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HomeMy WebLinkAboutPermit Building 1989-09-24--$ud( I IIS PEC 726-37 T ON CITY OF S CC)HBINATION APP PRI i'IGF I ELO ON/ PERM TTLICATI 37 Job Address EIIERGY SOURCES Hea t l,later Heater. Range Sq. Ftg. tlain_ Sq. Ftg. Acceil- Sq. Ftg. 0ther_ _l'lew_Add_A I te r_Re p . _Fence_Demo Change/Use 0ther w Or\-\J [_; { Lesal Descriptton fJ p$ ,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 ? \p a) \Q ( 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