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Home My WebLink AboutPermit Building 1985-01-08INSPECTION LINE 726-37 69 OMBI IT 7?6-37 Job Address EIIERGY SOURCES: Hea t l,later Heater Ran Sq. Fto. l.lain_ Sq. Ftg. Access._ Sq. Ftg. 0ther_ _l{ew_Add11 ter_Rep. _Fence_Demo_Cha nge/ U se 0ther \ N\ ao u crc l-egal Description iLoO K " )r)b- oDOwner Address Bu!lciin Fami l y q Pernrit Info: Descrit Residence tiith Attacher Ga ,e., Build Singie 7r? Constructi 6n i.na." ' U I Addre s s Phone DESIGN TEAI,{name addre s s 1CS. n0.exDI res ohone no. Pri mary Struc tura I EI ectri cal l,lechani cal ACTORS nai]',iP add res s lics. no-'exni res )(ohone no- Genera I Pl um El ectri ca I l'lecha ni ca l PLUilB I NG ELECTRI CAL MECHAN I CAL FFF CHARGF NO FFF C HARGF NO FFF CHAACF Each single fixture Residence of furnace/burner to BTU' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. Residence ( l bath)SERV I CES Recessed wal l Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate l"later serv ice Cha res nge in existing i dence Stationary evap cool er Sewer multifamily, comm or Tndrrqtrial Vent fan with sinole duct Storm Sewer 0f .amps. Vent systern apart from heatino or A-C^ COMI.I./IND. FEEDERS Mechanica l exhaust hood and duct Instal I /al ter/rel ocate distrih. fecdprs l'lood stove/heater 0f amp s. ISSUANCF OF PFRTIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Buiiding Division I HAVE CAREFULLY EXAMINED the completed application for nermit, and do hereb.y certify that all information hereon is true and correct, and I further certif-v that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that N0 0CCUPANCY will be madeof 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 employees who are in comcliance with 0l?S 701.055 will be used on this nroject. llAtlE(please print)o I GNATURE DAqE k r-'rf Zone___________Tyoe/Const. Un it 0 Ft9 Ftg Ftg l4ain al ue Fire Zone Bedrooms Load Acces s 0ther x val ue- ValueFlood Plain Stories 0cc.y Group TOTAL VALUATION- BUILDING PERNIT Charges and Su rcharges -//o--Ee*-Plan Ck. Conrn/Ind 65%/B1dq Per Fee Svstems Deve' charqe t1.57' opmmt Plan Ck. Res 30%/BIdq Per Fee PLUI,IBING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICAL PERt|IT Charges and Surcha rges Sidewal k A/C Paving Tota'l Comb. Permit I,IECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL lo"Tes Phone SQ. FT. I 7 ? COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. e.qrnple- Lot l. Block 3,2nd Addition to FfnlTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical ceiIino/o2. examETe- wa terhea teiTETEETil c-a I /orE. Square footage or valuationl-ETI- r forced air gas sol ar ]. example- 1250 sq. foot house, 500 sq. foot garage2. Example- JT-new project, check-i-ew - it aOaitioi, check add, etc.F. Bui lding permit information:1. example - construct single family house with an attached garage ?. examp]e - remodel existing garage into family room3. example - convert singie famiiy res.idence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructura'l Speciaity CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Bui)ding Division Staff must be able to contact appropriitepersons regarding des.ign information or job site comecti ons , etc . Abbreviated Ptumbing, Mechanica'1, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedu'les,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be.installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated?. If the item(s) to be instal'led are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF WILL 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 electrical Iabel Applicant to sign and date llhenever possibie, the initial application will be used asa.worksheet only. Where possible, Bu.ilding Divis.ion Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is.issued for hissignature. Fees and Charges P'lan 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. II. III IV, V. FOR OFFICE USE ONLY PERMIT VALIDATION /1/ d I r/t l I Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s i gnature date