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Home My WebLink AboutPermit Building 1996-06-14i ll Ori L i i'lE m COMBI IIATI ON APPL iCATION/PERMIT Jcb Address EIIERGY SOURCES: Heat l,later Heater Ranq Sq. Ftq. l'1a n Sq. Ftg. Access.__ e Legal Descripi.ion D Owner "'f,"{ffiec-> Addre t ,$N ,trffi - Phone Permi t n sc Farni I s i dence [,li re., Build Single u) Cons Addres s Phone name exn res Pri Structura I El ectri cal Mechanical CONTRACTORS name addres s Iics- no.exDl res ohone no. Genera I >{x tzSt I PLUtlBI NG ELECTR I CAL MECHAN ICAL FEE CHARGE NO FFF CHARGF t'J0 FFF THARGF Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated building (new fix. additional ) New ci rcu its a'l ts. or extensions FIoor 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 seoa rate Ilater servi ce Chan ge in existing dencerpq r Stationary evap cool er Sewer multifamily, corrn or T ndrrsf ri a'l Vent fan with sinole duct Storm Sewer 0f amps. Vent systern heatinq or A apart from .c. c0Mr'1./IND. FEEDERS Mechanical exhaust hood and duct I n sta I I /a 1 ter/ rel ocate distrib. feeders [,lood stove/heater 0f ! ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE Ll\N shall not be valiC REQUIRES that the Electrical work be done by until the label has been signed by an E'lectri, an Electrical Contractor, the electrical portion of this pernit cal Supervisor and returned to the Building Division r HRvr cAnEfuLLY EXAMINED the completed application for permi t,and do hereb.y certify that all information hereon is true shal'l be done in accordance with the 0rdinances of the Cityand correct, and I further certify that any and all work pe rformed of Soring field and the Laws of the State of Oreqon oertaining to the work described herein, and that NC 0CCUPANCY will be made of any structure Board is in ful]without the permission of the Buildi ng Division. 701.055, tha I further certify that my reqistration vrith the Builder's force and effect as required by ORS t if exempt the basis for exemPt ion is noted hereon, and that only subcontractors and ernployees who are in comcliance wi th 0l?S 701.055 wi] I be used on th is proiect t'lAtlE(pl ease pri nt)J c['t,"F r.,t SI -.-qNE (r, '' /'('qc IFFII : USE OI{LY -I Zone Cons t.Ftg Ftg Ftg l'lain x Value Fire Zone Bedrooms Load Sq Acce x Val Flood Plain Storie 0cc.y Group,Sq x Val ilF TOTAL VALUATION s 0the r BUILDING PERNIT Charges and Surcharges Plan Ck. Conrn/Ind 65%/B1do Per Fee teris 1.57 Plan Ck. Res 30%/Bldq Per Fee PLUI.IB ING PERMI T Charges and Surcha rges Fence Demo ELECTRICP,L PERI'IIT Charges and Surcharges Sidewalk A/C Paving Total Cornb. Permit T,IECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL . Ftg . 0ther PERMIT VALIDATION #-\q3bla lo-l+-q o Permi t Cl erk COMBINATIOiI AFPLICATIOII/PERMIT (CAP) Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpffigfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. example- heat,/electrical ceiling/or forced air gas 2. example- waterheater/electrical/or solarE. Square footage or valuat'ion, etc.1. example- 1250 sq. foot house, 500 sq. foot garage 2. g,(Srnp_i-g- if new project, check new - if addition, check add, etc.F. Building 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 into iEsTI''Fant (change of use)G. Value of work as defined in Section 303 (a) of the Structural 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 site 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 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 beqn abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the ful l schedulesC. BUILDING DIVISION STAFF I^IILL 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 is not authorizedto sign the eiectrical iabel Applicant to sign and date lJhenever possible, the initial app)ication will be. used as a worksheet on1y. 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 ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no p)ans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: I II. III IV Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: dates i gnaturename