HomeMy WebLinkAboutPermit Building 1983-02-28IIISPECTION LIIIE
726-37 69
FIELD
ION/PERMIT
INFORI1ATION LiNE
726-3753
Job Address*!61.f S>l.//rrt Sl
liater Heater
Ranqe
EIIERGY SOURCES
Hea t
Legal Descriptjon I
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ELECTRI CAL MECHAN I CALPLUIlB I NG
aHA pGFFFFCHARGFNNFFFNHARGFNOFFFN0.
e,'/t"'?4-Residence of
SQ. FT.('lrxw rner to
BTLI' sEach single fixture
a
/f Floor furnace
and vent
Relocated building
(new fix. additional)
Recessed wal I
Snarp hpetpr and vpnf
S. F. P.esidence(l bath)SERV I CES
Duplex (I bath) each
Temporary Constructi on Apol iance vent
'seDa ra teAdditional bath
Stat ionar.v evap
cooi erlnlater servi ce ge in existing
dence
Chan
res i
?roI ndu stri a I
multifamily, comm. or I Vent fan with
sinole ductSewer
0f amps.Vent systern apart from
heatino or A.CStorm Sewer
COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct
I nsta I I /a l terlre1 ocate
distrib. feeders t'Jood stove/heater
r 2 f urpr.0f /S \rt
/a.*ISSUANCF OF PFRI{IT
TOTAL CHARGES ?a.n TOTAL CHARGES 3a ?,1.4TOTAL CHARGES
WHERE STATE Llt, REQUIRES that the Electrical work be doneshall not be vali.l until the label has been signed by an Elec
by an Electrical Contractor, the electrical portion of this permit
trica1 Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do
oertaining to the work described herein, and that NC 0CCUPAI'ICY will be
I'lAt'lE(please print IGiIATURE
Ci ty
made
and
di
DA.',rahfk*
information hereon is truehereby certify that allcorrect, and I further certi fy that any and a'll work performed shal l be done in accordance with the Ordinances of theof Springfield and the Laws of the State of
further certify that my registration with the Builder'sof any structure without the permi
Board is in full force and effect
ssion of
' 0regon
the Buil ng Division. I
701.055, that ifas required by ORS exempt the basis for ion is noted hereon, and thatonly subcontractors and ernployees who are in compliance with 0l?5 701.055 wilI be used on project
Ftq. Access x Val,rn.*nuWu,
TOTAL VALUATION
Val
q.Flood Ptain Stories / 0cc.y Group El.
I tc Ftq . t'la i
ue /€, o*,4
Bed rooms Occy Load Sq
tZone *lJg4 IyDelcons
Zs
Fire Zon
Plan Ck. Conrm/Ind
65%/B1dq Per Fee ST,3A Systems Deve
Charoe (1.5r.opmentBUILDING PERI'IIT
Charges anC
Surc ha rges 7sa
Gr6
Plan Ck. Res
30%/81dq Per Fee
fd2.7 t,.33
l/a 1A /;t tf ls
FencePLUI4BING PERMIT
Charges and
Surcha rges
?a,-'
.8o D6mo
Total Cornb. Fermit /L/'' oA/C Pavi ng
Curb Cut
Gr€r Sidewa l kELECTRICP,L PERIlIT
Charges and
Surcha rges
I1ECHAIIICAL PERMIT
Charges and
Surc ha rges -?./---=.8y TOTAL
UL5I GN I LAI.1
I
nhonp nn
Fl pctrical ( e- ,, ']
New circuits alts.
or extensions
,ltn Tprr*n
PERMIT VALIDATION
*tpo4tZ
Permit Clerk
.)
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, Znd Addition toSpringfield Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
-ltl9a!
II.
l. example- 1250 sq. foot house, 500 sq. foot garage2. exa;ple-: JT-i-ew project, cheik-new - if additio;,
check add, etc.F. Building permit information:l. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction de)ays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Hechanical and Electrical Scheduies,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Euilding 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 theful1 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 author.izedto sign the electrical label
Applicant to sign and date
Hhenever possible, the initial application wi'll be used asa Lorksheet only. Where possible, Building 0ivision Staffwili prepare a type written copy and return it to theapplicant 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
appjication, and no plans wiil be processed until these
fees are paid. Al l other fees and charges are due and
payable when the permit is issued.
III
IV
V. FOR OFFICE USE ONLY
1.
2.E. Squa
Sxampl e- hea t,/
example- water
re footage or
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVI El^l
name
D BY:
s i gnature date
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