HomeMy WebLinkAboutPermit Building 1983-06-29IIISPECTIOII LIIIE
726-37 69
CITY OF SPRINGFIELD
COHBI IIATI ON APPL I CATION/ PERMIT
JNFOR}TATION ITNE
-37 53
Job Address //d/ t7/onf// 2 Bm>EIIERGY SOURCES:
Hea t
llater Heater
Ranqe
l-eqal Oescription aa {3oa
/2-
-Q>7-az
Address
Owner Z
Sq. Ftg. Access._
Sq. Ftg. 0ther_
l,lew Add Alter-- D.-
1-ence_O-mo C hdn ge/ Us e
-other---
Sq . Ftg . I'ta i
Val ue of l'lork:
k'#t5 ec '
.,''
,€., Bui1d SingleL
8A f 4PEA Slrzog ,,<-.Q- E 7
J DooRtde f SCons truc tr/,;i7 t/
ara
UJ
>,4
VJO
Addre s s Phone lics. no.exDt res phone noname
Pri ma ry
Structura I
El ectr i ca I
Hec han i ca'l
name
a)
El ectrical
llechanical
MECHANICALELECTR I CALPLUI.IB I NG
l^I,IAPGFFFF.HARGF NO FFFFFFCHARGFNO
furnace/burner to
BTLI' s
Residence of
FTSQEach sinole fixture.
wP l'A/,*rf {z EP.2Q-2
Floor furnace
and vent
New circuits aits
or extensions
Relocated bui lding
(new fix. additional )
-/46/*9".#3*l^*/,"?SERV I CESS . F. P.es i dence(l hath)
Duplex (1 bath) each
Apol iance vent
seDa rateTemporary Constructi onAdditional bath
Stati onar-v evap.
cool er
Change in existing
res i dence[,later servi ce
Vent fan with
sinole ductIndrrstriai
multifamily, conm. orSewer
Vent systern apart from
heatinq or A.C.0fStorm Sewer
l4echanical exhaust
hnnd and duct-c0r4r.1./IND. FEEDERS
llood stove/heaterInsta l I /al ter/rel ocate
distrib. feeders
?.a6X6ls €s.*tt<e0f amPs
ISSUANCE oF PFRI1IT /6.-*
TOTAL CHARGES /8.("0TOTAL CHARGESTOTAL CHARGES ?.4*
hIHERE STATE LAl.l REQUIRES that the Electrical work be done by an
shall not be vali'l until the'label has been signed by an Electrical
//c S IGi{ATUREl.lAttE (pl ease pri nt )P.
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Bui'lding Division
fy nI tforma 'I hereo n s true'|do here 'Icert ttha aandtonb.y,Y e'I ted a I atCAREHAVEFULLEXAIltcompp!r
0rd nanI ces f c 1the1Ido1neanrdccoceanwlththe tysrmedhabeaIIkworndIrttthaadtcorrecaIndcefu rtheran fy any
AI,IOCCUP wl II madebeCYnrdesck'Ir herebed nI NCthatanditdndLdSteofonrta1'I theto woirIeathLaeowsthe0regpengofSpng
n ht nthe tu de'I r son'I ec 1rt tha t 'I +stra o uJt'IfurmrISSnofthBuI'|Id Di sv1 rthe r m.y regIturethou twl hetstruc ngaof fypeny tha LandS1foron1Ishereonnotedfexemptasctr'|ed 7ORS 05501 tha t 'I e'IBoard 'Is fun 1I rco a effnd E req by
ectthon'Ibearewhon'II ncea thwl 70t?s 0 05 5Ionsuctobcon tra arS nd I comcvernpoyees
Fon 0
Fire Zone
Flood Plain Stories.
Bed rooms
7o
Occ.y Gro up Sq. Ftg
lue
/ Cons t
Load Sq. Ftg
ne /faa-6.
I ue---
TOTAL VALUATION-
'i ts_ _ _ __Sq. Ftg l'la i n x
Access x Va
othur4dE/Al V&<L \u
7zs opmentDeve
1. 5q
Plan Ck. Cornm/Ind
65%/81do Per Fee
Plan Ck. Res
30%/Bldq Per Fee
BUILDING PERI'IIT
Charges and
Su rcha rges
/-5.:a.1o
Fence
Demo
PLUI,IBING PERMIT
Charges and
Surcha rges
<o,46
.ap
Sidewalk
Total Cotttb. Permi tA/C Paving
ELECTRICAL PERIlIT
Charges and
Surcha rges
Curb Cut 6?,87TOTAL
ITECHANICAL PERHIT
Charges and
Surc harge s
-,b
- /.<
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal oescriptionl. example- Tax Lot 100, Lane County Map Reference
D_O'TT32. example- Lot 1. Block 3, 2nd Addition toSprf-i!-fielo EstaresC. Na&e, etc. of owner and construction lenderD. Energy Sources
I electrical cei forced air gas
2 e ec or so-TarE. Squa valuati on' eI
2
exampl e-
exampl e-
check add
1250 s,rt new, etc
q. foot house, 500 sq. foot garageproject, check new - if addition,
II.
III.
IV
F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family roomJ. examole - convert singie family residence into_ restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. OESIGN TEAI4 AND CONTRACTORS
To avoid design or construction de)ays, Building0ivision Staff must be able to contait appropriitepersons.regarding des.ign information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrica.l SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the l'lechanical and Electrical Schedules,the app'licant need fill-in only the No. Boxes adji6ent
- t0 the appropriate item(s) to 6e installedB. Full Plumbing, Mechanical, ana Electrical Schedu.lesare available at the Building Divisionl. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be instal'led are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF l.lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULESD. As noted on the CAp, the label must be delivered to theelectrical contractor for signature by his electrical -
supervisor. The general contractor ii not authorizedto sign the electrical labelAppiicant to sign and date
I'lhenever possible, the initial application wi.l .l be used asa.worksheet only. llhere possible, Building Division Staiiln r r.prepare a type written copy and return it to theapplicant at the time the actuai permit is issued io. f,is
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processea rniii tneietees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE O|,ILYv
PERMIT VALIDATION
Permit Clerk
(r->143
btt1t,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
t applicant exempt from registration wfth the Builder's Board because:Permi
Additionai Project Informat.ion:
PLANS REVIEWED BY:
atename 3s'l gnatu
-I .I