HomeMy WebLinkAboutPermit Building 1985-04-10IIISPECTION LINE
726-37 69 7?6-3753COHBIY
LegaI Oescription
Job Address
l{ater Heater
Ranqe
EIIERGY SOURCES:
Hea t
EX2')'#/rfr
Sq. Ftg. Access._
Sq. Ft9 . l.lai n
PhoneAddress
Owner
thA ,e., Build Single
t
Phone
Con s truct ion Lender
Addre s s
OESIGN TEAI.,I name address I ics. no.exoi res Dhone no-
a,Structura I
Prima
tlEl ectri ca I
,t
Hechan i ca I
PLUI.IBI NG ELECTR I CAL MECHANICAL
I
umbi
N0_FFF CHARGE N0_FFF CHARGF NO-FFF
2 Each single fixture f =Pt/ a).
Residence of
FTsQ
furnace/burner to
-_
BTU' s
/fRelocated bui ldino
(new fix. additional)New circuits alts
or extensions2- 68.rc)fc l
FIoor furnace
and vent
(l bath)
S.F. Residence
SERV ICES Recessed wal I
Soace heatpr and vpnf
.P
^
2/-o
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
tlater service res i dence
Change in existing Stati onar-v evap
cool er
40 ,
Sewer /.f,'multifamily, conrn. or
Industrial I Vent fan with
sinole duct-5*
?fr Storm Sewer a4 /or@ 5a*Vent systern apart from
heatinq or A.C.
COI.lI'l./JND. FEEDERS Mechanical exhaust
hood and drrrt
Instal 'I ocate Ilood stove/heater/fI0f*amps /dKZPre,-61 6
ffi-
TOTAL CHARGES Ef-TOTAL CHARGES TOTAL CHARGES 2?.n
IRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernitthe label has been signed by an Electrical Supervisor and returned to the Building Division
llAl.iE(please print)S IGNA
Ci ty
made
0tls
exempt
t55 wi'l
N c Iat for0n t anI d do he recompDermipap rtce 1 atth I II forman onti reonhe Ib.y fy true
nda t acorrec Ind rthefu certr I hat at II kwor oerformed Iha I I nndafybedone acco cerdan thwl heL na0rdi snce of theIe,fi dI ndaof rny
ofSprLawsthetheofteStang trta nl theto descriwork bedoeng here n'I and ttha OCCUPAI.ICYNC Iwl beIOregonftustrucwlre0 Itthouthesson'|thofpermi Buie dI n'|D I sI Iany hefurt r 'IrtIgce tha t ts tra onI thtIl Buthe I,l derfyregimy sfu'|I anIs'IrdBoa force eff,nd tec sa 1 bathefrequred70Rs0505thatI Ssl for oni sI hereonnoted tha tandbyexemptonlyandsubcontractorsIwhoemp0yeesn'II ncea twl h 701 U I becomD used no sthi ec tproj
HHERE STATE LAI.I REqUshalI not be valiC until
Plan Ck. Conrn/Ind
65%/81do Per Fee *;H€'"'6vstems DeveioDmmt
Charqe (1.52) 'BUILDING PERI'lIT
Charges and
Surcha rge s
a
aCO1.
Fee
Plan Ck. Res
30%/Bldo Per
zo{?,oo
FencePLUT,IBING PERMIT
Charges and
Surcha rges
___ea_ac
.yo D6mo
Sidewal kELECTRICAL PERIlIT
Charges and
Surcha rges
crD
A/C Paving
qle.-
1/*<a€?er.*Total Comb. lermit 6" / -gy
Curb Cut %1/.8VTlECHANICAL PERI,tIT
Charges and
Surc ha rqes l,/6
e2,
TOTAL
Zone Const.ts Ftg
Ftg
Ftg
. t'lai
0ther
'I
Fire Zone Bedrooms 0ccy
Flood Plain Stor:es /fkfoR Z occy
Load
Grou x Val
TOTAL VALUAT
ue
Ft9 . 0ther
/ul Iciln
arni I v
)e l,{ork (I Garanc
:TORS n ame addrcc<
l^HAPCE
4 if*
s
are
___2r_
r\LJ CITY OF SPRINGFIELD
Clty HCt'v Sprlngllcld, Orcgon
Dcp.rtm.nt ol publlc Workr
OFFICIAL RECETPT
No. B 64609COI4BINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. "Legal Description
1. example- Tax Lot I00, Lane County Map Reference
I7-T5-432. example- Lot l. Block 3, 2nd Addition toSlFTilTield EstatesC. Name, etc. of owner and construction lender0. Energy Sources1. example- heat/electrical ceilinq/or forced aii r2. exampj e-e- wa terEila GF7-c-fft cii ca-i/or soT-dF-E. Square fooEge or valuatioilGtd-
l. example- izJO tq. foot house, 5OO sq. foot garalZ. example- if new project, check-new _ if additio;check add, etc.F. Building permit information:1. exampie - construct single family house with anattached garage
?. examp]e - remodel existing garage into fami.ly rrJ. exampte - convert sing'le family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of the. Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bui.ldingDivision Staff must be able to contatt appropr.iitepersons.regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrica.l SchedulesA. Except where blink spaces ociur in the description-portion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Aoxes iOjiir
- to the appropriate .item(s) to Le installedB. FulI Plumbing, Mechanical, and Electr.ical Schedulesare avaitabti at the Builiins-Di;ision1. To conserve space on the permit form the schedulhave been abbreviated2. If the item(s) to be insta'lled are not covered cthe abbreviated schedules you should consuit theful l schedules' C. BUILDING DIVISION STAFF l.lILL 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 ii not authorizedto sign the electr.ical labelApplicant to sign and date
l,lhenever possible, the initial application wi]l be used asa.worksheet only. Where possible, Building Division Siaiiwill prepare a type written copy and returi 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 unti.l thesetees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
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Rec'd From
Address
Received For:
Amount Received
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fuht gusrlts FoRMs, rNc.l$3)12.81a9
Permit Clerk
63S
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PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAIICY:
a
rmit applicant exempt from registration with the Builder's Board because:Pe
Additional Project Information:
nane il*te Raq;* sisnature
PLANS REVIEWED BY:
=rdate
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