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Home My WebLink AboutPermit Building 1989-03-16INSPECT]ON LINE 7?6-37 69 CtTY OF SPRINGFIELD COMBI IIAT I ON APPL I CATION/PERMIT INFORI4ATJON LTNE 726-3753 o0 -so L rob Address3fr'/ *9;UZ, _€?SOURCES: Hea t l,Ja Hea ter Varue of ,r"rb{O. Sq. Fto. l4ain_ Sq. Ftg. Access._ Sq. Fto.0ther I'ler^l Add Al Ter-m'. - -Feni6 Demo Cha nge/Use -0ther- l-egal Description 03 -t Owner Address I'honc n .e., Build Single -+< Construct ion Lenfur .\\ Add res s l)hone I DES I GN TEAI,I nanre addresy lcs. no.exnl res to ne no- Primary Structura l Electricai l"'lec ha n i ca I CONTRACTORS naile address (lic+. no.exol res Genera I P \l c 5 l,lec ha n i ca I P LUIlB I IIG ELTCTRICAL MECHANICAL N0.FEE CIlARGE NO FFF rHA PNF N0 FFF rilA anF Each single fixture Residence of SQ. FT furnace/burner to BTLI' s Relocated buiIdinq (new fix. additional )222 Floor furnace and vent S . F. lles i dence(l bath)SERV I C IS Recessed wal I SDaae heater and vent Duplex (1 bath) each Add.i ti onal bath Temporary Constructi on Apol iance vent seDa rate l,later servi ce Change i n exi sti ng res'i dence Stationary evap cool er Sewer mu'l ti f anri 1y, comm or Tndrrstrial Vent fan with sinole duct Storm Sewer 0f s.Vent system , heatinq or A apart from .c. c0r.ilr./tND. FTEDERS ittechanical exhaust hood and drrct Instal I /al ter/relocate distrih. feeders tlood stove/heater 0f amp s. ISSUANCF OF PFRI1IT TOTAL CHARGFS TOTAL CHARGES TOTAL CHARGES I^IHERE STATE 111,1 REQUIRES that tlre Electrical vrork be done by an ilectrical Contractor, the electrical portion of this permit sha'll not be valil untj.l the label has been siqned by an ilectrical Supervisor and returned to the Building Division he c ompleted apnlic that any and a1 State of Oreoon t 1 o n for Dernl 'I t an d do he re b.y cert 1 fy t ha t a n rma t on n s true a n d cor rec t a nd I fu r the r c ert 'I f.v I t^ro r k DE rfo rmed s ha I I be done I n accorda nc wi t h the 0rd 1 n ances of the c 'I ty of S r)rl n9 f i e I d a nd th La WS f the DE rta '|n I ng to t he WO rk des c rl bed herei n a nd tha t NC 0cc UPANCY WI 1 I be made of any structure without the permission of the Buildinq Division. I further certify that m.y reqistration vrith the Builder's Board is .in full force and effect as required b.y ORS 701.055, that if exempt the basis for exemption is noted hereon, and that onl-y subcontractors and emp.loyees who are in comcliance with f)ns 701.055 r.rilI be used on this project. D l,lAllE( p1 ease print) -K0 6 S INiIATURE DA,TE s7 Zone M4 -ty*ii^'t i ts_Fttt Ft! Ftg l4a i x Value Fi re Zone Bed rooms Stori es Load Acces s 0ther 'I ue Flood Plain Group_ Sq x Value Q*o-,Yl1ao I lJZ-T0TAL VALUATI0N-- BUILDING PERI'lIT Charges anC Su rc ha rges 73 Plan Ck. Conln/lnd 65%/Bldo Per Fee 4q_r'7 t Plan Ck. Res 30%/B1do Per Fee PLUI4BING PERMIT Charges and Surc ha rges Fen ce D6mo ELECTRICAL PERIIIT Charges and Surcha rges 22-) la Sidewalk A/C Pavi ng Curb Cut Total Comb. Permit I,IECHANICAL PIRMIT Charges and Su rc ha rge s TOTAL y'ye7,eo )e l,Jork (I Garaop New circuits alts. or extens'i ons 2 t COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to SpFingIield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources air gas E 1. examp'le- 1250 sq. foot house, 500 sq. foot ga2, example- if new project, check new - if addit check add, etc. ra9e i on, F. Building permit information:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3, example - convert single family residence into iEsTilFant (change of use)G. Value of work as defined in Section 303 (a) of the H. Structural Spec DESIGN TEAM ANO ialty Code CONTRACTORS or construction delays, BuildingTo avoid design Division Staff must be ab]e to contact approjob pri ate sitepersons regarding design information or corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA, Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to theB. Full Pl appropriate item(s) to be installed umbing, Mechanical, and Electrical Schedules III are available at the Building Divisionl. To conserve space on the permit form the scheduies have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult thefull 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 electrical supervisor. The general contractolis not authorized to sign the electrical label Applicant to sign and date Whenever possibie, the initial application wiil be used as a worksheet only. l.lhere possible, Building Division Staffwili prepare a type written copy applicant at the time the actual s i gna ture,IV. Fees and Charges and return i t to the permit is issued for his PIan check fees are due and payable at the time of theapplication, and no plans wiil be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. FOR OFFICE USE ONLYV PERMIT VALIDATION $t^ \q5 ep ,# Perm'i t Cl erk 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 g nature dat e3{<€?