HomeMy WebLinkAboutPermit Building 1989-09-24--$ud(
I IIS PEC
726-37
T ON CITY OF S
CC)HBINATION APP
PRI i'IGF I ELO
ON/ PERM TTLICATI 37
Job Address EIIERGY SOURCES
Hea t
l,later Heater.
Range
Sq. Ftg. tlain_
Sq. Ftg. Acceil-
Sq. Ftg. 0ther_
_l'lew_Add_A I te r_Re p .
_Fence_Demo Change/Use
0ther w
Or\-\J
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Lesal Descriptton fJ p$ ,35 3l Ol0O
Value of llork:
H /2,4qleY": 'lvoe/+L /qzugE
Address E// /1//*//Y Pho"" 74/E/fr4 n t Info Descr
Fami I Attached Gara
re., Build Single
TE /t/{ oFF *ill nEfiAOF t4 rH V.ztY
Construction Lender cfrl 9/YEEr ellftE #Or 172779, A///
Addres s Phone
DESIGN TEAM name address (r 1CS. nO exDl res ohone no.
Pri mary
Structura I
El ectri cal
Mechan i ca I
n ame add res s tcs. no.exot res (ohonp nn.
o 77
Plumbinq ElhEil/E o/{E
El ectrical 7ft0,2
['lechanical
PLUI,lBI NG ELECTR I CAL MECHAN ICAL
FEE CHARGE NO FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
sq. FT
furnace/burner to
BTLI' S
Relocated buildinq
(new fix. additional)New circuits alts
or extensions
Floor furnace
and vent
S, F. Residence(l bath)SERV I CES Recessed wal I
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa ra te
[,later servi ce Change in existing
res i dencp
Stationary evap
coo l er
Sewer multifamj1y, conrm. or
Industria l
Vent fan with
sinole duct
Storm Sewer 0f -amp s.Vent systern apart from
heatino or A.C.
COMII./IND. FEEDERS Mechanical exhaust
hood and duct
Instal l /al ter/re1 ocate
di stri h fppdprc l'Jood stove/heater
0f t,&q(,a 56
ISSUANCT OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES bt
WHERE STATE l-lt,l REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this perm.itshall not be vali:l until the label has been signed by an Electrical Supervisor and returned to the Building Division
t he comp eted a p!'),l ,l CA t 'I o n fo r Derm'l t a nd do hereb.y cert T fy t ha t a I I 1 n forma t 'I on he re0n 'I s t rue
and co rrec t and I further c ert 'I f v tha t a ny a nd a I I wo rk pe rfo rmed sha I I be do ne 'I n acc0r da nc wt t h the 0rd 'l na nces of the City'| be madeof Springfield and the Laws of the State of 0regon Dertainin g to the work described herein,and tha t NC OCCUPAI.ICY wl 'I
of any
Board i
s t ru ct ure wl t hou t the permissi
and effect as
employees who
0 n of the Bu 'I I d I ng D 1 I s 'I on I fu rt her cer ti fy t ha t m.y re g 'I s tra t t on l,|t th the Bu I I der s'I n f u I I force req u t red by ORS 701 0 55 th at I f e xemp t t he bas 1 s for exempt I n '|s no ted hereon nd tha t
I ubcon tr ndonvsactorsa are 'I n c0mc I I an ce wl th 0 I?S 7 055 I{l 'I I be us ed on t h 1 s D roj ect
(
tlAl.lE(please print)ICNATU DATE
E I
Zone_________Tyoe/Const. Uni ts Sq. Ftg l'la i n Val ue
Fire Zone Bedrooms Load Ftg. Access_x Val
Flood Plain s 0ccy Group Sq. Ftg Va'l ue
TOTAL VALUATI nil
Storfe 0ther
BUILt)ING PERTIIT
Charges and
Su rcharges
_9!_JOE
Plan Ck. Corm/Ind
65%/Bldo Per Fee
Svs
Cha
tems Deve'rqe (1.52'opmmt
Plan Ck. Res
30%/BIdq Per Fee
PLUUBING PERMIT
Charges and
Surcha rges
Fence
Dgmo
ELECTRICP.L PERI,IIT
Charges and
Surcha rges
Sidewal k
A/C Pavi ng Total Comb, Permit
I,IECHANICAL PERHIT
Charges and
Surc harges
Curb Cut
TOTAL 6a;su
v rA), FllzEictAq q,q/uL/.E9 A2rf,/an^*w5
:I(}R\
00
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legai Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. elample- Lot 1. Block 3, 2nd Addition to
SEiin-E-fi el d EstatesC. Name, etc. of owner and construct.ion lenderD. Energy Sources
1. exampl e-2. example-
E. Square footag
hea t/ e l ectri ca l or forced air gas
wa ea e or soTar
e or valuat on, etc.1. example- 1250 sq. foot house, 500 sq. foot garage?. example- jinew project, checkTew - if addition,
check add, etc.F. Buiiding permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence intorestaurant (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 information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description. portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only 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 abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consuit theful l 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 theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical iabel
Applicant to sign and date
}lhenever possibie, the initial application wilI be used asa worksheet only. lJhere 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 ture.
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
II.
III
IV.
v
PERMIT VALIDATION
6 ?
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s'l I nature date