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Home My WebLink AboutPermit Building 1981-10-0253 Job Address l-egal Description EIIERGY SOURCES: Hea t lJater Heater Ranqe Owner EY Value of l,lo oc) n ess. Ftg. 0ther l,lew Add Sq. Ftg Fts . Acc Addr6ss k Pho e4>Farni I n I ct ce Ga ra t^lo s ng e LA ?oS Cons truct o n PhoneAddress 2-? Pri ma Structura I iACTORS name addres s Iics. no.)exD I res ohone no. El ectri cal Mechanr'ca I FFF CHARGE NN FFF ll0 EI PLUI,IBI NG ELECTRICAL MECHAN I CAL FFF rHARI:F Each single fixture Residence of F'r-sQ furnace/burncr to BTU' S Rel oca ted bu'i I d i nq (new fix. addit'ional)New circuits alts or extens'i ons Floor furnace and vent S. F, Residence(t bath)SERVICES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Construct ion Apol iance vent separate tJater servi ce Change in existing res i dencc Stati onar.v evap cool er Sewer multifamily, comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f amps.apart from .c. Vent systern heatinq or A COI,II.I. /IND. FEEDERS Mechanical exhaust hood and duct Instai I /a l terlre1 ocatedictrih- fppdcrs I'Jood stove/heater 0f ISSUANCF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE srATE LAt.l REQUIRES that tlre Electrical work be done by an Electrishail not be valil until the label has been signed by an Electrical supervi 2-t/ cal Contractor, the electrical portion of this pernit sor and returned to the Building Division ' exempt 055 wil I NEDI the I ncato atanddo'Icertcompap!')nl-hereb.y fy d Indtc0 rrecan therfur 'Icert t fha nd Ia woI r k Srmed Iha beI I nf-v oerfo done ordancecc thwl tt1'If Ie anddofSD eth wsLa Sthe ta any ofngte nl1 to het rkwo '|r0reoe rta SCde herebed n'I and tthag0nngstrucaoftuwlretthouhetrmistpesofnButheI'I 'Id 'I s'I on1ny fuIng certrther 'I atth s'I trafyregmyrdBoas'I nI Ifu I f,rceo and e ffect sa red ORS 0 051 5 ttha 'I frequiby ba 1s fors t on'IheLexemp on us ontbc rsrac to nda 11y who rea nI I 'I twl be sedu n 'Ithernpoyeesanceh0r?s 7ot IcomD ect I,IAI'1E I SEea 1 n(p tpr )TUREIG'il4 tion hereon is true ,he 0rdinances of the City N0 0CCUPANCY wi l l be made tion urith the Bui lder'sis noted hereon, and that ToTAL VALUATIoil-"--.-..-- Zone x Val [tr. Other its Ftq . l'la i Group _ Sq. FtS Const. Un Bedrooms Stories Fire Zone Flood Pl ain Val ue Val ueLoad Sq. Ft!. Access Plan Ck. Comm/Ind 65%/B1do Per Fee 1 ,VE s7 opmentBUILDING PERTIIT Charges and Surcharges Plan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges 0emo Sidewal kELECTRICAL PERI,IIT Charges and Surcha rges Total Comb. PermitA/C Paving Curb CutMECHAIIICAL PER},IIT Charges and Surc ha rges @ c 15"0'c)' -. TOTAL (ohone no- COMBINATION APPLICATION/PERMIT (CAP)PERMIT VALIDATION I Applicant to furnish A. Job Address B. Legal DescriPtion 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. examp'le* Lot 1. Block 3, Znd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources I ceili forced air gas sol ar1. exampl e- 2, exampl e- E. Square footag heat/el ec WA ea r e or e or valuation, example- 1250 s, exampie- if new check add, etc. q.foot house, 500 sq. foot s 'i a rage 2 project, check new - if add tion, F. Bu'ilding permit information:family house with an 't i '1{ { J I j : 'i 1 ,i ) { i 1 examp I e aTGcIEa - construct single garage into fimily room idence into examole - examo.l e - res ta u rant remodel existi ng 9a fami rage i convert single 1y res G. Value of work a (change of-use) s defined in Section 303 (a) of the Structural SPeciaitY Code H. DESIGN EAM AND CONTRACTORS To avoid design or construction delays, Buiiding Division Staff must be able to contact appropriate persons regarding design information or iob site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occurirr the description portion of the Mechanical and Electrical Schedules' the applicant need fill-in only the No. Boxes adiacent to the appropriate item(s) to be jnstal'led B. Ful l Plumbing, Mechanical, and Electrical Schedules are ava'i lable at the Bu'i lding Division 1. To conserve space on the permit form the schedules have been abbreviated ?. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor, The general contractor is not authorized to sign the electrical label. III. Applicant to sign and date Whenevei possible, the initial application will be used as a worksheet oniy. Where possible, Building 0ivision Staff wiII prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna tu re.IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and . payable when the permit is issued. V. FOR OFFICE USE ONLY 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 SI g na tu re date LIIIE CIT COMB I iIAT I m ON APPLICATION/PERMII69 6-37s3 Job Address Leqal Description Ranqe Hea t II]ERGY SOURCES Val ue of 0c) Ftq. I'lain_ Ftg. Access. So cd 5a terlE.