HomeMy WebLinkAboutPermit Building 1984-10-01No
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GarathAami I
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COMBI
SPtuda€t2
PAfu{,els
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Phone ce
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0D
ng e
&
Val ue of l'lork
l,later Heater
Ranqe
EIIERGY SOURCES
Hea t
I NSP
725-
Job Address
l-egal Description
Owne r SAnl fA
Addres s
5.
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Addre s s
Construction Lender
APPL I CAT I RMIT
Ftq . I'lai n_
Acffi+ tlPaT
Sq. Ftg. Access._
Sq. Ftg. 0ther_
_tlewJdd_Al ter_PeP.
_Fence_Demo Change/Use
0ther
name
0
tl
El ectri ca I
Structura l
Pri ma
l,lechani cal ohone no.exDt resrpsqI(lics. no.adrn ame
-ONTRACTORS tcml,*tf E{hptoya
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E
MECHAN I CAL t-\tjELECTRICAL \ \ \\t.'t*PLUt4BI NG \.) v
l. HAAGFFFFFFFCHARGFNONNFEECHARGEfurnace/burner to
BTU' s
Residence of
SQ. FT.Each single fixture
Floor furnace
and ventNew circuits alts.
or extensions
Relocated bui lding
(new fix. additional)
Recessed wal l
Sna.F heatpr and ventSERVICESS. F. Resi dence(l bath)
Apol iance vent
seDa rateTemporary Constructi onAdditional bath
Stationary evap
cool erChange in existing
res i dencel^later servi ce
Vent fan with
sinole duct
multifamily, cofin. or
I ndu stri a ISewer
Vent systern apart from
heatinq or A.C.0fStorm Mechanical exhaust
hood and ductCO|TI./IND. FEEDERS
InstaI I /aI ter/rel ocate
distri h. fepdprs
0f amp s"
ISSUANCE OF PFRI1IT
TOTAL CHARGESTOTAL CHARGES
WHERE STATE LAtl REQUIRES that the Electrical work be done by an Elec
shall not be vali'l until the label has been signed by an Electrical Supe
trical Contractor, the electrical portion of this permit
rvisor and returned to the Building Division
TOTAL CHARGES
- 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 oerformed shall be done in accordance with the 0rdinances of the City
of Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registrat'ion vlith the Bui'lder'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 enpioyees who are in comcliance with 0l1S 701.055 will
DArE /o-/-?y'l,lAtlE ( p1 ease pri nt )SIQaozce )' /Vr.suv;*)
used on this
E
ni ts So
Flood Plain Stories Occ.y Group_Sq.,Ftg.-^T"'#J
ue
x Va
a
0c cy Load Ftg Acce s s
ue
TOTAL VALUATION
BedroomsFire Zone
1o -l -t
0the r
Ftg. l'lain.
& 9.zs Svste[]s Deve
charqe t1.51
opmentPlan Ck. Comn/lnd
65%/81dq Per Fee :\\I
BUILDING PERNIT
Charges and
Surcha rges
\< cL'
(E) \- -/'
PIan Ck. Res
30%/Bldo Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges DBmo
Stdewal kELECTRICAL PERI|IT
Charges and
Surcha rges A/C Paving Tota'l Comb. lermit
Curb Cut
TOTAL 'rt.ccb
t,IECHANI CAL PERMIT
Charges and
Surc harges
I
Phone
Duplex (l bath) each
l,lood stove/heater
COMBINATION APPLICATiON/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. glulplg: Tax Lot 100, Lane County Map Reference17 03 432. gx!Ipl_9: Lot l. Btock 3, 2nd Add.ition tosprrngfield Estates
9. Name, etc. of owner and construction lenderD. Energy SourcesI. example- heat/electrical ceilinq/or fgrced air gas_ ?. examplE- waterhE-tt#7ETEc-iffior sorarL. square footage or valuationl-El-
l. ;I?gl+].?sq sq. foot house, 500 sq. foot saraset. *TBtg-,tr new project, checkrre-w _ if aOUition,cnecK add, etc.F. Building permit information:1. .I?rp]. - construct single famity house with anattached garage
Z. +ggp --."*6del existing garage into fami.ty roomr. exampte _ convert single family residence iniorestaurant (change of use)G. Value of work ai defined in-Section 303 (a) of the.. Structural Specialty CodeH. DESIGN TEAM AND CON1RACTORS
Ig Sygjd !:tls-n or.construction de.tays, Buiid.insurvtslon Staff must be ab.le to contait appropriitepersons.regarding design informat.ion or jbU ifte--corrections, etc.. Abbreviated Plumbing,.Mechanica.l, & Electrical SchedulesA. Except where blink spuces-oiiu" ;;-;;. descriptionportion of the Mechanical and E.lectricat Scneluiei,the appt icant need fi il_in onty ilre No. 6i;;-;;jii.nt_ to-the appropriate item(s) to -be installedB. Full plumbing, Mechanicit, ana-ffelt.ic.i S.h"dr.l.sare available at the Buiiding Division1. To conserve space on the-permit iorm the scheduleshave been abbreviated2. If the item(s) to be instal.led are not covered onthe abbreviated schedules you should .onruit-ttiful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANDCHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to theelectrical contractor for signature by h.is ete.i.iiai'-supervisor. The general conlractor is not author.izedto sign the e'lectrical labeiApplicant to sign and date
Hhenever possible, the initial application wil.l be used asa.worksheet only. lrJhere possibii, Auilding Division-iiaiiw'ill.prepare a type written copy ind return it to theapprrcant at the time the actuai permit is issued toi rrissignature.
Fees and Charges
Plan check fees are due and payab)e at the time of theapplication, and no plans wiil-be procesied unti.l tteiefees are paid. All other fees and .h;;;;i are due andpayable h,hen the permit is issued.
FOR OFFICE USE ONLY
PERMIT VALIDATION
II fl
u3
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v (b
III.
IV
V Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
.---
nuffi-.glfr, ;-., \ i= r.1\-Si g aatd C;-': .-'i.U
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: