HomeMy WebLinkAboutPermit Building 1982-01-04I
INSPECTIOII LIIIE.
726-37 69
CITY OF SPRiNGFIELD
COI1BI I{ATI ON APPL I cATION/PERMIT
INFORIIATION LlNE
726-3753
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Job Address
Legal Description ' 7dl 'G sS
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liater Heater €Mp<c-
Ranqs eAs
EIIERGY SOURCES:
Heat LA9
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Sq. Ftq. l'1ain_
Sq. Ftg. Access.--
Sq. Ftq. 0ther
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_Fence_Demo_C ha nge/ U se
-other-Owner S"Rl- 's N\ A so * g7
scr
Fami I
+n .e., BuiId SingieAddress8 8 3 t.loRTF Lgt* Sfhon" #a
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Construction Lender HOfIE J
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Address Phone
exnt res (nDES IGN TEAI.,I name rddress l0ne no
Pri ma ry
Struc tura I
El ectri cal
!l'lec ha n i ca I
ACTORS name address''lics. no-exDl rFq (ohonp no. )I
Genera I
Plumbinq VAirEe Pcu>sbuoa'Box t(, Da<rre-za- tZe PB q/zr/'gz q31-)26 L
Lrtt..tis tleela.:t- Roy n .FAll cELLk , qlqz* 2o.- t3t- c-Li ectr i ca l
fiec ha ni ca I
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PLUI.IB I NG ELECTR I CAL MECHANICAL '
FEE CHARGE NO FFF CHARGF NO FFF CHARGF
?Each single fixture aa5,ys"Residence of
FTSQ
furnace/burner to
BTU' s
Relocated bui lding
(new fix. additional)
New circuits alts
or extensions -2 6D xA6E a 6.n
Floor furnace
and vent
S.F. Residence(l hath)SERV I CES Recessed wal I
SDace heater and vent
Duplex (l bath) each
Additional bath Temporary Construct i on Apol iance vent
spna ratc
[.later servi ce Change in existing
rpcidpncp
Stationary evap.
cool er
/d.n multifamily, corm. or
Indrrsiria lISewer /L I Vent fan with
sinole duct 3.-o
Storm Sewer 0f amps.Vent systern apart from
heatino or A-C-
cor,lr.r. / IND. FEEDERS I Mechanical exhaust
hood and drrct ,/.so
Instal I /al ter/re1 ocate
di stri h- fppdpr<l'lood stove/heater
0f I 6.tS PrPtaa,oA1
ISSUANCE OF PFRIlIT /o,n
TOTAL CHARGES l9-TOTAL CHARGES fiso
HHERE STATE L{l.l REQUIRES that the Electrical work be done byshall nct be valil until the labcl has becn signcd bj rn Elcctl-'i
an Electrical Contractor, the electrical portion of this permit
cal 9upc; vi:c:" rnd rcturncd tc the 9uilCing Divisicn
TO]AL CHARGES
I HAVE CAREFULLY EXAIIINED the completed application for oermit, and do hereb.y certify that all information hereon is tlueand correct, and I further certif-v that any and all work performed shall be done in accoidance with the 0rdinances of the Cityof Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that N0 OCCUPAI,ICY will be madlof 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 baiis for Lxemfition is noted hereon, and thatonly subcontractors and ernployees who are in comoliance with 0l?S 701.055 r,rilI be used on this project.
tlAl'lE (p l ease pri nt )s IGNATURE DATE
zone_-M_M___tyoe/Const. &-il tnits Sq. Ftg.
Fire Zone Bedrooms Occy Load Sq. Ftg.
Flood Plain Stories / 0cc.y Group /7- Z Sq. FtS.
ToTAL VALUATI0N_
lue
lue
l'lain x Value--..-_-
Plan
65%/
Ck. Cormn/ I nd
Bldq Per Fee ( q.q 6 t'"-: -SYsteris Deve'
Charoe (1.5?'opmentBUILDING PERNIT
Charges and
Surcharges
6a
2-Fee
Plan Ck, Res
30%/81ds Per Z<. Fae {q,,c-rLD fufe
Fence ?**n ??g D,gJffiDPLUUBING PERMIT
Charges and
Surcha rges z,zn Dgmo
Sidewal k
;#ir-eL
ELECTRICI.L PERI,:IT
Charges and
Surcharges 6o
aa
A/C Pavi ng Tota'l Comb. Permit I 17,A/
Curb Cut
TOTAL /71, d?
IlECHANICAL PERI,IIT
Charges and
Surcha rges
f,a
4
)e l,lork (I Garaoe
(
I nnr-n nn . ,
FOI1 OFFICE USE O|ILY
Access x Va
otn",*€re2e_c_^E!_1_uu
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l:*-szna*z)t
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COMBINATION APPLICATION/PERI,IIT (CAP)
I. Applicant to furn.ishA. Job AddressB. Legal Descriptt'on
l. example- Tax Lot 100, Lane County Map ReferenceIITSZ:2. example- Lot l. glock 3, Znd Addition toSprTn-gfield Estatesq. Name, etc. of owner and construction lenderD. Energy Sources
el ca il i forced air gas
2 or solarE. Squa va I uation, eIexamp_le- 1450 sq. foot house, 500 sq. foot garageelample-.if new project, check-new - if additio;,check add, etc.
?
II.
F. Building permit information:l. example - construct single family house with anattached garage
?. example - remodel existing garage into family roomJ. exampte - convert single family residence into
^ restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Speciaity CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction delays, Buitd.ing0ivision Staff must be able to contalt appropriitepersons-regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the applicant need fill-in on)y the No. Boxes adjaient
_ to the appropriate item(s) to be insta.lledB. Full Plumbing, Mechanical, and Electrical Schedu.lesare available at the Building Div.is.ion1. To conserve space on the-permit form the schedu.leshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l 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 h.is electricalsupervisor. The general contractor ii not authorizedto sign the electrical labelAppiicant.to sign and date
lJhenever possible, the initial application wil'l be used asa.worksheet oniy. lJhere possible, Buitding Division Staffwill prepare a type written copy and returi it to theapplicant 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 theapplication, and no plans will be processed until thesefees are paid. AII other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III
IV.
V
PERMIT VALIDATION
&\o
Permi t Cl erk
2-
UNJ
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
oo
rmit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name i gnature da te /- y-93
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