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Home My WebLink AboutPermit Building 1985-09-26-'L,A,8ZB jpa I NS PECT I ON 26-37 69 L COHBI IIAT APPL I CAT RM II Job Address /5b u), Legal Description l.later Heater Ranq EIIERGY SOURCES: Hea t Val ue of l,lork J,aoo I - ,SS. , ,r Sq. Fto 5q. Ftg Sq. Fto . l'1ain . Acce . 0the tL)i 3 Owne r I i.e., Build SinglePhoneAddress /7a? /Ye .te 57 BuiIci i Farni I y nq Permi t I nf o : Descri be l.lork ( Residence l'lith Attached Garaqe Construction Lender o 2 7 \)c s\ N Addres s Phone DES I GN TEAI1 name address / l ics. no.exoi res ohone no. Pri ma ry n ame nhnnp nn - )CONTRACTORS Structura l l'lechani cal Electrical Tt1Ja, t/135 ? llD 4PI .'L/rvl L-,f Il'lechanical PLUIlB I NG ELECTR I CAL MECHAN I CAL FEE CHARGE NO FFF CHARGF NO FFF CHARGF Each single fixture Residence of CTSQ furnace/burner to BTLI. s Relocated bui lding (new fix. additional) New ci rcui ts a l ts or extensions FIoor furnace and vent SERVICES Recessed wal I Snaap hpelPr and vpnt S. F. Residence(l bath) Temt< Lktr../ q>e-Duplex (l bath) each Additional bath Temporary Construction Apol iance vent seDa rate tlater service Change in existing res i dence Stati onar.v evap coo l er muItifami1y, comm lndrrstrial 0r Vent fan with si nol e ductSewer Storm Sewer <9'7ae 0f Vent systern apart from heatinq or A.C. COMII./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/rel ocate di stri h- feeders 0f ISSIIANCF OF PFRI,IIT 2O-a>TOTAL CHARGES TOTAL CHARGES rorAl cHARcEs ,w* . / s4 WHERE STATE L{ll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perr,ritshall not be valiri until the label has been signed by an Electrical Supervisor and returned to the Buildini] Division ing Division. I further certify that my registration vrith the Builder,s llAl.lE(please print)S IGiIATURE DATEJ. ty I HAVE CAREFULLY EXAIIINED thc completed apnlication for permit, and do hereb.y certify that all inforrnation hereon is trueand correct, and I further certifyof Springfield and the Laws of thL that any State of and all work performed shall be done in accordance with the 0rdinances of the Ci0regon oertaining to the work described herein , and that l,l0 0CCUPAI,ICY will be madeof any structure without the permission of the Build Board is in full force and effect as required by ORS 701.055, that if exempt the basi ce with 0l?S 701.055 rvilI be used s for exemption is noted hereon, and thatonly subcontractors and emp loyees who are in comcl ian on this nroject : USE OilLY Ftg. Access x Value_ ,tn. otn""lop ?75.4F--r*u" Zaai- Type/Const So !q0c 0c cy Load tsZone C B.c.y GrouFlood Plai Fire Zon Bed rooms Sto ri es Val ue ct -c(-gb ToTAL VALUATI0N_-- Ftg. t'lain Plan Ck. Comm/lnd 65%/B1dq Per Fee (o . ua Bt 7O,l1 Systerxs Develooment Charqe (1.51)/a5.*BUILDING PERI'IIT Charges and Surcharges z..ro 62.50 Pian Ck. Res 30%/81dq Per Fee Fen cePLUi4BING PERMIT Charges and Surcha rges dro ,GO Dgmo Sidewal kELECTRICAL PERI|IT Charges and Surcha rges A/C Paving Total Comb. Permit /o t- {o Curb CutMECHAIIICAL PERMIT Charges and Surc ha rges -_:_/il_-_4 TOTAL 206.70 ^--a- , a l'Jood stove/heater COMBINATION APPLICATION/PERHIT (CAP) Applicant to furnish A. Job..AddressB. Legal Description 1. example- Tax Lot 100, Lane County I7-I3-432. example- Lot l. Block 3, 2nd AdditSpringfield Estates C. Name, etc. of owner and construction ID. Energy Sources I. example- heat/electrical ce.ilinq/o2. examplE waterhEaTeFlelfEETil calTorE. Square footage or val uat.ion, -EE.-- l. example- 1250 sq. foot house, 500 :2. example- TT-new project, ctrecttw check add, etc, Map Reference ion to ender r lo1cqd air gas :d;F- sq. foot garage - if addition, II III F. Building permit information:1. example - construct single family house with anattached garage ?. example - remodel existing garage .into family room3. example - convert single family-residence inio - restaurant (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, Bu.ildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated PIumbing, Mechanical, & Eiectrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaient - to the appropriate item(s) to be instaj'ledB. Full Plumbing, Mechan.ical, and E)ectrical Schedulesare available at the Building Divis.ion1. To conserve space on the permit form the scheduleshave been abbreviated2. 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 e.lectricalsupervisor. The general contractor ii not authorizedto sign the electrical label.Applicant to sign and date llhenever possible, the initial application will be used asa^worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actuai permit is issued for his s i gna ture. Fees and Charges P'lan check fees are due and payable at the t.ime of theapplication, and no plans wi)1 be processed until thesefees are paid, All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY IV V PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: 7-zfrAGda tenameLe7,/z €K signatu PERMIT VALIDATION (r1 (5/ tt'-trh Permit Clerk w I