-Ftq. 0ther Cha nge/ Use EYOwner tnc, I edac Bu F Work Ga Permit Info: Descr e.,ng eAddresskcPhone/f)-r ros--a i,. rCons truc t i on Le G"s t'r PhoneAddress 7? 'Ina Pri ma r S tructura I El ectri ca l name !'lechani cai ruaar:FFFFFFFNOFEECHARGENO El al MECHAN I CALELECTR I CAL N0. PLUIIBI NG furnace/burner to BTU' S Residence of FTsqEach single fixture Floor furnace and vent New circuits alts or extensions Relocated bui lding (new fix. additionaI ) Recessed wal l Snacp heater and ventSERV I C ESS. F. Residence ( I bath) Duplex (l bath) each Apol iance vent seDa rateTemporary Constructi onAdditional bath Stationary evap cool errpq 1 Chan ge in existing dencetlater serv'i ce Vent fan with sinole duct mu'ltifamily, comn. or Tndrrqtria lSewer Vent systern apart from heatino or A.C.0f amPs.Storm Sewer l4echanical exhaust hood and ductCOI.II'I. / IND. FEEDERS l,Jood stove/heaterInsta l I /a l ter/rel ocate dictrih. feeders 0f amPs. ISSUANCE OF PFRIIIT TOTAL CHARGESTOTAL CHARGES HHERE STATE Lltl REQUIRES that the Electrical wo rk be done by an Electrical Contractor, the electrical portion of th by an Electrical Supervisor and returned to the Building DivisionshalI not be valiI untiI the Iabel has been signed i s permi t iGiIATUREI'lAi.lE( pl ease pri nt)DA 2-t/ toncomp ny of t on hereon is truermit, and do hereb.y certify that all inCAREFULLY EXA|!app I ca Ordinances of the Cityrmed shall be done in accordance with theand correct, and I further certify that a and all work to the work described herein, and that NC OCCUPANCY will be madeDertainingof Soringfield and the Laws of the State istration r.rith the Builder'sDivision. I further certify that my regof any structure without the permission of 0regon the Buil ding ion is noted hereon, and that.055, that if exempt the basis for exemptBoard is in full force and effect as required by ORS 701 with 0l?S 701.055 will be used on this Donly subcontractors and ernployees who are in comoliance LJni ts Val ue T0TAL VALUATI0N_ x x S .0ther al. Access FICE U e/Const.Val ueZone Bedrooms StoriesFlood Plain Fire Zo Load Sq. Ftg Group Sq. FtS o. Ftg. l'lai opmentSvstems Deve charqe (1.51Plan Ck. Conn/lnd 65%/B1dq Per Fee Fee PIan Ck. Res 30%/Bldq Per BUILDING PERI'IIT Charges anC Surcha rges Fence Demo PLUI4BING PERMIT Charges and Surcha rges Sidewalk Total Conrb. PermitA/C Pavi ng ELECTRICP,L PERIlIT Charges and Surcharges Curb Cut 15 L'dTOTAL I,IECHANICAL PERMIT Charges and Surc ha rqes @ a I l.later Heater 1n3F,l E $3 nhnnp nnUL5IbN ILAI,!( addre s s TOTAL CHARGES COMBINATION APPL ICATION/PERMIT ( CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference t-rT3-732. e;anple- Lot l. Block 3,?nd Addition toffing-field EstatesC. Name, etc. of owner and construction IenderD. Energy Sources PERMIT VALIDATION t1 ctTY oF SPRtNGFtELD Ciry Holl Springfield, Oregon . I Deportmenl of Public Works OFFICIAT RECEIPT l. exampl e-2. exaffilE-E. squaET6-ta heat/e l ectri ceilin forced air gas wa te ter ca or solare ge or vaiuat o[' 2 example- 1250 sq. foot house, 500 sq. foot garage example- if new project, check new - if addition, check add, etc.F. Building permit information: ',1. example - construct single family house with an attached garage2. example - remodel existing garage into fimily room3. examole - convert single family residence intoiEiTi-urant ( change of -use )G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, l'lechanical, & Electrical SchedulesA. Except vrhere blank spaces occur irr the descriptionportjon 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, Hechanical, and Electrical Schedulesare avai lable at the Building Division1. To conserve space on the permit form the schedules have been abbreviated?. If the item(s) to be installed are not covered onthe 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 theeiectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical iabel.Applicant to sign and date I'lhenever possible, the initial application will be used asa.worksheet only. Hhere possible, Build.ing 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 unti.l thesefees are paid. Ail other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY L ,,tfo'B 573s1i) r)d \ II. Received F,or: (t i.) il () 0 Amount Received r,) i III IV v SIGNAIURE 3xatroi.ruixau!! mrNrEiS tuo!Na oi grao! tarl.6 I ) PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: datenames'l gna tu re