HomeMy WebLinkAboutPermit Building 1985-10-05.!{IhID\ u^,ill tt^tu *
TION L
69
CITY OF SPRTNGFTEID-
COIIBI IIATION APPL I CATION/PERMIT 726-37s3
Job Address o2
e
Hea
EIIERGY
l,later Heater
Ranqe
l-egal Description o
Owner r'Vaiue of l,lork:30 z,e-z
Sq. Ftg. Access._
Sq. Ftg. other
_l'lew_Add7!gr IErjnep._
_Fence_Demo Change/Use
-other---
Sq . Ftq . l.la i
Address eId :e., BUin
ti
ng ehAtDesclrlork
Ga ra
Construction Lender 24c<zG)ta / khzcrrt ru:tc .%
Address Phone fu Wor tVt <,qa aRtruYcs - /rv <,
Structura I
Pri
EI ectri cal
Hechan i ca I
CONTRACTORS name address''l ics- no.(cxni res )ohone no.
4a,
I ectri ca 1
d-?r
PLUHB I NG ELECTRI CAL MECHANICAL
{
N0.FEF CHARGF N0-FFF CHAPGF NO FFF CHARGF
2 Each single fixture /a*Residence of
FTSQ
furnace/burner to
BTU' S
/*
Relocated bui lding
(new fix. additional)New circuits alts
or extensions2 all EroBG
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES Recessed wal l
Snace heatpr and vpnf
Duplex (1 bath) each /Ht/tr Ds/r /zue.
Additional bath Temporary Construct i on Apol iance vent
seDa rate
[.later servi ce in existingChange
res i de nce
Stationary evap
cool er
Sewer multifamily, corm. or
I ndust ri a I /Vent fan with
sinole duct voo
Storm Sewer 0f Vent systern apart from
heatino or A.C.
COMI'I./IND. FEEDERS Mechanical exhaust
hood and duct
I n sta I I /a I ter/ rel ocate
distrib. feeders l'lood stove/heater
0f amps.
ISSUANCE OF PFRI1IT
TOTAL CHARGES 10.n TOTAL CHARGES
O,rorAl CHARGEs lWry, ,/A,a-o
WHERE STATE LlN REQUIRES that the Electrica'l workshall not be valii until the label has been signed by
be done by
an Electri
' an Electrical Contractor, the electrical portion of this permit
cal Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereb.y certi
oertaining to the work described herein, and that NC 0CCUPANCY will be made
Building Division. I further certify that my reqistration with the Builder's
only subcontractors and employees urho are in comcliance with Ol?S 701
l,lAl.lE ( pl ease pri nt )S IGNA
\
and
0regon
fy that all information hereon is truecorrect, and I further certify that anypringfield and the Laws of the State of
and all work performed shall be done in a ccordance with the Ordinances of the CityofS
permission of theffect as required
of any structure without the
Board is in full force and e by ORS 701.055, that if the basis for exemption is noted hereon, and thatexempt
055 wil]be used on this project.
Zone /Ul.tO tyoe/const."7/lr5?3)n
Fire Zone Bedrooms 0c
Flood Plain Stories / 0c
cy
xFtgc.y
$lq . os stozf P*i n
its Sq. Ftg
Ftg. Access Val ueLoad Sq.
c,^oro-Ei?;q..0ther Val ue
TOTAL VALUATI
Plan Ck. Comm/Ind
65%/B1do Per Fee
wg@5+19 , n -f' b13r-tems Deverqe ( 1.57
Svs
cha
opment /y.A.BUILDING PERMIT
Charges and
Surcharges
__/zz_'_75.oE Fee
Plan Ck. Res
30%/Bldo Per
FencePLUI4BING PERMIT
Charges and
Surcha rges
/o.*.{o Dgmo faa /?.af,
Sl dewa I kELECTRICAL PERIlIT
Charges and
Surcharges
6
.60 Total Cornb. Permit /68. {aA/C Paving
Curb CutI{ECHANICAL PERMIT
Charges and
Surc harges
ae,
, //o /sz 55TOTAL
u"_Vl&.o"
V,%<5-oE.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. g$Iglg-: Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
hea t/e I ec tri ca ceilin forced air gas1. examol e-^+a. examp le-E. squaE-66-ta
example- 1250 sq
exampie- if new
check add, etc.
wa e
ge or valuat on, etc
r solar
1 . foot house, 500 sq. foot garageproJect, check new - if addit.ion,2.
F. Building permit information:1. example - construct s.ingie family house with anattached garage
?. examp-le - remodel existing garage into family roomJ. example _ convert single family residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI4 AND CON1RACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropr.iitepersons.regarding design information or job iitecorrections, etc.II- Abbreviated Prumbing, Mechanicar, & Electricar scheduresA. Except where blink spu.es o.ir" in the description--portion of the Mechanical and Electrical Schedules,the appl.icant need f.iIt-in only the No. aoiei-idjui.nt
_ to-the appropriate item(s) to be instal.ledB. FulI PIumbing, Mechanical, and Electrical Schedu.lesare available at the Building Division1. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult iheful I schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered tortheelectrical contractor for s.ignature by his eteciriiai"-supervisor. The generai coniractor ii not authoriied
- to sign the electrica'l labei.III. Applicant to sign and date
lJhenever possibie, the initial application wil.l be used asa.worksheet only. Where possibie, Bui)ding O.ivision-iiaiiwill.prepare a type written copy and return it to theapplicant at the time the actuai permit is isiueJ io" f,is
s ignature.IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiil be processed unti.l thesefees. are paid. Al l other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
6Us 4s?
PERMIT VALIDATION
Permit Clerk
E -( b
(nt
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
d
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
gna date ./O-8.,a.s-nane Latrye VG6 si