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Home My WebLink AboutPermit Building 1984-05-18INSPECTION LINE 726-37 69 .T-TY O-SPRTNGFIELD COMBI NATI ON APPLI CATION/PERMIT INFORI,IATION LiNL 726-3753 Job Address Zao /{" da 4/ €f=ee"f Lesar Descriptlon //-dZBl-Z/, rlc,. eZW Hea Ranqe EIIERGY SOURCES lJater Heater Value of l.lork:x+;trfi,#:: So. Ftg. Other_ !-New__-.Add_At Eeff e H - _Fence_Demo Change/Use -other- . l.lain Acce s s Sq. Ftg Sq. Ftg J*o,8"^0wner e Builc.inq Perntft Info: Describe Work(': Family Residence l,lith Attached Garaqe ,e., Build Single 4eroe,Ma>clt-,cx ftS2ry< €,9a/ F /J Construction Lender Bor.>rr*, / As*e/47& Zrro< bD ttTE .lnZnavEHE Ts. ss u \ Addre s s Phone DESiGN TEAI.I name address I ics. no.exD res phone no. Pri ma ry Structura I El ectri cal l''lechanical , ACTORS name addres s lcs. no.exDl res ohone no. ,tta/rt /an ./e81s- fuk ,& Ae"ax a'{e 97o#r Z*--aoaiaGenera I ,Eu k),ll,qrus-Pl umbi nq lt/U r'lI I /u I PLUIlB I NG ELECTRI CAL MECHAN I CAL FFF CHARGF NN FFF CHARGF NO FFF CHA RGF Each single fixture Residence of FTSQ furnace/burner to BTLI' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. Residence(l bath)SERV ICES Recessed wal I Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sFna ra f Fw'blater service {o.n ge in existing dpncp C han res i Stati onar.v evap coo l er ?o'Sewer 44?.o1).multifami ly, comm. or Indrrctrial Vent fan with sinole duct Storm Sewer 0f Vent system heatino or A apart from .c. I ,l/*xur /a.n c0Mr.1./rND. FEEDERS i,lechanical exhaust hood and duct /laweB Dp /2.n I n sta I I /a I ter/ rel ocate di stri h fppdprs I'lood stove/heater 0f amps. (laeP<?/o.+ I fu,quro /o.e ISSIJANCF OF PFRMIT TOTAL CHARGES 75.*TOTAL CHARGES 22.-TOTAL CHARGES HHERE STATE LAN REQUIRES that tlre Electrical workshall not be valiC until the label has been signed by be done by an E'lectri ' an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division 0regon oertaining to the work described herein, and that NC 0CCUPANCY will be DAIES?,/€-8rS 1 GNATURE Ci ty made and s 0 llAl''lE(please p "intl k),e/,(e//, apnlication for perm'it, and do hereb.y certify that all in and all work performed shall be done in accordance with t I HAVE CAREFULLY EXAMINED the completed formation hereon is truecorrect, and I further certify that any he Ordinances of theofSpringfield and the Laws of the State ofof any structure without the permission of further certify that rny reqistrat'ion r.rith the Builder'sthe Buildin Division. I Board is in full force and effect as required by ORS 7 1.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in compliance with 0l1S 701.055 wilI be used on ,thi s project D.,q, Ftg. Access x Value_ rts. otner f,4ytd!3--)a_---Va tue ?, faO,o 521 fupp'u TorAL VALUATTIN?9/{&'- zone .tVl.til Fire Zone / fu units so Bpd rooms 0c cy Load Flood Pl ain Stori 0c cy eroup V-Z sq Const.tuefra.a' faR Ftg. l'lain Plan Ck. Comm/lnd 65%/B1do Per Fee 28.7,S vs terns Cha rqe DeVe(r.5%opment 9?z.roBUILDING PERMIT Charges and ha Plan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges 9o Dgmo Sidewal kELECTRICAL PERTIIT Charges and Surcha rges ac, o alc pavingQ?f,al -6 j}65 <,.Tota'l Comb. Permi t Ef&.ea Curb CutI,IECHANICAL PERMIT Charges and Surcharges 837.a5TOTAL ___25_:__ COMBINATION APPLICATION/PERHIT (CAP) I. Applicant to furnishA. Job AddressB. Legai Descriptionl. g-.Ipl_g: Tax Lot 100, Lane County Map Reference17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION baqSg gi1 gas E ga rage ition, F. Building permit information:1. example - construct singie family house with anattached garage2. example - remodel existing garage into family room3. example - convert single 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, 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 descr.iptionportion of the Mechan'ical and Electrical Schedu'les,the appiicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Divisionl. To conserve space on the perm.it form the schedules have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult theful'l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to thee1ectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label Applicant to sign and date llhenever possible, 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 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 andpayabie when the permit is issued. FOR OFFICE USE ONLY II. III. IV. V Permit Clerk 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 gnatu date g-27-E7