HomeMy WebLinkAboutPermit Signage 1980-04-25ECTION LINE
37 69 6-3
Job Address
Lesar Description f 1b3Tl )O :-j l'later Heater
Ra
EIIERGY SOURCES
Hea t
Owner a "'H*b,co
Sq. Ftg. Access.---
Sq. Ftg. 0ther--
_l{ew_Add_A 1 te r_Re p .
_Fence_Demo Change/Use
0ther
Sq. Fto llain
Address Phone 'it n n hlork
Ga
t
dence l,lith A
e., Build Single:ffi
-(-,f)^ StmaQ]-
Construct i on Lender
Phone
Jcor!
&
DES 1GN TEAI{name address lics. no.exD l res e
Pri ma ry
St ructura I
Electrical
i'4ec han i ca I
n ame a ddres s (lics- no exDl res 'ohone no- )
toOZ u:t
El ectri al
llechanical
PLUI1B I NG ELECTRICAL MECHAN I CAL
CHA RG F NO FFF CHARGF NO FFF CHARG F
Each single fixture Residence cif
FTSQ
furnace/burner to
BTLI' s
Relocated bui'ldino
(new fix. additional )
New ci rcui ts al ts
or extensions
FIoor furnace
and vent
S . F. Res i dence(l bath)SERV I C ES
Recessed wal I
Soace heater and vpnt
Dupiex (i bath) each
Additional bath Temporary Construction Apol iance vent
sepa rate
tlater servi ce ge in existing
dencp
Chan
res i
Stati onar-v evap
cool er
Sewer Indrrctria l
multifamily, comm. or Vent fan with
sinole duct
Storm Sewer 0f S.
Vent systern apart from
heatino or A.C,
cor.il.l./IND. FEEDERS Mechan ical exhaust
hood and duct
Instal I /al ter/rel ocate
distrih. fpedprs l'lood stove/heater
0f s.
ISSUANCF OF PFRIlIT
TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES
WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valil until the label has been signed by an Electrica'l Supervisor and returned to the Building Division
, and I further certif-v that any and all work performed shall be done in accordance with the 0rd'inances of the Cityeld and the Laws of the State of 0reqon pertaining to the work described herein, and that NC 0CCUPAI'ICY will be made
cture without the permission of the Building Division. I further certify that m.y reqistration urith the Builder'sfull force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and enrployees who are in comcliance with 0l?S 7n1.055 vlill be used on this
I'lAl.1E(p lease pri nt)SIGNA/?
I HAVE
and correctof Soringfi
of any stru
Board is in
c0mp I information hereon is trueapr)fy that acatcertont, an
Dro.j ect
Zone Tyoe/Const. Un i ts So Ftt:
Ftg
Ftg
Value
Val ue
Val ue
x
x
X0cc.y Group Sq
TOTAL VALUATI NN
Flood Plain S to ri es
l4ain
Acces s
0the r
Fire Zone Bedrooms 0ccy Load
Plan Ck. Comm/Ind
65%/81do Ppr Fpp
tems Deverse (1.57
Svs
Cha
opmentBUILDING PERIIIT
Charges anC
Surcha rges
(/--\.-:/-Plan Ck. Res
30%/B1dq Per Fee
FencePLUI'4BING PERMIT
Charges and
Surcha rges Dgrno
S'idewa l kELECTRICAL PERIlIT
Charges and
Surcha rges A/C Paving Total Comb. Permit
Curb CutIlECHANICAL PER[4IT
Charges and
Srirc ha rr:e s TOTAL 5&
COMBI IiATION APPLICATION/PERMIT
Addres s
CONT ,I0RS
FFF
I
COMBINATION APPLICATlON/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition to
SpifiEField Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
1. examp-le- heat/electrical ceiling/or forced air gas2. example- waterheater/electricaVor soTarE. Square footage or valuationl-GTc. -1. example- 1250 sq. foot house, 500 sq. foot garage
2, example- if new project, check new - if addition,
check add, etc.F. Building permit information:t. glqryle - construct single family house with an
;ttaclEd garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specia lty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, Bui)ding
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be instaliedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Bui lding 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 theful I 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 generai contractor is not authorizedto sign the electrical label.IIL Applicant to sign and date
Whenever possibie, the initial application w.il'l be used asa !,/orksheet only. Where possible, Bui lding Division Staffwill prepare a type wnitten copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wil l be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
PERMIT VALIDATION
V. FOR OFFICE USE ONLY -Permit Clerk
PROJECT CONDIT]ONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Perm'it applicant exempt from registration with the Builder's Board because:
PLANS REVIEWED BY
name Si g natu re date
Addit'ional Project Informat jon:
liL CI
COI|B I iIAT
TY
ION APPL I CAT I ERMIT 726-3753
Job Address
l-egai Description -_J
EIIERGY SOURCES
Hea t
l,later Heater
Ranqe
Value of t,lork.l z--,,f )tr 1\( \,t-'u-t
Rccess]
Sq. Ftq. Other
_l l e w_A d d _A I t e r- Pe p-l -
_Fence_Demo_Chan gel Use
-other-
intq.
Sq. Ftg
Ovrne r N-Lb v-\C - \rqc k .e., Build SingleAddressPhonenq
Re
Bui l1,l
Fani i y
Pernrit Info: Describe llork(
sidence lJith Attached Garacle
rl C-Qld,t,,t,l,t StnaL
Construct i on Lender
D
t-p
{.\5
Addre s s Phone
DTSIGiI TEAM name addres s I i cs. no.exo i res ohone no.
