s) to be insta'lledB. Full Plumbing, l"lechanical, and Electrical Scheduies
are 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 on
the abbreviated schedules you should consult theful I 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 theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
Whenever possible, the initial appl ication will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapp)icant at the time the actual perm.it is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theappiication, and no plans will be processed until thesefees are paid. AlI other fees and charges are due andpayable when the permit is issued.
III.
IV.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permi t appl i cant exempt f rom reg'istrat'ion wi th the Bu i I der' s Board because
Additional Project Information:
PLANS REVIEWED BY:
name s'ignature da te
PECTION L
-37 69
--u-,
u;Gfffi
COIlBI IiATi ON APPL ICATI ON/ PERI'l IT
TION
/ lt)-
Job Address
l-egaI Description
EIIERGY SOURCES
Hea t
llater Heater
Ranqe
5q. Ftg. Access.---
So. Ftg. 0therllew-Addrqlter_]trp. -
_FenceJemo Change/Use
0ther
Ftq n_
"T4Hroo0wner
Builcinq Pernrrt Info: Describe-l'lork(1.e., Build Singie
Far:tilv llesidence lJith Attacheci Garaqe)Addres s Phone
J .tU t5 t L?-CLwf t"h,
Constr uction Lender
n-0-oxi , L)
eo
_a5
wu
1
Addre s s Phone
addre s s tcs. no ohone noDES I GIi TEAI{name
Pri ma ry
Siructura I
Eiectric3 l
i'!echan i ca i
adciress )I ics- no. )exoi res (ohone no.CCii iRACiORS n ane IGene ra I \hf*fi Z(
I
il ectri ca I
'lechan i ca I
ELECTR I CAL I'lECHAN I CAL?LL|I!B I iIG
FFF {.HA RGFFFFIHARGFNOctrcI]I]ARGF ito. Il'-,.1
furnace/burner to
BTU' S
l_,:eCn Slnqle llxture
I
i
Floor furnace
and vent
l.lew ci rcui ts ai ts
or extensions
Relocateo burloinq
(new rix. adcjitionai)
SERV I CES
Recesseo wal i
SDace heater and venti
I
S . F. P.es i rience(l latn)
Duolex (l bath) each
Apo'l 'iance vent
seDa rat eTemoorary Constructi onAdcii t.ional bath
.Stationary evap
coo I er
Chanqe in existing
res i dencellater service
Vent f an w.i th
sinole ouct
mul tifami 1y, comm
Tnciust:^ial
or
0f am Ps.
apart from
.c.
Vent systen
heatinq or AStorm Sewer
i4echani ca I exhaust
hood and drrctCOMI.I.IIND. FEEDERS
I
I
l'lood stove/heaterInstal I /al terlrel ocate
di stri b. feedersI
0f amp s.i
i
iSSUAIICE OF PFRIlIT
TOTAL CHARGEST0TAL CHIiRGESTOTAL CHARGES
I^JHERE STATE Llli REQUiRES that tlre Electrical work
shall not be vaiil until the label has been signed by
be done by an Electrical Contractor, the electrical portion of this permit
an E'lectrical Supervisor and returned to the Building Di.vision
-#z
herebv certify that alj information hereon is true
done in accordance r*ith the Ordinances of the City
escribed herein, and that N0 OCCUPAIICY will be mader certi fy that m.y reqi strati on r,ri th the Bui I der' st the basis,for exempt'ion is noted hereon, and that'Il be used on thjs nroject.
