The URL can be used to link to this page

Home My WebLink AboutPermit Building 1987-11-04rION LINE 69 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT 7?5 EIIERGY SOURCES Hea lJater Heaterzdal-egal Descri ption Job Address Owner Va'l ue of l,lork G:6 Sq, Ftg. Access..-- Sq. Ftq. other_ J,lew___rq66_41 ter_Pep. _Fence_Demo Change/Use 0ther Ftg Address .g96 9rxrsr sr.Phone d Gara n t Info Descr l,li th Attac re.r Build Single Construction Lender Addres s Phone h \ Dht t]ES I GN TEAI4 *dfne address s n exoi res ohone no. Structural Pri ma El ectri cali l'4echan ica'! narT€tACTORS addres s 'lics. no-''pxni res )( nhonc nn. 'l Generar D Un/Zp , Pl umbi nq E'l ectri caI l'lechanical PX.IjTTATN6 ELECTR I CAL MECHAN ICAL FEf,CHARGF NO FFF . HA PGF I'lo FFF CHARGF Each singlle fixtune Residence of SQ. FT furnace/burner to BTU' s ReI ocated hiul-1ding (new f ix- addn-t,iornal )r/'New ci rcui ts al ts YT.EHTbana 7.P Floor furnace and vent S. F. P.esidermce(l bath)SERV I CES Recessed wal I Snacp hpaicr end vcnf Duplex (n haUh) each Temporary Constructi onAdditionall hatiln Apol iance vent seDarate hlater service ge in existing dence Chan resi Stati onar.v evap cool er Sewer multifamily, T ndu stri a I comm.0r Vent fan with sinole duct 0f Vent systern apart from heatino or A.C-Storm Sewer COMI'1./IND. FEEDERS Mechan icai exhaust hood and duct Instal i /al terlre1 ocate distrib. feeders I'Jood stove/heater 0f s. ISSUANCE OF PFRI1IT TOTAL CHARGES -lz-5->TOTAL CHARGES TOTAL CHARGES WHERE STATE LAI{ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiil until the Iabel has been signed by an Electrical Supervisor and returned to the Buiiding Division I HAVE CAR.EiFU[-1-Y EXAMINED the completed application for permit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the Cityof Springfield amd the tr-aws of the State of 0reoon pertaining to the work described herein, and that NC 0CCUPANCY will be madeof any structure wit|rout the permission of the Building Division. I further certify that m.y registration r.rith the Builder's Board is irn fu;|tr ,force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcomtnactDrs iand ernployees who are in compliance with ORS 701.055 will be used on this nroject, I,,lAl"lE(please pri ht S I GNATURE DATE const. o{-: ' . Uni ts Sq. Ftg. l4ai n x Va lue- Fire Zone Bedrooms TOTAL VALUATION x Tone I y'4 Fl ood P lai n Stori es / 0cc.v B<tr # .te*77 -0ccy Acces s Val ueFtg Ftg Load Sq eroup B-2 sq Plan Ck. Cornm/Ind 65%/81do Per Fee v=- g7.//<?q:Svsterns DeveloDment tharqe (1.5%)') f,*o Plan Ck. Res 30%/81do Per Fee BUILDING PERNIT Charges and Surcharges _*.-u?__ FencePLUMBING PERMIT Charges and Surcha rges DEmo Sidewalk A/C Paving Total Comb. Permit ELECTRICP.L PERI,!IT Charges and Surcha rges ?4>7 Curb Cut /s% 7714ECHANICAL PERMIT Charges and Surc harges TOTAL iui 'am Dsn .Z-.o-o*-- Ehe;p4a*q+v C0MBINATI0N APPLICATI0N/PERMIT (cHr 7 Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot l. Biock 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/2. ExEmETe- waterE. Square footage or r ceili forced air gas or sofar valuat on, etc II III IV 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addit.ion, check add, etc.F. Bu'i lding permit informat.ion:1. example - construct single family house with an attached garage2. example - remodei existing garage into fam.ily room3. example - convert singie family residence intorestaurant (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, Bui)ding Division Staff must be able to contact appropriate persons regard'ing design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare 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 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 electricalsupervisor. The general contractor .is not authorizedto sign the electrical labelApplicant to sign and date Hhenever possibie, the initial application will be. used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai 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 PERMIT VALIDATION Permi 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 date // I