Pri ma ry
Structura l
EI ectri cal
l'techan'i cal
COiITRACTO RS name (address )(ohone no.'(lics. no. ) (exoires)
tcczGenera I
Pl umbi
I 'I
tiechan i ca I
ELECTRICAL MEC HAN I CALPLUIlBI IIG
FEF CHARI;F NN FFF CHARGF il0 FFF
Each single fixture furnace/burner to
BTLI' s
Floor furnace
and vent
Relocated building
(new fix. additiona) )
New ci rcui ts al ts
or extensions
S ERV I CES
Recessed wal l
Soace heater and vent
S. F. Res i dence(l bath)
Dupiex (i bath) each
Temporary Construction Apol iance vent
seDa ra teAddi tional bath
Stati onar,v evao
coo I erl,later servi ce Chanqe in existing
res i dence
Industrial
multifamily, comm. or Vent fan with
sinole ductSewer
0f Vent system apart from
heatinq or A.C.Storm Seler
COI,ITI./IND. FEEDERS
Mechanical exhaust
hood and duct
I'lood stove/heaterInstal I /al terlrel ocate
di stri b. feeders
0f amps
lSSUANCF OF PFRIIIT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
LIHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perr,rit
shall not be valil unt'il the label has been signed by an Electrical Supervisor and returned to the Building Division
and correct, and I further certif-v that any and all work performed shall be done in accordance wjth the 0rdinances of the City
of Soringf.ield and the Laurs of the State of Oregon oertaining to the rvork described herein, and that NC 0CCUPAI,ICY will be made
of any structure without the permission of the Building Division. I further certil"y that my registration vrith the Builder's
Board is in full force and effect as reciuired by ORS 701.055, that if exemot the basis for exemDtion is noted hereon, and that
only subcontractors and ernployees who are in comcliance with OPS 7n1.055 vrill
I'lAilE(please print)S I Gi,IATURE)/-1_
ac-tl
nforrnation hereon is truethe comp e apnlication for oermit, and do hereb.y certify that a
used on this pro.ject
L
t-/7FOIl OFFIC! USE Oi{LY
TOTAL VALUATION
x
al
Occy LoadI Sq.Ftg
0c c.y Group Sq. Ftg
'i ts
Bed rooms
/ConstZone
Fire Zone Val ue
Flood Plain Stories.
Acces s.
0the r
Fto. l'lain x Value
opmentPlan Ck. Comm/lnd
651/81do Ppr Fee
Svstems Deve
chutqt (1'5qBUILDING PERiIIT
Clrarges anC
Surcharges -=/-Plan Ck. Res
30i,/81dq Per Fee
FencePLUI,lBING PERMIT
Charges and
Su rcha rges Derno
Sidewalk
Total Comb. lermit
ELECTRICAL PERIIIT
Charges and
Surcharges A/C Pav i ng
Curb CutIlECIIANICAL PERMIT
Char_oes and
S"ra:ir.tc_s r 0TAL 5CD
Residence df
SQ. FT.
COMBINATION APPLICATION/PERi'tIT ( CAP)
I. Appi icant to furnishA. Job AddressB. Lega) Descriptionl. examole- Tax Lot 100, Lane County Map Re
17-T3-432. example- Lot 1. Block 3, 2nd Addition toSpringfie)d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
el ectrica l cei I i
eater ca or s
/or forcr
oTa r +e ec
val uat 0il ,
PERMIT VALIDATiON
clrY oF SPRINGFIEtD c
CirY Holl
Springfield, Oregon
Deportmenl of Public Works
OFFICIAL RECEIPT
No. B 53334
't9
I\,D-(
1. exampl e- heat/2. Exar:riTe- rvater
SquaiE-i6-otage or
C r Rec'd F
Received For
(
E c
l. examole- 1250 sq. foot house, 500 sq. foc2. eGmple- ji n-ew project, check-new - .i f achecr-add, etc.F. Bui)ding pernrit informatjon:1. example - construct single family house r.rattached garage2. examole - remodei existing garage into fa3. llqncle - convert singie iaii'ly-residence
- rdtafant (change of-use)G. Value of work as defined .in Section 303 (a) oStructural Specialty CodeH, DES IGN TEAi..i AI,ID COIiTRACTORS
To avo'id design or construction delays, BuildDivision Staff must be able to contatt approplpersons regarding design.information or job s.corrections, etc.
Abbreviated Plumoing, ilechanica'1, & Electrical SclA. Lxcept r.rhere blank spaces occur in the descripportion of the l{echanical and Electrical Schecthe applicant need fill-in only the No. Boxes
_ to the approoriace item(s) to be insta.lledB. Full Plumbing, I'lechanical, and Electrical Scheare available at the Building Div.isionl. To conserve space on the permit form the shave been abbreviated
lO0'L
(r
(t
II
(-
f
G
(o
()
(E
()
(!
(!
2. If the item(s) to be installed are not covthe abbreviated schedules you should consu (n,
ful I schedulesC. BUILDIiIG DIVISiON STAFF I^JILL FILL OUT ALL FEES
CHARGES Oi{ THE SCHEDULESD. As noted on the CAP, the label must be delivertelectrical contractor for signature by his e)ersupervisor. The general contractor ii not auilto sign the eieccrical label.Applicant to sign and date
Hhenever possible, the initiaJ app'lication will bea.worksheet only. Hhere possible, Building Divisiowill prepare a type r./ritten copy and returi it to tappiicant at the time the actual permit is issuecj f
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans ni)) be processeC untr.l thesetees are paiC. Ail other fees and charges are due andpayable vrhen the permit is issued.
FOR OFFICE USE O|,ILY -
Amounl Received
/)
(B
(E
III
IV.
(EY rN
ti,
ORIZEO SIGNATURE
EUGENE Oi 97aol
t-
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit appl icant exempt from registratjon with the Builder,s Board because:
Additional Project Information:
PLANS REVI EI.JED BY :
da tenameSIgnature
-w
(
(
5BE IIOil.T U i H EU LL
)