HomeMy WebLinkAboutPermit Building 1986-08-04I NSPEt?6-3 CITY OF SPRINGFIELD
COHBI I{ATI ON APPLICATION/PERMIT 7?6-37
[',ater Heater
EIIERGY SOURCES:
Hea t0Job Address
Legal Description
Owner 'w b'b"'Dr(n)
Sq. Ftg. Access
Sq. Ftg. 0ther
llew Add AIte---IeD':-
_fence_Oemo Chai-ge/Use
0ther
Sq. Ftq. I'lai
Address Phone t e
sc rDe
ht At
.e., Build Single
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Addres s Phone
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name address I ics. no.exot res lone no,
Primary
Struc tura I
El ectri ca I
l{echanical
TACTORS name address lics- no-exo l res ohone no-
General nl I
PI I
anl I
PLUIIB I NG
()
ELECTRICAL MECHANICAL
FEE CHARGF NN FFF .HAPCF il0 FFF CHAPGF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU' S
Relocated bui lding
(new fix. additional)New circuits alts.
'L"*EPobtaee 72.e
Floor furnace
and vent
S. F. P.es i dence(l bath)SERV I CES Recessed wal I
Soace heatpr and vpnt
Duplex (l bath) each 4 Zz*/*rfuz /ao./2.4
Additional bath Temporary Constructi on Apol iance vent
sepa rate
tlater service rec i dpncp
Change in existing Stationary evap
cool er
Sewer
I ndu stri a I
multifamily, conrn. or Vent fan with
sinole duct
Storm Sewer 0f s.Vent systern apart from
heatino or A.C.
COMI!./IND. FEEDERS Mechanical exhaust
hood and duct-
Instal I /ai ter/rel ocate
di<trih fppdcr<l'lood stove/heater
0f amps
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES 2?,96 rorAl CHARGEs thlg- /g. t'
HHERE STATE LlNshall not be vali.l
REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernituntil the label has been signed by an Electrical Supervisor and returned to the AuiiJin! Division
l,lAl.lE (pl ease pri nt )*
and
of
of
Boa
onl exempt
055 wil
CARE het e ted tca on rfo t ancompappDerm cert i ttha a n tiforma on s truereonhereb.y fy
atco rrec nd further cert t tha rkwo rformedDE hasandafy donebe n nceaccorda thwl heL na0rd i esnc theof ci tyredndathwsLatheof
any
of5png fi State n n to theoe rta0regon work crldes hereibed n nda atth NC Y wlgOCCUPANC be madestructuwlretthouhetspermiiosofnButhedDionfurtrInghecerttthastra t on th Bufym.y vn he der sregany
rd s n fu eandrcefo tffec s red 0Rs 055701 that frequ i by bas s ofi exr on a ndtheemptihenotedreon tha t
bcSU rsontracto andv awho re n cean thwl 7t\0usel,'lp oyees comD 1 be US ed 0n th s D roj ec
zon"l-_r9_l_____Jype/const.5/f 5R, units sq. Fts.
Fire Zone Bedrooms Occy Load Sq. Ftg.
ToTAL VALUATI0N--,,\a tr(o8Df
lue
1ue -9-&t6'
l'la i n
Flood Plain S tori es
lue
Ftg.
Access x Vaotn""h@u^eroup Brt?
Plan Ck. Corm/Ind
65%/B1do Per Fee i '17,x,=?Svstens Deve
Charqe ( 1.57
opment
I /y.4.BUILDING PERI'IIT
Charges and
Surcharges
o6/
7.72 Plan Ck. Res
30%/Bldo Per Fee
Fence f€-€PLUI4BING PERMIT
Charges and
Surcha rges Dgmo {onrra.rto-- 2.?2
Si dewa l kELECTRICP.L PERIIIT
Charges and
Surcha rges
ZZ,5O
,?d Total Comb. Permit 23?,72A/C Paving
Curb CutI,IECHANICAL PERHIT
Charges and
Surc ha rges
Ata
.66 TOTAL z%.fu
lur
:arn )e l^lork (
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COMB I NATION APPLI CATI ON/PERMIT
I. Applicant to furnishA. Job AddressB. Legal Description
(cAP)PERMIT VALIDATION
II
l. example- Tax Lot.100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, ?nd Addition toS[i1n!Fietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
l. examole- heat/electri_c?l ceili!g/or forced air gasz. examDte- waterheater/electrtcal/or solarE. SquaiE-T66Gge or va luation, et-c.1. example- 1250_ sq. foot house, 500 sq. foot garage2. exarnple- JT-new project, cireck-n-ew - it aaaition,
check add, etc.F. Building permit information:I. example - construct single family house with anattached garage
?. examp]e - remodel existing gaiage into famiiy room3. example - convert single famjly res.idence intoiElTilFant (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 delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechan.ical and Electrical Schedules,the applicant need filI-.in only the No. Boxes adjaientto the appropriate item(s) to be .installed
B. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Divis.ion1. 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 thefulI 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 his electricalsupervisor. The general contractor is not authorizedto sign the eiectrical Iabel.Applicant to sign and date
Hhenever possible, the initial application will be used asa.worksheet oniy. Hhere possible, Building Division Staffwiil prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.
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
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III.
IV
v Permit Clerk w
PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name s'l gna date I - Y-E6