HomeMy WebLinkAboutPermit Building 1988-01-28CITY OF
COHBINATION AP ERMIT
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SDPFLT g:Legal Description Fl+ref,<-tGiI<-
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Value of lto.t,,Aqfl t.I
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Ran Use SUI,lor :€. r ngtn
C-A.I\5S $ lq'/ ClqP Friustsy gctsG .5\ )Qg
llater Heater
n
denceF
EIIERGY SOURCES:
Heat
tg. Ma
So. Fto. Access.
I\AJE_TAA-,owner FD.t tA-N,(e-rrL) s\.u56r
b-N .,Pt C- PhoneAddress 3 LD\,
Construction Lender
Addre s s Phone
expi resI ics. no.addressnameDESIGN TEAI4
Pri ma
Structura l
El ectri cal 2
Hechan i cal ohone no.exo i res )(lics. no.name
I
EI
l''lechani cal
MECHAN I CALELECTRI CALPLUI,IBI NG
FFF CHAPGFNOFFFCHARGEFFFCHARGENO-
furnace/burner to
BTU' s
Residence of
FTSQEach single fixture
Fl oor furnace
and vent
New circuits alts.
or extensions
Relocated building
(new fi x. addi ti ona l )
Recessed wal l
Snacp hpatcr and ventSERVICESS.F. Residence(l bath)
Duplex (l bath) each
Apol iance vent
seoa rateTemporary Constructi onAdditional bath
Stationary evap.
cool er
Change in existing
rpqi dencel^later servi ce
mu1 ti fami 1y,
Tndrrstrial
comm.0r Vent fan with
sinole ductSewer
Vent systern apart from
heatino or A.C.0f amps.Storm Sewer
Mechanical exhaust
hood and ductCOMH./IND. FEEDERS
trlood stove/heaterI n sta l I /al ter/ re l ocate
di stri b. feeders
'1
A
)
ISSUANCE OF PFRI,IIT
TOTAL CHARGESTOTAL CHARGES
WHERE STATE
shall not be val
LAI.I REQUI'i'l unti I
RES that the Electrical work be
the label has been signed by an
done by an Electrical Contractor, the electrical portion of this permit
E'lectrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of 0regon Dertaining to the work described herein, and that NC 0CCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with 0l?S 701.055 wi]l be used on this oroject.
S IGNATURE TE-u181-Eg-l,lAt'lE(please print) 5l H, Q--olS:
FOI1 OFFICE USE ONI.
x
YFlood Plain Stories 0cc.y Gro iln
ilp
Ftg. 0ther I
Load Ftg. Access x Va1
Zone
Fire Zone Bedrooms
Val ueConst. Uni ts So. Ftq(:dai n
Plan Ck. Conrn/lnd
65%/8ldq Per Fee
Svstems Develooment
Charqe (1.51,) 'Charges and
Surcharges
fl
/)a-67! r
BUILDING PERI'IIT
Plan Ck. Res
30%/B1do Per Fee
FencePLUt,lBING PERMIT
Charges and
Surcha rges DEmo
Sidewal kELECTRICAL PERI'IIT
Charges and
Surcha rges A/C Paving Tota'l Cornb. Permi t
Curb Cut .0 3_3,bTOTAL
HECHANICAL PERMIT
Charges and
Surc harges
. Ftg.
( addressPACTNRS
n Iu iRE 3Hq.+.1 r^91.Lf\-)u ^a^-..r 6rfi A t
0f amps
TOTAL CHARGES
ToTAL VALUATI0N-'
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. glupplg^ Tax Lot 100, Lane County Map Reference17 03 432. glqTp.lg: Lot 1. Btock 3,Znd Addition tospringfield Estates
9. Name, etc. of owner and construction lenderD. Energy Sources
air gas
E
ga ra ge
i ti on,
F. Building perml. example -
a ttac hed
it information:
construct single famity house with an
2.
gara ge
3.
exampl e
examp I e
res ta ura
- remodei existing gara ge into fami1y room- convert s ing
of
Ie fami1y res'i dence i nto
G. Value of
nt (c hange
defi nr
use )work as ed in Section 303 (a) of the
H.
Structural Special ty Code
DESIGN TEAM AND CONTRACTORS
To avoid design
Division Staff
or construction del ays, Bu i ldingmust be able to con tact appropriatejob sitepersons regardi ng design information orcorrections, e LL.II Abbreviated Plumbr'ng, Mechanical, & Electrical SchedulesA. LxcepE where blank spaces occur in the descriptionportion of the Mechanjcal and E.lectrical Schedulei,the applicant need fijl-in only the No. Boxes iaji6.nt_ to_the appropriate item(s) to -be instal.ledB. Full Plumbing, Mechanical, and eteiiiical Schedu.lesare avai lable at the Building Divisionl. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. 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 etectriiai'-supervisor, The generat conlractor ii not authorizedto sign the electrical labelApplicant to sign and date
Hhenever possibie, the in.itial application wi.ll be used asa.worksheet on)y. Where possible, Bui)ding Division Staiiwili.prepare a type written copy ind returi it to theapplicant at the time the actual perm.it is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiil be processed until thesetees are paid. Al1 other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III
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PERMIT VALIDATION
Permi t Cl erk c4
/tgrt
2't/+ r
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:
datenamenatures't I
t'.
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