HomeMy WebLinkAboutPermit Building 1980-07-22a
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COMBI IIATI ON APPL I CATION/PERMIT
Job Address 3
Lega l Descri ption
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DES I GN TEAI.,I name-)address J lics. no exDt res phone no
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ELECTR I CAL MECHAN I CALPLUIlB I NG
FFF NHARGF NN FFF THARGF NO FFF CHARG F
Residence of
FTSQ
furnace/burner to
BTLI, S
Each single fixture
r New circuits alts
or extensions
1, oE tVoPt:/g,a
Floor furnace
and vent
Rel ocated bui i di ng
(new fix. additional)
SERV I CES
Recessed wal I
Snace hpatpr and vpnt
S . F. Res i dence
( I bath)
Duplex (l bath) each
/D,fr Temporary Construction Apol iance vent
seDa ra te/Additional bath
Change i n exi sti ng
res.i dpnce
Stationary evap
coo 1 erl,!ater servi ce
multifamily, comm 0r
Tndustrial
Vent fan with
sinole duct-Sewer
0f Vent systern apart frbm
heatinq or A.C.Storm Sewer
COMI'I./IND. FEEDERS
Mechanicai exhaust
hood and duct
l,Jood stove/heaterI n sta I I /a 1 ter/ rel ocate
di stri b. feeders
0f
t/ /1
lu lT
ISSUANCF OF PFRI1IT
TOTAL CHARGESTOTAL CHARGES /0,@ TOTAL CHARGES /6,oo
WHERE STATE Llll REQUIRES that tlre 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 E'lectrical Supervisor and returned to the Building Division
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NC 0CCUPAI,ICY 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 ernployees who are in comcliance with 0l?S 70i.055 wi'll be used on this oro.ject.
l,lAl,lE(please print S I GiIATURE o*JfJZ-1A
for oe
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rmed ah donebe n daaccor enc t theh rd n oances f Cthendadanfuhertrtttworka tyrrectcerhaandfyany
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>Fire Zone_;l_ped
Ftood Plain IJO sto
Ftg
Ftg
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TOTAL VALUATION C(
l'la iffil sq
Val u"oors I occy Load Sq
'I ueries Z- }cc.y Group bv
Val ue
Access
other 51L
rqe f1.57
Svs
Cha
terns Deve opmentPIan Ck. Comm/Ind
65%/81do Per Fee
?,Abo \ 1'B )
BUILDING PER}1IT
Charges anC
Su rcha rges
,0Q_
Plan Ck. Res
31%/Bldq Per Fee
Fence 6-3qNPLUI4BING PERMIT
Charges and
Surc ha rges
/.a.ea_
Dgmo
Sidewal k
Total Cornb. Permit /a/,68
ELECTRICAL PERIIIT
Charges and
Surcha rges A/C Paving
Curb CutI1ECHANICAL PERMIT
Charges and
Surc harges -rth TOTAL */atca
trr
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n amP
Genpra I Itrq< e lt J-l*^ c-,,^- c,o1-nt c.
COMBINATION APPLICATiON/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
54 obz
Q-P qLb t
l.
2.E. Squa
1.
2.
ex amp I e- hea t/e-l eqlrj sq I _qeil-l!g/ExampTe- wa terhTa IG77EE tr I ci7o
re footage or valuation, etc.
or forced air qas
r solar
example- 1250 sq. foot house, 500 sq. foot garage
exampie- if new project, check new - if addition,
check add, etc.
F Bui lding perm
l. example -
a t tac hed
rit information:
construct single family house with an
gara ge
II
2. example - remodel existing ga!.age into family room3. example - convert singie family residence .into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction detays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanjcal and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Piumbing, Mechanical, and Electr.ical Schedules
are avai lable at the Building Divisionl. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be instal1ed are not covered onthe abbreviated schedules you should consult thefui I scheduiesC. BUILDING DIVISION STAFF HILL 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 js not authorized
iII to sign the electrical label
Applicant to sign and date
IV
Whenever possible, the initial application wil l 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 his
s i gna tu re.
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 andpayable when the permit is issued.
FOR OFFICE USE ONLY Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registrat.ion with the Builder's Board because:
Additional Project Informat'ion :
PLANS REVIEWED BY:
name s'l gna tu re date 7- zz- Yo