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Home My WebLink AboutPermit Building 1990-08-27ECTION LINE 37 69 CITY OF SPRINGFIELD COMBI I1ATI ON APPL ICATION/PERMIT Job Address 554 SLI l-egal Description liater Heater Ra EIIERGY SOURCES Hea t sOwner fr,"t?if,\3, 5q. Ftg. Access._ 0therSq. Ftq vno".(yg{//)Address lioo Oeknoat wn'l t Info scr arn .e., Build Singie 4ol Phone Constructi on Lender Addres s \ao \ $\ \ DESIGN TEAI,I name address I ICS- nO^exDt res ohone no. Structura I Pri Electrical Hechan i ca I name a ddres s (1CS. nO.'exni res )nhonp nn I El ectri cal l.'lechanicaI PLUIlBI NG ELECTR I CAL MECHAN ICAL FFF CHARGE NO FFF CHARGF NO FFF rHA AC F Each single fixture Residence of FTsQ furnace/burner to BTLI' s Relocated buildinq (new fix. additioial)New circuits alts. or extensions Floor furnace and vent S . F. Res i dence ( I uatn)SERV I CES Recessed wal I Soace heatpr and vpnt Duplex (l bath) each Additional bath Temporary Construction Apol iance vent sepa rate ["later service Change in existing reci dencc Stati onar,v evap, cool er Jndrr<tria l multifamily, corm. orSewer Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heat-ino or A-C- coMr.r./rND. FEEDERS Mechani cal exhaust hood and duct I n sta l I /a I ter/ rel ocate di st-ri b^ fepders l,lood stove/heater ampa0f ISSUANCT OF PFRI{IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES IIHERE STATE LAI,I REQUIRES that the Electrical work be done shall not be vali'l untiI the label has been signed by an Elec bytri 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 OCCUPAHCY will be Building Division. I further certify that m.y reqistration vrith the Builder's subcontractors and employees who are in compliance with 0l?S 701.055 will l{AtlE(please print)IGNA'Tr{ , Ci ty made any of ect I HAVE CAREFULLY EXAHINED the completed application for oermi t rfo rmed , and do hereby certify that all information hereon is true and correct, and I further certi fy that and al l work pe shall be done in accordance with the Ordinances of theof Springfield and the Laws of the State structure without the permission of thes in full force and effect as required of any Board i by ORS 701.055, that if exempt the is for ion is noted hereon, and thatonlyon thi Fire Zone Bedrooms_ 0ccy Load Sq. Value ToTAL VALUATI0N_ Zone x x x Uni ts . 0ther Access s q7rt,J l'la i n 0c c.y Group Sq. FtS /Cons t Ftg Val ue Val ueFlood Plain Stori e Pl an Ck. Conrn/Ind 65%/B1do Per Fpc Svstems Deve Charqe (1.s1 opmmt 37'-'BUILDING PERI.IIT Charges and Surcha rges _392?___/?s Plan Ck. Res 30%/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surc ha rges D6mo Sidewal kELECTRICAL PERI1IT Charges and Surcha rges A/C Pavi ng Tota'l Comb. Permit Curb CutI{ECHANICAL PERMIT Charges and Surc ha rges ?377,TOTAL COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSFilnlTietd EstatesC. Name, etc. of owner and construction IenderD. Energy Sources electrical ceilin r"forced air gas 2 e Ld or solarE. Squa va I uati on hoIexample- 1250 sq example- if new check add, etc. foot use, 500 sq. foot garage 2.project, check new - if addition, F. Building permit information 1 exampl e a ttac hed - construct single family house with an 9arage II. 2. example - remodel existing garage into family room3. example - convert single family residence inlorestaurant (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, Building Division Staff must be able to contact appropriate persons regarding design informat'ion or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appiicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full P'lumbing, Mechanical, and Electrical Schedulesare availabie at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal'led 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]abel must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label Applicant to sign and date Whenever possible, the injtia'l application wi'll be used asa.worksheet only. Where possible, Building D.ivision Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed untii thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III IV V PERMIT VALIDATION # /" 323 7'zo -g o Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registrat'ion w'ith the Bujlder's Board because: Additional Project Information: PLANS REVIEWED BY: name sig nature date fL 2!_:2_a._ r