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Home My WebLink AboutPermit Building 1986-09-26qL,gffi 5eo COHBI TI APPL I CATI ERMIT Job Address 5 Legal Description Ran l,Iater Heater EIIERGY SOURCES Heat Val ue of l,lork V1 ooo . Ftg. l4ain_ 5q. Ftg. Access.-- Sq. Fts . 0ther IOwner .O Addres s Construction Lender Phone4 a tI [.^lork Farni o: Des g.,ng oo \o s'\ N Addre s s Phone DL5 l GN TEAI.1 name address lics. no.exDr res ohone no. Pri mary Structura I El ectri cal l'|ec ha n i ca I CONTRACTORS name address'( pv ni rps'I i cs - no - ')ohone no.btvrrNuulvl TNc, 413s?aD ,e " /? -E.lGenera I 3vq-b4qPl umbi ng EI 1 I hani PLUI.{B I NG ELECTR I CAL MECHAN I CAL FEE C HARGF NN FFF CHARGF NO FFF CHAAGF Each single fixture Res idence of SQ. FT furnace/burner to BTU' s Relocated building (new fix. additional) New ci rcui ts al ts or extensions FIoor furnace and vent S. F. Residence(l bath)SERV I C ES Recessed wal I Soace heater and vpnt Duplex (1 bath) each Ttmr< Lktr.,/ qaa Additional bath Temporary Constructi on Apol iance vent seDarate l^Jater servi ce ge in existing dence Chan res i Stationary evap. coo l er Sewer multifamily, comm 0r Indrrstrial Vent fan with sinole duct Storm Sewer (9'7a*0f Vent systern apart from heatino or A.C. COMI.I./IND. FEEDERS l4echani cal exhaust hood and duct- I nstal I /al ter/rel ocate d.i stnib. feeders I'lood stove/heater amps.0f ISSUANCF OF PFRI{IT 20-a'TOTAL CHARGES TOTAL CHARGES ToTAL CHARGEs ,W*. /.;4 WHERE STATE LAIJ REQUIRES that the Electrical workshall not be valiC until the label has been signed by be done by an Electri ' an Electrical ca1 Supervisor Contractor, the eiectrical portion of this permit and returned to the Building Division I work oerformed shall be done in accordance with the 0rdinances of theoertaining to the work described herein, and that NC 0CCUpAt,lCy will be l,lAl.lE ( pl ease pri nt )IGNATUREr,d_,,d/rc Ci ty made b.yI HAVE CAREFULLY EXAI1INED the comp)eted apnl ication for oermit, and do here certify that all information hereon is trueand correct, and I further certifyof Springfield and the Laws of the that any and a1 State of 0regonof any structure without the permis further certify that m.y registration r.rith the Builder'ssion of the Buil di nq Division. I 701.055, that ifBoard is in full force and effect as requiredonly subcontractors and employees who are in by ORS exempt the basis for exemption is noted hereon, and thatcomcliance with 0l?S 701 055 will be used on this Droject . Ftg. Access x_ Vatue.rrn.Ornu"r4@ruru"@ Uni q Fire Zone Bedrooms 0ccy Load b xZone C.st. S- tY eroup-ft-Q s Ftg. l'lain Val ue TOTAL VALUATION- Flood Plain Stories PIan Ck. Comm/Ind 65%l9ldq Per Fee (o , ua Bb'to,ll Systerns Deve Charqe (1.5c opment /a5.*62.5o z.fo ee Plan Ck. Re 30%/Bldq Pe srF FencePLUI^,IBING PERMIT Charges and Surcha rges c>e GO Demo SidewalkELECTRICAL PERIIIT Charges and Surcha rges Tota'l Cornb. Permi t /a t- {aA/C Paving Curb CutI,IECHANICAL PERHIT Charges and Surc harges ----/E:-.6b TOTAL 2d270 BUILDING PERT'IIT Charges and Surcharges I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot I. Block 3, Znd Addition to Springfield Estates.C. Name, etc. of owner and construction lenderD. Energy Sources1. exampl e-2. exampl e-E. Square footag heat/electrical cei 'I r forced air gas solarwaeaere0r e or valuation, el. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- if new project, check new - if addition, check add, etc.F. Building permit informatjon:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. e&lple - convert single family residence into iEsTEIFant (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. 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 adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are avai lable at the Buiiding Div'ision1. 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 shou)d consult thefulI 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 thee'lectrical contractor for signature by his eiectricalsupervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date Whenever possible, the initial application wi'11 be used as a worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to the appl'icant at the time the actual permit is issued for his s ignature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. Ail other fees and charges are due and payable when the permit is issued. II. III. IV. V. FOR OFFICE USE ONLY PERMIT VALIDATION (01 o/ q->t(-trb Permit Clerk 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 s't gnatu dat e 7-2*86 q>