HomeMy WebLinkAboutPermit Building 1986-07-17 (2)w trUt
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CITY OF SPRINGFIELD
COHBI I,IATI ON APPL I CATION/PERI'I tT 53
Legal Description
Job Address
Hea
Ranqe
EIIERGY SOURCES:
llater Heater
owner *4{*tEW ?Dlcy,.tbot- -Ot6( n Value of#l.lork:92,ooo
Sq. Ftg. Access.
Sq. Ftg. Other
.l'lain
t Info:
FamiI
c ng ePhone
I TConstructiLn LenJer U
Addre s s Phone
ooCo
s
-.f,
name address lics. no.exo rFs
%bc,r+eo* I M I knU,ids ?o. o,
Pri ma ry
Structura I
l'|echani cal
El ectri ca I
IACTORS name I addrpss'Il(/IcxnirpsI ohone no.
Aencrr I
Pl umbi nq
E l ectri ca l
itechan i ca I
PLUI1B I NG ELECTR I CAL MECHAN ICAL
FFF CHARGF NO FFF CHA AG F I'10 FFF CHAIIG F
Each single fixture Residence of
FTsQ
furnace/burner to
BTLI' S
<,52
Relocated bui Idinq
(new fix. additional)New circuits alts.
or extensions2 6,R br4RE )
Floor furnace
and vent
S.F. Residence(l bath)SERV I CES Recessed wai I
Soacp hcatpr end vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
s eDa ra te
[.later serv ice ge in existing
dence
Chan
res i
Stationary evap
cool er
Sewer mu1 ti fami ly,
industrial
comn. or Vent fan with
sinole duct
Storm Sewer 0f s.Vent systern apart from
heatino or A-C.b6.15rr*,/s*COI,!I.!. / IND. FEEDERS Mechanical exhaust
hood and drrr:f
I nsta I I /a I ter/ rel ocate
di ctri h^ feedprs l'Jood stove/heater
0f s.'&z*hzt*lw
/r+>urrc ?eo ,G.
ISSUANCF OF PFRIlIT
?-5p TOTAL CHARGES
I,IHERE STATE LAI.I REQUIRES
shal I not be val i'J unti I the
the ,|
E ctrie c I rktaw0 be done a n E ectr1 Con tractorca1'I ethe ec'|tri 'Ia 'Ibyrt on ofpo
abeI haI 1 nbeensa IE caectri I 'I asor rend rntu toed Buthe I1 Idbygned D I s1 '|Superv 0nng
s perrii t
@TOTAL CHARGES TOTAL CHARGES
I HAVE CAREFULLY EXAi{INED the completed appl ication for oermit, and do
that any and all work performed shall be done in accordance with the 0rdinances of the Ci
l.lAl'lE ( pl ease pri nt )s
ty
made
hereb.y certify that all information hereon is trueand correct, and I further certifyof Springfield and the Laws of the State of 0regon Dertaining to the work de
sion of the Building Division. I further
scribed herein, and that NC OCCUPANCY will becert'ify that m.y reqistration vrith the Builder'sof any structure without the permi sffect aBoard is in full force and e s required by ORS 701.055, that if t the basis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in comoliance with 0l?S 701.055 be used on this Droject.
FOI1 OFFICEOJS Oi{[Y T\
Ftg
Ftg
Ftg
Access x Vaorn""@u
t
o.5
Flood Plain S tories
cy Load Sq.
TOTAL VALUATI ON
0c c.y Group Sq.
Iue
ue
ts So l4ainZone
lueFire Zone Bedrooms 0c
P'l an Ck. Corm/Ind
65%/81do Per Fee 7.8 Svstens Deve
charqe (1.52 opment ty3.BUILDING PERI.IIT
Charges and
Surcharges 6./o Plan Ck. Res
30%/Bldo Per Fee
FencePLUt.lBING PERMIT
Charges and
Surcha rges
/?a
_ __/,4*_.-:_ _' '€;o Dgmo
Sidewal kELECTRICAL PERTIIT
Charges and
Surcharges
I
A/C Paving Total Cornb. Permit z 19.?o
Curb CutI,IECHANICAL PERHIT
Charges and
Surcharges
___/5=_.60 3tz.TTOTAL
I tusp
1726-ll-
\r
Address q,?E Mill €*taf re [^lork (
I Garaop
I LAI,,I )one no -AIEQadar I
IIIt
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, 2nd Addition toSFiiI!-fietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. exampi e- heat/2. EIIfrETIe- water
SquaiE-Tit-tase or
electrical ceiling/or forced air gas
h=eaterT "f-aTi]*7.on, etc.
r solar
E valuati
F
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- J-f new project, check-new - if additio;,
check add, etc.
Building permit information:1. example - construct single family house with an
attached garage
2. examp.le - remodel existing garage into family room3. example - convert single famity residence intorestaurant (change of use)
Value of work as defined in Section 303 (a) of theStructural Specialty Code
DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction delays, Bui)ding
Division Staff must be able to contact appropriitepersons regarding design information or job site
G
H
II corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building 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 scheduIesC. BUILDING DIVISION STAFF I"JILL 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 ejectricalsupervisor. The general contractor is not authorizedto sign the electrical Iabel.
Appl icant to sign and date
Whenever possible, the initial application will be used asa worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return it to theappiicant at the time the actuai 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 andpayable when the permit is issued.
FOR OFFICE USE ONLY
Lt t,q 0f
-Bag'll-
III
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Bu'ilder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
nu^" Lo7rve 74# ,ig nature date 7-2,/ -3e