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Home My WebLink AboutPermit Building 1986-05-22COHBI NATI ON APPL I CATION/PERI{IT Lega'l Description Job Address Hea EIIERGY SOURCES: l{ater Heater Owner t*?:(?Ac -r(a. osT- Val ue of Sq. Ftg. Access._ Ftg. 0therSqFtg A IAddl{ew Use Address a>Ll i dence I'li ..e., Bui ld Single 65{oPoeiXe$,D qlao+Af>ni ur- Ae i )Lq+ . (.rzairsk{rft c .< O Construction Lender ."-fr.r rttzt ca!oet (tFs, + =42oD <?;l),..'ct Address Phone DL5 N TEAI.I name addres s \lics. no.exDI res rone no. Primary Structura l El ectri ca l Hecha ni ca I :TORS name addres s exDl res ohonp no- 4', nl PLUt{B I NG q) ELECTRICAL MECHANICAL FFF CHARGF NO-FFF l^H A OT:F NO FFF CHARGF Each single fixture Residence of sQ. FT. furnace/burner to - BTU' s Relocated buildino (new fix. additioial)New circuits alts. or extensions Floor furnace and vent S.F. Residence(l bath)SERVICES Recessed wall Soace heatcr and vent Duplex (l bath) each Additional bath Temporary Construction Apol iance vent seDa ratP llater service Change in existing resi dencp Stationary evap. coo l er Sewer multifamily, corm. orIndustrial Vent fan with sinole duct Storm Sewer 0f Vent systern apart from heatino or A.C- coMr.{./rND. FEEDERS Mechanical exhaust hood and duct I nsta l I /a I ter/ rel ocatedistrib. fepdprs lJood stove/heater 0f ISSUANCF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES TJHERE STATE L.lU REQUIRES that the Electrical work beshal] not be vali,l unti] the label has been signed by an done by El ectri an Electrical Contractor, the electrical portion of this pernit ca1 Supervisor and returned to the Build.ing Division L nd ItcorrecandfeanddngfiSpri wlstructure ns fu fo1 on su bcontractorsly 1{Ar.rE ease rtpp Ftg Fts Ftg x TOTAL lues Flood Plain Stori es re Zone Bedrooms Occv Load Const. Uni l'lain x Val Group__ tlq . Acces . Other Plan Ck. Comn/Ind 65%/B1do Per Fec Systems Deve' charqe (t.5Zl opmeot t ffiBUILDING PERfiIT Charges and Surcharges _____lZ 7 Plan Ck Re Pe sr-3!ll!l ds Fee \ FencePLUT,IBING PERI,IIT Charges and Surcha rges Demo Sldewal kELECTRICAL PERI,!IT Charges and Surcharges A/C Paving Tota'l Comb. Permit Curb Cut HECHANICAL PERHIT Charges and Surcharges /5e?_ bo &aTOTAL certi fy the basi that my registration withs for exemption is notedf exempt .055 wi l l true beshall 1n accordance tY't th the Ordi nances of thetothedescri bedwork and NCthatherei n wlOCCUPAI,ICY I be Ci ty madefurtherIderBuithethatandthathereon, 0r?s TLtl onused thi s Project.be / COMBINATIOI{ APPLICATION/PERT4IT (CAP) I. Applicant to furnishA. Job AddressB. legal Description c. D. l. example- Tax Lot 100, Lane County Map Referencer-71T,[:2. e)(a!ple- Lot 1. Block 3, 2nd Addition to SEiin-67i el d Estates Name, etc. of owner and construction lender Energy Sources I e- heat/electrical I forced air: gas ?e-r ec or solar-E. SquarE or valual. example- 1250 sq. foot house, 500 sq. foot garage2. exarple- F-n-ew project, .check-new. - if aOditioi, check add, etc. F Bul. 2. 3. ilding permit information : example - construct single family house with an attached garage examole - examp l e - res tau ran remodel existing garage into family room convert single family residence intot (change of use)G. Value of work as defined in Section 303 (a) of theStructurai Specialty CodeH. OESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriite persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful'l PIumbing, Mechanical, and Electrical Schedules' are available at the Buiiding Divisionl. To conserve space on the permit form the scheddles have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. EUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electricai label Applicant to sign and date t'lhenever possible, the initia'l application will be used as a worksheet only. l,Jhere possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna tu re. Fees and Charges P'lan 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 II. III. IV. v PERHIT VALIDATION 0 ,{ Permit Clerk V PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Additional Project Information: PLANS REVIEWED <- n si g nature Permit applicant exempt from registration with the Builder's Board because: L INE CITY OF SPRINGFIE T COHBI NATI ON APPL I CATI ONIPERI.I TT 7 Job Address € Lesar Descriotion l) O> C: /O OflaT Owner Sq. Ftg. Access._ Sq. Ftg. 0ther_ _t{ewJddJl ter_Rep. _Fenc e_Demo_C ha n g e,/ U s e 0ther l,later Heater I ue of l.lork Ftg n ng et dence oo0 Descr EIIERGY SOURCES: Heat 5^trzlq5ffone 9)., 6svo?re*La^ o l leov fi*' ^o ?qef,+i dur s 2 E)=. , Construction Lender Addres s Phone \- .{ cb oJ 0o name s ics. no.exDt res Dhone no. Primary Structura I E I ectri ca I Mechanical IACTORS name addrps s 'I ics. no.exot rps nhonp nn ?I o O 1 ?t)oltoo )ilx /q,(- l.!echani ca l PLUIIBI NG ELECTRI CAL MECHANICAL FFF CHARGF iJn FFF CHARCF NO FFF THAPGF Each singie fixture Residence of FTSQ rstrrydLE Relocated building (new fix. additionai) New circuits alts. Pl'&'\3Xooe 22S Floor furnace and vent S.F. Residence(l bath)SERV I CES Recessed wai I Snare heater an.l vehl Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate |later servi ce ge in existing dence Chan res i Stationary evap. cool er Sewer multifamily, conrn I ndustri a l 0r Vent fan with sinolp drrct Storm Sewer 0f Vent systern apart from heatinq or A.C. coMr.r. / IND. FEEDERS Mechanical exhaust hood and duct I ns ta l I /a l ter/re l ocate di <fri h fpoders trlood stove/heater 0f amps \Scr rssuANCE oF PFRltrr L)\N TOTAL CHARGESTOTAL CHARGES $t N TOTAL CHARGES \t WHERE STATE Li\I,l REQUIRES tha't the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Build'ing Division information hereon is true .h the 0rdinances of the City at t{0 0CCUPAI.ICY wil l be made tration with the Builder's on is noted hereon, and that only subcontractors and employees who are in comoliance with ORS 701.055 wi'll be used on this nroject l.lAl'lE( p1 ease pri nt)SIGNATURE vr---_ DATE c/-> t- t the permi and effect N tncat an cert ttha acompapr)reb.y fy IandcorrectIandrthefucertr'|tha t has '|I ac cordance'I n w1 tedonbend1aworkDEfy If Ie andd Lawsthe tathesofSof any ofn9tepri n1'I to workthe crldes hereibed n thandoertang0regon s ructut wlre thouaof 'Inyss ofn Buithe dI n'|1 S'I 0n'I hefurt certr 'I ttha sIIgmyfyreg '|Board '|S fun II Iforceu red ORS 7 05I 5 tthaas 'I f t bas s1 forthebyreqexemp exempti Zone__Bedrooms 0ccy P l ai n Stori es \ Occ.y lue Val lrF 'I llp f,}b>)l d q'Pt8"ror AL VALUATION Load Fts. 0ther\L)x3[-\c)Ei Fi re Fl ood . Ftg. Access Zone t.&\)S!Lunits sq. Fts. r,rai Pl an Ck. Corm/ Ind 65%/B1do Ppr Fpp S vs terirs Cha roe Deve f1.57 \\IN3t t3 opmmtBUILDING PERI.IIT Charges and Surcharges \Plan Ck. Res 30%/81dq Per Fee I FencePLUI4BING PERMIT Charges and Surcha rges __\){_\-__ D6mo Sldewal kELECTRICAL PERIlIT Charges and Surcha rges a _eL (o A/C Paving Tota'l Comb. Permi t Curb CutI,IECHANICAL PERHIT Charges and Surc harges _\5 l? 80TOTAL :ami I v e l^lork( Ga raoe \ YVtlr.,.r. N91"\. TEAI,I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot I00, Lane County Map Reference 17 03 432. example- Lot l. Block 3, 2nd Addition to SpiTngfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources1. examp'le- heat/ejectrical ceiling/or forced air gas 2 . e x a mp Ie - wa t e r ir e a t e r 7el@EiT-a I / o r s oTII-E. SquaiE-Tootage or valuation,GTc. l. example- 1250 sq. foot house, 500 sq. foot garage?. example- if new project, check new.- if addition, Eheck-add, etc.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 intorestaurant (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 deiays, Bui)ding Division Staff must be able to contact appropriatepersons regarding design information or job sitecomections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiil-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. FulI Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the schedLiles have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI scheduIesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the labe'l must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is.not authorizedto sign the electrical labelIII. Applicant to sign and date Whenever possibie, the initial appl.icat.ion wilt be used asa worksheet only. Where possibje, Building 0ivision Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.IV. Fees and Charges Plan check fees are due and payable at the time of theappiication, and no plans wili be processed unt.il these . fees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION /n Permit Clerk :ata >5q' e uJ)l?il S*1 otr PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: datenameSignature