HomeMy WebLinkAboutPermit Building 1984-02-10INSPECTION LINE
726-37 69 {0r1BI T1 ERI,I I T 726-37
Job Address .2 EIIERGY SOURCES:
Hea
l.later Heater
Ran
Ftg
Ftg
Ftg
n
Sq.
Sa.
Access._
0ther
_l'lewJddAl ter_Pep.
Fence
_Otner
_Demo_C ha nge/ U se
o0
\o
\
s
l-egal Description -4,<--'6
VWzs4 -Se}a€fiJap .b0wner
Address m e Builtiinq Pernit Info: Describe Work('
Family Residence tlith Attached Garaqe
.€., Build Single
d Aq/C <*-/ry'C-ret>e)7 f1Tq,&trae,;*€.wy A/P+
Cene+ruetfuffeillf €8ezfr 4r*# b)?be,
Addre s s Phone r
DES I GN TEAI,I name address I ics. no n
Pri mary
St ructura l
El ectri cal
Hecha ni ca I
name a ddress lics. no-)(exni res (ohone no-)
ob l-f r-A t o a q ? <- aata
EI ectrical
l''techani cal
PLUT{BTNG \)N ELECTRICAL \\N MECHANTcAL \nb,
N0.FEE CHARGE NN FFF CHARG F I'10 FFF CHAA,CF
Each single fixture Res.idence of
SQ FT
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
Snacp hpatpr end veni
Duplex (l bath) each
Addi tional bath Temporary Constructi on Apol iance vent
seDa rate
[^]ater servi ce Change
res i de
in existing
nce
Stationary evap
coo'l er
Sewer multifami1y, connt 0r
T ndustri a I
Vent fan with
sinole drrct
Storm Sewer
Vent system apart from
heatinq or A.C.
COMH./IND. FEEDERS Mechan ical exhaust
hood and duct
I nstal I /a I ter/ rel ocatedictrih- fppders trJood stove/heater
0f s.
ISSUANCE OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
IIHERE STATE LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereb.y certify that all information hereon is true
and coffect, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the Cityof Springfield and the Laws of the State of 0reoon pertaining to the work described herein, and that NO OCCUPAI'ICY will be madlof any structure without
Board is in full force a
the permission of th e Building Division. I further certify that my registration with the Builder'st as required by ORS 701.055, that if exempt the basis for exemption i
iiance with 0l1S 701.055 wi'lI be used on this rrroject.
s noted hereon, and thatonly subcontractors oyees r.rho are in 7t/s,/#/llAl'lE(please print I e l' DArE
V FOII OFFICE USE OiI
zone \\\l Const ts-Ftg rlain 53{x Val u.5-895,-
Fire Zone
-
Bedrooms
-
0ccy Load Sq Ftq. Access fa4Urq__value- RBO- --------------T
Flood Plain
-
Stori \0c c.y Grou S q.Fts 0ther x Val
TOTAL VALUATION 5
BUILDING PERNIT
Charges and
Surcha rges
:a_z :---_Z<
Plan Ck. Conrn/Ind
65%/81do Per Fee zo.rc terns 0pment
PIan Ck. Res
30%/Bldq Per Fee
PLUI,IEING PERMIT
Charges and
Surcha rges -U-N Fence
Dsmo
ELECTRICP.L PERI,IIT
Charges and
Surcha rges
_\)-H.Sidewal k
A/C Paving Tota'l Cornb. Permi t
TlECHANICAL PERMIT
Charges and
Surc ha rges
Curb Cut
TOTAL 5q.d
Ir
AT, I (}RS
)'o
0f amps,
\J.N
COMBINATION APPLICATiON/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. elarJrplq- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. exampi e-2. examblE-E. squaFffiota
hea t/e I ical i I in or forced air gas
WA e t.l *-
ge or valuat on, etc
l. example- 1250 sq. foot house, 500 sq. foot garage'1. example- if new project, check new - if addition,
check add, etc.F. Bui lding permi t information:1. example - construct singie family house with anattached garage2. example - remodei 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, BuildingDivision Staff must be able to contact appropriitepersons regarding design informat.ion or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiI|-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedulesare available at the Building Divisionl. 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 1 schedulesC. BUILDING DIVISION STAFF l^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 electricalsupervisor, The general contractor is.not authorizedto sign the electrical label.Applicant to sign and date
Hhenever possible, the initial application wi'll be used asa worksheet only. Where possible, Building Div.ision Staffwi)l prepare a type written copy and return it to theapplicant at the time the actuai permit.is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed until thesefees are paid. AII other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
II.
III
IV
V
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
PERMIT VALIDATION
Permit Cler
\t\Cr t)tE, A?\QR'SXRr)CK- QtrPN\R \\€\L\\\ES, CclP\ C)F NG.Qret\ETT(
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
aut.2:\D -\st{n s'l gnature