ott:r,z/-/3'$6t.lAi.lE(pIease print ll,r l/\/
the
0regon
the Bu iany
rd
rmidLcoforn L anEFEDi!e DEELULEXAI,II ppcomD
and nda fu rrthe t a nd a l,JO kr rf,DC rmedo ha beSthatco rrec rt afyny
dntto!{ohe rkfor.i f e ad nd o f She teta of ngStheLawstoertaDn9
fudDon herttUwiuthnofsofretho+SSepermi g
aBo fun aforce nd ct as u 0RSr 7 ttha exemD055effesedby
d nce twl h nD<7fit 055Uontracto rsk^an rvh 0 a re anem!r oyeev c0mD
F F U
Flood Piain Stories _ Occ.y Group Sq
Ftg
Ftq
Ftg Value
TOTAL VALUATIO
x
X
0ccy Load I __sg
Const.Zone l4ain
Val ue
alue
Fire Zone Bedrooms Acces s
0the r
Plan Ck, Cornm/Ind
55%/B1do Per Fee
Svstems Devecharce (1.5q opmentBUILDING PERI'IIT
Charges and
Surcharges Plan Ck. Res
30%/Bl dq Per Fee
FencePLUI4BiNG PERMIT
Charqes and
Surcha rges Dgrno
SidewalkELECTR]CAL PERIlIT
Charges ano
Surcha rges A/C Pavi ng Total Cornb, Permit
Curb Cut s,coI,IECHANICAL PERI,IIT
Charges and
Surc harges TOTAL
cYnt rcq
Residence of
SQ. FT.
Sewer
I
I
0n I
COiqB] NATIOi! APPL I CATION/PEP.I'IIT ( CAP )
Applicant to furnish
A. Job AdciressB. Legal Description
. 1. examole- Tax Lot 100, Lane County Map Ref, 6-ctLl J5 +32. examcle- Lot 1. BIock 3, Znd Add.ition toS[Fi-i[Fie1d EstatesC. llame, etc. of owner and construct.ion lender -r..0. Energy Sources \
1. example- heat/eiectrical ceiling/or forcerz. eElElu- r,raterirea iEi7b; roffi
2. gClrG:
-i
f new project, ctreit-iEw - if acc.nEE[-Icd, etc.F. BuilCing per,rit informat.ion: f1. examcle- - construct single family house wj L-
dttached garage2. e:rqnole - remodel existing garage into fam3. qllptr - convert singie iafr:ty'resiaence {
- rGE'jrant (change of-use)- (
G. Value of work as defined in Section 303 (a) ofStr"uctul al Specialty CcdeH. DESiGII TTAiI AND CONIRACTORS
To avoid design or construction delays, Buildir i.
Division Slaff must be able to contaat approorDersons regarding design information or job s.ircorrections, etc.
Abbrevisteo Plumbing, i,lechanical, & Electrical Sche recA. :xceot '.rnere blank spaces occur in the descript:ortion of rhe Mechanical and Electrica.l Scheduthe applicani neei fjll-in only the [,lo. Boxes d .gc
- to the aopropriate item(s) to be .installed i.B, Fujl Piumbing, I'iechanical, and Electrical Scherjare available at the Building Division1. fo conserve space on the permit form the sc dthave been abbreviated (
2- if the item(s) to be jnstalled are not covethe abbreviated schedules you should consulful I schedulesC. BUILDIIJG DIVISiON STAFF HILL FILL OUT ALL FEES , (
CHARGES Oii iHE SCHEDULESD. As noted on the CAp, the jabel must be de.livereteiectrical contractor for signature by his eieclsupervisor. The general contractor ii not autht G,,to sign the ejectr.icai Iabel.Applicant to sign and date
Hhenever possible, the initial appiication will be u --a.worksheet only. lhere possible, Buildinq Divis.ion 6twill-preoare a type written cooy and..tu"n it to inapplicant at the time the actual permit is issue<i fo
s i gna ture -
Fees and Charges {PIan cneck fees are due and payable at the time of t ir.
appiicarion, and no plans wiil be processed uniii tnt* Ifees are paid. ill other fees and charges are due andpayabie when the permit is issued.
FOR OFFICE USE ONLY
PIRMIT VALIDATION
ctTY oF SPRINGFIELD {,
City Holl
Springfield, Oregon
Deporlmenl of Public Works
OFFICIAL RECEIPT
{\\,
0. B 55253 rl
'r9Dole
Rec'd F
Address
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€
€
€
€
€
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Received For:
II
IIi
iY.
gY
Amounl ved
Permi t Cl erk
-G AUTEORIZED SIGNAiURE
PFINTERS EUGENE OR 974OI
(
U
PROJECT CONDITiONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
,l
Permit applicant exempt from reg'istratr'on with the Builder's Board because:
Additional Project Information :
datenameS1gnature
PLANS REVIEWED BY: