HomeMy WebLinkAboutPermit Building 1984-02-08 (2)7?6-37 69 CCillrl iiai I uN APPL I CATIuit/ f-urillT
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t1l-egal Description
Job Address EIIERGY SOURCES
Hea t
t,later Heater
Ranqe
Val tlork
Fto. tlain_
Ftg. Access._
_Fence_Demo_C ha n ge/ U se
0ther
Sq
!q
Sq
I'lew Add A I ter ,?ep.
Ftg. 0ther
0wner [zYt A ,rO rr DVtr 0€- b, 7{7 -// Z o
be l,Jork
Fami l
n t
ce
.e., Build SingieAddress q33)o l/q q, 5-o Phon%l/brt'
Tu^e-1,',a,^.1 /C , )'n Cr.,c\$cP1 \tsr:r\nr. r \h
Construction Lender trY ttYtrrc^, BLr r ( FlL't(:
Address Phone
rnCV-,-
oDd CStructura I
Pri ma coJc
/^v^,-r^t-
Electrical lV).ltt
Hec ha n'i ca I
CONTRACTORS name address lics. no.exDt res ohone no.
Genera I
Plumbi
E l ectri ca I
Itlechanical
PLUI{B I NG ELECTRTCAL \\)u MECHANICAL \\\
FEE CHARGF NO FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTU' s
Floor furnace
and vent
Relocated building
(new fix. additional)
New circuits alts
or extensions
SERV I CES
Recessed wall
Sn:ap hpiiPr rnd vpnt
S.F. Residence(l bath)
Duplex (l bath) each
Temporary Constructi on Apol iance vent
seDa rateAdditional bath
e in existing
e naF
C hang
resi d
Stationar,v evap.
coo I erl.later servi ce
multifamiiy, corm. or
Indrrstria l
Vent fan with
sinole ductSewer
Storm Sewer 0f s apart from
.c.
Vent system ,
heatinq or A
Mechanical exhaust
hood and drrctIPltTFu'.rfiitg \1.-\5pp c0Mr.1./IND. FEEDERS
I nsta I I /a l terlrel ocate
di stri h- fepders llood stove/heater(5,I)Rr, i-,IA\$\
0f amps
ISSUANCF OF PFRtlIT
TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES \5.,u>
WHERE STATE Lll,l REQUIRES that tlre Electrical work be done by an Electrical Contractor, the e'lectrical portion of this pernit
shall not be vali:l until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAHINED the completed apfr'lication for permit, and do hereb.y certify that all information he
and all work oerformed shall be done in accordance with the Ordinances
n oertaining to the work described herein, and that ll0 0CCUPAI,ICY will be made
Division. I further certify that my registration vrith the Builder's
on r v subcontracto rs
.
and *r)3;": i!" ; " + ;\): 7 ;, !_
.ps zn r .
l.lAl.lE( please pri nt)ZDATE
ny
of 0rego
,he Bu
exempt
055 wi l
ng
701
(L
reon i s true
and correct, and I further certify that a of the Cityof Springfield and the Laws of the Stateof any structure without the p,
Board is in fulI force and eff,
ermission of t itdi
ect as required by ORS .055, that if the basis for exemption is noted hereon, and thatI be used on this roj ect
IGNA'
.l
<ri
r.h
FtgFire Zone- Bed rooms
-Xotn"" ^ \tC)al ue0c.y e.oriB-f:-sq. Fte
Ftg
al
Const.
Load
Value
TorAL vALUATrot ?A.ceEz
its \.
Flood Plain Stories
Plan Ck. Comm/Ind
65%/B1do Per Fec
f'-)zl..w o2*a-7q-B CJEE?
opmentterns icq.-BUILDING PERI'IIT
Cltargas and
Surc ha rges 8zl --Plan Ck. Res
30%/Bldq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges
___\i._=___
CD Demo
Si dewa l kELECTRICAL PERI1IT
Charges and
Surcharges A/C Pavi ng Total Comb. Fermit
Curb Cut LI ? I.J '{{l \, l.
I,IECHANICAL PERMIT
Charges and
Surc ha rges TOTAL
t\,
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7 lo-: i
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
PERMIT VALIDATION
?examp I e-
Spri ngfi
Lot 1. Block 3, Znd Addition toeld EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. examole- heat/2. ExamETE- water
SquaiE-76-tage or
air gas 2EE
Il. example- 1250 sq. foot house, 500 sq. foot garage2. exarnple- JT-new project, cneik-i-ew - if aoditioi,
check add, etc.F. Building permit information:1. example - construct singie family house with anattached garage
?. example - remodel existing garage into family room3. exampie - convert single family res.idence inlorestaurant (change of use)G. Value of work as defjned in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc.
Abbreviated Piumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be instaljedB. Full Plumbing, Mechanical, and Electricaj Schedu'les'are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF I.JILL 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 his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.Applicant to sign and date
llhenever possibie, the initial application will be used asa-worksheet only. Where possible, Building 0ivision Staffwill prepare a Lype wr.itten copy and return it to theapplicant at the time the actual perm.it is issued for his
s i gnature.
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. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
bZ
II
III.
IV (
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name,si gnature date z- z\-rq