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Home My WebLink AboutPermit Demolition 1985-12-13L t COHBI APPL I CATI TT Job Address Legal 0escri ption tlater Heater EIIERGY SOURCES: Heat Owner Val ue of l.lork . Ftq . l'la i n_ Sq. Ftg. Access._ Sq. Ftg. 0ther_ _l{ewJddll ter_Pep. _Fe nc e_Demo_C ha n ge/ U s e 0ther Address Phone llorkn arn ci '|:€. t Single Construction Lender Addres s Phone b4 (,) Structura l EI ectri caI Hechanica l J; PLUI,IBI NG ELECTR I CAL MECHAN I CAL FEF CHARGE NO FFF CHARGF NO FFF CHARGF Each single fixture Residence of SQ. rr furnace/burner to BTU' s Relocated building (new fix. additional)New circuits alts.or extensions Floor furnace and vent S. F. Residence0 uailr)SERV I CES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDarate l.later servi ce Cha res nge in existing i dence Stationary evap cool er Sewer multifamily, corm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f apart from .c. Vent systet'r , heatinq or A coMr.r./IND. FEEDERS Mechanical exhaust hood and ductInsta'l I /al terlrei ocatedistrib. feeders l,lood stove,/heater 0f ISSUANCE OF PFRt,lIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES the permi nd effect onc0mp any of 0regon the apnl icat permit, an hereby cert that ail in tion hereonand correct, and I further cer s trueti fy that and all work periormed shall be done in accoidance with the 0rdinances of the Citv 0CCUPAI'ICY wi I I be made of Springfield and the Laws of the State oertaining to the work described herein , and that l.l0of any structure Board is in fulI wi thout ssion of the Buil di ng Division. I 701.055, that if stration with the Builder'sfurther certify that my regiforce a as required by ORS exempt the basis for exemption is noted hereononly subcontractors and , and thatempl oyees who are in comcli ance with 0l?S 701 .055 wilI be used this project l.lAl.lE(please print LIIGNATURE i.JHERE STATE LII,J REQUIRESshal'l not be valiC until the that the Electrical work be done bylabel has been signed by an Electri an Electrical Contractor, the electrical Supervisor and returned to the Bui ca] portion of thi s perni tIding Division ToTAL VALUATI0N_ x Va ue x Va ueFt9 Fire Zone Bed rooms e/Con s t Uni t cy Load Sq. FtS Zone o. Ftg. l,lain . Acces . OtherFlood Plain Stori Plan Ck. Conrn/Ina 65%/81dq Per Fee BUILOING PERI.IIT Charges and Surcharges Pian Ck. Res 30%/81dq Per Fee n \ PLUI4BING PERMIT Charges and Surcha rges oeno \-79 \:_Sldewalt <.._ELECTRICP,L PERI:IT Charges and Surcharges ittaA/C Paving Curb Cut HECHANICAL PERMIT Charges and Surc harges \L.4 TOTAL I itecha ni ca I 1 COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Oescriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432, example- Lot l. Block 3, Znd Addition to SpTT:ry--field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources .l. examoi e-2. examo'l e- Square foota hea t/e I ectri ca l t forced air gas wa e ec or so itr E ge or valuat 0n,l. example- 1250 sq. foot house, 500 sq. foot garage ?. examp'le- if new project, check new - if addition, EfrEEF-add, etc.F. Buiiding permit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3, exampie - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAI4 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. II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except urhere blink spaces ociur 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 available at the Building Division1. To conierve 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 the ful l schedules C. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electrical supervisor. The general contractor is.not authorized to sign the electrical label.III. Applicant to sign and date l,lhenever possible, the initial application will be used as a worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna ture.IV. Fees and Charges P'lan 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 VALIDATION d L Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Proiect Information: PLANS REVIEWED BY: name s i gnature date I )