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Home My WebLink AboutPermit Building 1990-03-20NL COMBI |,IATI OI'I APPL icATION/PERMII RIlA 726-3753 Job Address EIIERGY SOURCES: Hea t lJater Heater Ranrte Sq. Fto. l'lain_ !q. Ftg. Access._ Sq. Ftq. 0ther_ _l,lew_Add-Al ter_Rep . _Fe nce_Demo_C ha nge/ U s e 0ther t* \ti \l d Legal Descri ption ,& Value of tlork:f,zgz,'^Owner Phone Bui lciin FamiIy q Permit Info: Describe llork( Residence tlith Attached Garaqe ..e., Bui1d Single Constructi on Lender Addre s s Phone DESIGN TEAI.I name addre s s tcs. no-exo res ohone no - Primary S. tl R Structura I El ectri cal Mechan i ca I CONTRACTORS name addres s I (lics- no oxot res ohone no. I Pi tn {7 El ectri caI l'lechan ical PLUI{B I NG ELECTRICAL MECHAN I CAL FFF CHARGF NO FFF rHA PNF NO FFF CHARGF Each single fixture Res idence of SO. 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. P.es i dence ( I bat-h )SIRVICES Recessed wal I Snarp hpatpr and vanf Duplex (1 bath) each Additional bath Temporary Construction Apol iance vent seDa ra te l,later servi ce Change in existing rpc i dpncp Stationar,v evap. coo l er Sewer multifamily, comm. or Tndustrial Vent fan with sinolp drrct Storm Sewer 0f c Vent system apart from heatino or A.C. c0r4t1./IND. FEEDERS Mechanical exhaust hood and duct Insta l I /al ter/rel ocate di stri h. feeders l'lood stove/heater 0f amps. ISSUANCI OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAN REQUIRES that the Eiectrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apfrlication for oermit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and ernployees who are in comcliance with 0l?S 701.055 will be used on this project. I.lAl.lE(please print)I GiIATURE (o F E Zone ?(-. Tyoe/Const.--1-+- Fire Zone Bedrooms S*.units r Sq. Ftg Load So. Ftn er*o@sq.Ft; . l'lain I . Access Val ue Flood Plain Stories nrn""@uu,,"€H-- TOTAL VALUATION BUILDING PERIIIT Charges and Surcha rges &_-se___Plan Ck. Comm/lnd 65%/8ldq Per Fee GA.7=Svs Cha tems Deverqe ( 1.52 opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surc ha rges Fence Dgmo ELECTRICAL PERIlIT Charges and Surcha rges Sidewal k A/C Paving Total Cornb. Permit fZzv I,IECHANICAL PERMIT Charges and Surc ha rge s Curb Cut TOTAL %-q COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. exampl e- he2. example- waE. Square footage air gas 1. example- 1250 sq. foot house, 500 sq2. exampie- if new project, check new - EfEcI-Edd, etc. foot garage if addition, II. F. Building permit information:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. example - convert single family residence into iElTIfFant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Spec'ia1ty 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 Electrica'l Schedules, the applicant need fill-in only the No. Boxes adjacentto theB. Ful I Pl appropriate item(s) to be installed umbing, Mechanical, and Electrical Schedules IiI. 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 consu'lt the fu l I schedulesC. BUILDING DIVISION STAFF l.llLL 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 electrical supervisor. The general contractor is not author.izedto sign the eiectrical label Appiicant to sign and date lJhenever possibie, the initial application will be used as a worksheet oniy. l,lhere possible, Building Division Staffwill prepare a type written copy and return it to the app si gt l icant at the time the actual permit is issued for his na ture. (i-e c-<-, pt- + lttl U'lIVFees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from reg'istration with the Builder's Board because: Add'iti onal Project Information: PLANS REVIEWED BY: name s i gnature te 7-t3eo I NSP 726- INE . CITY OF SPRINGFIELD COHBI NATI ON APPLI CATION/PERMIT Job Address 5 \t" 5l.-EIIERGY SCURCES: Hea t l.Jater Heater Ranqe. Sq. I-to Sq. Ftg Sq. Ftc 'I . Access. . 0ther _t'lew_Add_Alt€r'ilep. _Fence_Demo_C ha nge/ tise 0ther l-ega1 Description , ,l ,.1 ;-.!,{_;l- .t } . " , , .-,, .,i. .*. ,.rr. N,Tf\Owner d, -, 1'7 Address ,,.' -i lf.{'^ i:r-t " Phone } ? r '.1,' Bui I cli r Fami'ly nq Re Perhrft Info: Des s i dence I,li th Atta CT ch, ,e., Build Singie '")t/Ll77 '-:) Construct onL Addres s Phone Prima Structura I El ectri cal Mec han i ca I CONTRACTORS name Iics. no.) (expires ohone no. Genera I Pl umbi no Electrical a t 11 \ hani N \M PLUI.lBI ELECTR I CAL l' MECHAN I CAL FFF CHARGF NN FFF CHARGF I't0 FFF CHARGF Each single fixture Residence of furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S. F. Res idence ( l hath)SERV I CES Recessed wal I SDace heater and vent Duplex (l bath) each Additional bath Temporary Construction Apol iance vent seDarate tlater service Change in existing resi dence Stationary evap coo I er Sewer multifamily, comm. or Industrial Vent fan with sinqle duct Storm Sewer 0f amps.Vent system apart from heatino or A.C. coMr.r./IND. FEEDERS ivlechanical exhaust hood and duct Instal I /al ter/rel ocatedistrib. feeders tJood stove/heater 0f s. ISSUANCF OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAI.I REQUIRES that the Electrical work be done by an shall not be valiC until the label has been signed by an Electricai Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed application and correct, and I further certif-v that any and all workof Springfield and the Laws of the State of 0regon oerta of any structure without the permission of the Building Board is in full force and effect as required by ORS 701 only subcontractors and ernployees who are in comoliance for oermit, and do he;"eb.y certify that all information hereon is true performed shall be done in accordance with the Ordinances of the City ining to the work described herein, and that NC 0CCUPAI'ICY will be made Division. I further certify that my registration vrith the Bui'lder's .055, that if exempt the basis for exemption is noted hereon, and that with ORS 701.055 will be used on this nroiect. tlAl'lE(please pri S I GNATURE DATE G II, /qcS Zo Const. Un its s o. Ftg. l'lain al ue Fire Zone Bedrooms ccy Load_!q. Ftg. Access xr Val Flood Plain es 0cc.y Group Sq. Ftg Val ue TOTAL VALUATION- Stori 0ther BUILDING PERMIT Charges and Surcharges P'l an Ck. Conrn/ I nd 55"4/B1do Per Fee Svsterns Deve' Charqe (1.5%' opment Plan Ck. Res 30%/Bldo Per Fee PLUI4BING PERMIT Charges and Surc ha rges Fence D6mo ELECTRICP,L PERI1IT Charges and Surcharges Sidewal k A/C Paving Total Comb. Permit 14ECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL IS IS s0. FT. __l_t5_,c24___' ,fs COMBINATI ON APPLICAT]ON/PERMIT ( CAP)PTRMIT VALIDATION Applicant to furnish A. Job Address B. Legal Description 1 examp I e- 17 03 43 exampl e- Spri ngfi Tax Lot 100, Lane County Map Reference 2 Lot l. Block 3, Znd Addition to eld Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electric?l ceil i!g/o 2. dxample- waterheater/electrical/or Square footage or vaiuation, etc. r forced air gas sol ar E II. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc. F. Building permit information: 1. examp'le - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. example - convert single family residence into iESTaurant (change of use) G. Va1ue of work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or iob site corrections, etc. Abbreviated PIumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the appiicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Ful I Plumbing, Mechanical, and Eiectrical Schedules are avai lable at the Building Division 1. To conserve space on the permit form the schedules have been abbrev'iated 2.'lf the item(s) to be installed are not covered on the abbreviated schedules you should consult the ful l schedul es C. BUILDING DIVISION STAFF HILL 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. Applicant to sign and date l,lhenever possible, the initial application will be, used as a worksheet on1y. Where possible, Building Division Staff will 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. 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. .il- tl3?g III IV V. FOR OFFICE USE ONLY Permit Cle 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 name s'l gna tu re date E CITY OF SPRI}IGFiFLD COMBi NATI Oii APPL ICATION/PERMIT 725-3753 Job Address EIIERGY SOURCES: Hea t l.Jater Heater t''la n !q. Ftq. Access. Legal Description Yd r Owner Addres Phone B F tI : Descri l,lork'I .e., Build Single 1 1 A n Construct i a.J I LOJ \I ,{ T7 Addre s s Phone name I CS nO.phone no Pr Structura I El ectri cal l,lechani cal name lics n6-trxnl rpq I (nhone no. ral L E hani PLUt,lB I NG ELECTRICAL MECHANICAL NO FEE CHARGE NO FFF IlHARGF I'10 FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTU' s Re'located building (new fix. additional)U .Dlew c'i rcui ts a ltsror extensions )r s( Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate [.later servi ce Change in existing res i dence Stationary evap cool er Sewer multifamily, comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f S. Vent systenr apart from heatinq or A.C. c0r.1t1./IND. FEEDERS Mechanical exhaust hood and duct Instal I /a'l ter/rel ocatedistrib. feeders tlood stove/heater l:c0 ISSUANCE 0F pFRtlIT TOTAL CHARGES TOTAL CHARGES 3t &2 TOTAL CHARGES WHERE STATE LAI.I REQU shalI not be valiC untiI IRES that the Electrical work be done the label has been signed by an Elec by an Electrical Contractor, the electrical portion.of this perm'it trical SurJervisor and returned to the Building Division NED t he comr,ap c at 'I on for Derm l f and do hereb.y certi fy tha t a I 'I n fo rma t 'I on hereon s true a nd co rrect and I further certify that ld and the Laws of the State ture without the permission full force and effect as req any and a 'I 'l r.lork per fo rmed s ha I I be do ne I n accorda nce w1 th the 0rd 'I n an ces o f the City be madeto the work described herein, and that t'lO 0CCUPA['|CY willfSpr'I ng f 'I e of 0regon oertai ing ion vlith t s noted he tu,lrl r he Bu I I deof any struc Board is in of the Bu ilding Di oRS 701.0 I i ance wi vl S 'I 0n I fu rther c ert 'I fy th at my reg 'I s trat r S uired by 55 th at 'I f exempt the ba S 'I s for xempt I on 'I reon, and that only subcontractors and employees who are in comc th ORS 701.055 wilI be used on this oroject. nt't &lan' T O/596N srGN^i,lAtiE (I eas e p m F Zone_____-Tyoe/Const. Uni ts Sq. Ftg Fire Zone Bedrooms 0ccy Load Sq. FtS . l'lai n Val ue Acces s lue Flood P1ain Stories 0cc.Y Gro Val ue TOTAL VALUATION-Sq. Fts . 0ther BUILDING PERMIT Charges and Surcha rges Plan Ck. Comm/Ind 65%/81do Per Fee Svsteris Deve charqe (1.5q opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Su rc ha rges Fence Dgmo ELECTRICP,L PERI1IT Charges and Surcharges Si dewal k A/C Pavi ng Total Cornb. Permit I,IECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 38 . Ftg. Pl umbi no COMBINATION APPLICATION/PERMIT ( CAP) I. Applicant to furnish A. Job Address B. Legal DescriPtion 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exampl e-2. exampl e- E. Square footag air gas 1 example- 1250 sq. foot house, 500 sq. foot g example- if new project, check new - if addi check add, etc. ara9e tion,2 II. F. Building permit information: 1. example - construct singie family house with an attached garage 2. example - remodel existing garage into family room 3. example - convert single famiiy residence into iEETl'urant (change of use) G. Value of work as defined in Section 303 (a) of the Structura'l 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 Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installedB. Full Plumbing, Mechan'ica'1, and Electrical Schedules are available at the Building Divisjon 1. To conserve space on the permit form the schedules 2 have beq-n abbreviatedIf the item(s) to be installed are not covered on the abbreviated schedules you should consult the ful l schedulesC. BUILDING DIVISION STAFF l.liLL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the labe'l must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrica'l label Applicant to sign and date lJhenever possibie, the initial application will be, used as a worksheet only. l.lhere possible, Building Division Staffwili prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. Fees and Charges PIan 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. FOR OFFICE USE ONLY III IV V PERMIT VALIDATION 5-Bo#naos Permit Cler PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Project Informat'ion: PLANS REVIEWED BY: name s't gnature date