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HomeMy WebLinkAboutPermit Building 1987-02-26-N512A-3iOg- -- _ COHBINATION APPLICATION/PERMIT Job Address ( I c, S" SCesfb Legal Desription /?cf= e r_ EZ ,rcl-ZTi\llater Heater Ranqe. EIIERGY SOURCES: Heat__G A5 r-)JJ_)v\) owner Q-Rbr{}.) . Z Arc.. Jla lue of llork rE-?, s-6i Sq. Ftg. Access._ Sq. Ftg. 0ther_ _llewJdd_Alter_Rep. _Fence_Demo Change/Use 0ther n Address -=fr y? d vhone/g&t Fam i o: Des :e,, Build Single ,/par,-o /aqs72 D,R,bryr zt*>s Construction Lender rJ-rr/ d- Addre s s Phone h N \ DESIGN TEAI,I name (address exo r res phone no. Primary S'<L tri-tStructura I E l ectri cal Mechan i ca l name I i cs. no.exDt res ohone no- S6-.LFGenera I Pl umbi nq ? icalEl l'lecha ni ca I PLUMB I NG ELECTR I CAL MECHAN I CAL FEE CHARGF NN FFF THAPGF I.J I I FFF aHAptiF Each single fixture Residence of FTSQ furnace/burner to BTU' s Relocated building (new fix. additional),l New ci rcui ts al ts or extens i ons z?5'c Floor furnace and vent S. F. Residence ( I bath)SERV I CES Recessed wal l Snacp hpafpr end vcnt Duplex (1 bath) each Temporary Constructi onAddi t iona'l bath Apol iance vent seDarate l,later servi ce e in existing ence Chang resi d Stationary evap, cool er Sewer multifamily, cornm I ndu stri a I or Vent fan with sinole duct 0f amps,Storm Sewer apart from .c. Vent systern heatinq or A COMI{./IND. FEEDERS Mechanical exhaust hond and drrrf I nsta I I /a I terl rel ocatedistrib. feeders [.Jood stove/heater 0f -amps.I A r-rcR H/AC-Aa.15n ?s?sr., ISSUANCF OF PFRIlIT TOTAL CHARGES ??-SZTOTAL CHARGES TOTAL CHARGES /eeD WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certi performed shall be done in accordance with the 0rdinances of the City ning to the work described herein, and that NC OCCUPANCY will be madeDivision. I further certify that m.y registration vrith the Builder's ,r#,fuS]GNA s 0 fy that al'l information hereon is true and correct, and I further certify that any and all workof Springfield and the Laws of the State of Oreqon oertai structure without the permission of the Buildinof any Board i s in full force and effect as required by ORS 7 1.055, that if exempt the basis with 0l?S 701.055 wi lI be used o for exemption is noted hereon, and that only su bcontractors and employees who are in compliance n this oroject. nAr'rE(please p"int) lllprejqS l'1, #loS Le'y Flood Plain Stories 2. 0ccy utr zaaafg"y Load Sq. Ftg. Access x Val eroup F-Z sq. Fts. otner/dffiafuyX-Cyal l4ain xcon*.5/tr4-,5?Anits sq.Fts TOTAL VALUATION- Val ue ue ZSA 6b zone LD,/ Fire Zone Bedrooms Pl an Ck. Cornm/Ind 65%/B1do Per Fpe terns Deverqe ('1.5% opmmtSvs cha I )N.4,^BUILDING PERT'lIT Charges and Surc ha rges Plan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surc ha rges Domo Sidewal kELECTRICAL PERI1IT Charges and Surcha rges -.5?_.7o A/C Paving Tota'l Cornb. Permi t Curb Cut 77a yTOTAL MECHANICAL PERHIT Charges and Surcharges a.e> -64 re WOrk( Ga ra oe ,1 oRS ___/5:-_ COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Lega l Description l. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources 1. example- heat/electrical ceilinq/or forced air oasz. examp te- waterheater/electrical/or solarE. SquaiE-Tootage or valuation, eTc. - l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - .if addition, check add, etc.F. Building permit information:1. example - construct singie family house with anattached 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 Sect.ion 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construct.ion delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechan.ical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appiicant need fill-in only the No. Boxes adjaientto 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 abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedu'les you should consult 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 theelectrical contractor for signature by his electricalsupervisor. The general contractor ii not authorizedto sign the electrical labelIII. Applicant to sign and date Whenever possible, the in.itial application w.ill be. used asa.worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapp'licant at the time the actual permit.is issued for hissignature.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION 4 r;b1 I qqb Prt/ Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: name s i gnatu date --og PLANS REVIEWED BY: \ T LINE COMEI APPLICAT IO ERMIT 7 Job Address L i '. S" \>4E;1,)EilERGY-souRCES Heat (=r /.t 5 liater Heater Ran Legal Description / ,.!/aiue of tlork:?-e, 1-ri) Sq. Ftg. I'lain-- Sq. Ftg. Access._ Sq. Ftq. