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Home My WebLink AboutPermit 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 ($ (g € € € € € { { 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: