HomeMy WebLinkAboutPermit Building 1988-08-10NSP.JTiON LINE
126-37 69
CITrcF SPNTNGITETT
COHBI NATI ON APPLICATION/PERMIT 7 26-37 5
Hea
Ran
EIIERGY SOURCES
I'later Heater
Z
tuLegal Description
Job Address
Owner
Value of tlork:fSaoa.'o
Sq. Ftg. Access.--
Sq. Ftq. 0ther
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_Fence_Demo_C hange/ U se
0ther
n
Address
Fami l dence
e
A
Construction Lender Pzror-*:4,kr:L 3,ryn'k*,+z 4, z
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u
Phone
DESIGN TEAI.I name address 'I i cs. no.exD l res ohone no-
Primary
Structura I
El ectri cal
Mec han i ca I
NT name add res s (lics- no-)exD l res ohone no.
Dwsez.Genera I
I
1
l'lechani cal
PLUHB I NG ELECTR I CAL 14ECHAN I CAL
FEE CHARGE N0.FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New circuits alts
or extens ions
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Temporary Constructi on Apol iance vent
spDa rateAdditional bath
l,later servi ce Change in existing
res i dence
Stati onar.v evap.
cool er
Sewer
I ndu stri a I
multifami ly, coffir. or Vent fan with
sinole duct
0f amps.Vent systern apart from
heatino or A.C.Storm Sewer
c0Mt1./IND. FEEDERS
Mechan ical exhaust
hood and duct
Instal I /a l ter/re l ocate
di stri b. feeders ['lood stove/heater
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES
WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication for oermit, and do hereb.v certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rd.inances of the City
of Springfieid and the Laws of the State of Oregon pertaining to the work described herein, and that N0 0CCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for sxemption is noted hereon, and that
only subcontractors and ernployees who are in comcliance with 0l1S 701.055 will be used on this nroject.
t'lAl'lE( p1 ease pri nt)IGNATURE DATE 7- tct -lt
I
Ftg
Ftg
Ftg
Zone ?L.
E-Load
Iu
iwzI
e/con*-.<-/#/< Units Scr
Group
TOTAL VALUATI
Bedrooms
Stori es
Fire Zone
Flood Plain
l'la i n
Acces s
0the r
Val ue
Plan Ck. Conrn/Ind
65%/91do Ppr Fpp
Svsterns Deve'
charqe (1.51'opmmtBUILDING PERI.IIT
Charges and
Surcharges 't _??E_=_/7.?a Plan Ck. Res
30%/Bldq Per Fee
FencePLUT,IBING PERMIT
Charges and
Surcha rges Demo
Sidewal kELECTRICAL PERtlIT
Charges and
Surcharges A/C Paving Total Comb. Permit
Curb Cut 3/"-%TOTAL
HECHANICAL PERMIT
Charges and
Surcha rges
Addre s s
]TORS
t
0f amps
COMBINATION APPLICATION/PERMIT (CAP)
I . Appl i cant to furn i shA. Job AddressB. Legai Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 43?. example- Lot 1. Block 3, 2nd Addition toSFFiigFietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. example- heat/2. examb'l-e- water
Square footage or
air gas
E
l. examp_le- l!!!. sq. foot house, 500 sq. foot garaget. example- jf new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family room3. example - convert single fam.ily residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contatt appropriitepersons regarding design informat.ion or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, &. Electrical SchedulesA. Except where blank spaces occur in the descr.iptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientt0 the appropriate item(s) to be instailedB. Full PIumbing, Mechanical, and Electrical Schedulesare avaiiable at the Building Division1. To conserve space on the perm.it form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should 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 theelectrical contractor for signature by his electricalsupervisor. The generai contractor ii not authorizedto sign the electrical labelApplicant to sign and date
Whenever possible, the jnitial application will be used asa.worksheet only. Where possible, Building Div.ision Staiiwili prepare a type written copy and returi it to theapplicant at the time the actual perm.it 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 wiil be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
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Permit Clerk
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 gnature da te €'za-:g