HomeMy WebLinkAboutPermit Building 1984-01-17wLx <0
726-375I
7
NE
Job Address
Lega1 Description
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EIIERGY
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Phone
Construction Le
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name
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MECHAN I CALELECTR I CALPLUIIB I NG
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Genera
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FFFNOFFFCHARGECHARGFNOFEEfurnace/burner to
BTU' s
r 0Ara r'r.o0
Residence of
SQ. FT2.
Floor furnace
and vent
New ci rcui ts al ts,
or extens ions
Relocated building
(new fix. additional)
Recessed wal'l
Snacp heater and ventSERV I CESS . F, P.es i dence(l bath)
Duplex (l bath) each
Apol iance vent
seDa rateTemporary Construct i onAdditional bath
Stati onar,v evap
cool er
Change in existing
rps i dencptnlater servi ce
1.nO/Vent fan with
sinole duct
multifamily, conrn. or
I ndustri a ISewer
part from
c.
Vent systern a
heatinq or A.0f .ampsStorm Sewer
./fr)Mechanical exhaust
hood and ductCOT'lIl. / IND, FE-EDERS
l,Jood stove/heater6.oo I nsta I I /a I ter/ rel ocate
distnib. feedersIR e Or,,,,a .
,tLab"oC)ve7 0amp s,tr)of z@
bc"uo Y'10\'10
ISSUANCE 0F PFRIIIT
TOTAL CHARGES 3.h2'TOTAL CHARGES ts,bo_sTOTAL CHARGES I GO
WHERE STATE LAI.I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the completed apnlication for oermit, and do hereb.y 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 0rdinances of the City
of Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that my registration urith 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 ernployees r,lho are in comcliance with 0l?S 70i.055 wi'l I
ortrc/-/74tiAtlE ( p1 ease pri nt )IGiIATURE
us s project.
FoR oFFI
Flood Plain Stories Occ.y Group !q
Ftg
Ftg
Ftg
Zone
Bedrooms xFire Zo np
I
Load
l'lain x Val
Val ue
TOTAL VALUATION
st. Uni ts Scr
Access
0ther
Plan Ck. Conrn/Ind
65%/B1do Ppr Fce
Svstems Deve
charqe t1.57
opmentBUILDING PERMIT
Charges and
Surc ha rges Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surc ha rges
__15__a _O__
DEmo
Sidewal kELECTRICA.L PERIIIT
Charges and
Surcharges u A/C Paving Tota'l Cornb. Permi t
Curb Cut H3l 3 l--
I,IECHANICAL PERMIT
Charges and
Surc ha rge s .l?/
3-o a
TOTAL
COMB I
re tljork (
Garaoe
( addre s s
Each single fixture
---l-1_-c-P--
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Referencet7 03 432. example- Lot 1. Block 3, Znd Addition to
SITin-E-f,ietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
l. exampl e-?. exampl e-
E. Square footag
heat/electrical cei 'I forced air gas
wate ea r e or solaF
e or valuation,l. examp'le- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check 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 - conver.t single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descript'ion
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in oniy the No. Boxes adjacent
to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Eiectrical Schedules
are available at the Bui)ding Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful I schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
superv'isor. The general contractoris not authorized
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initiai application will be used as
a worksheet only. Where possible, Building Division Staff
wili prepare a type written copy and return it to the
applicant 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 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.
II
III.
IV
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
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Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY:
permit appl icant exempt from reg'istrat'ion with the Bu'ilder's Board because:
Additional Proiect Information:
PLANS REVIEWED BY:
name s1 g nature date
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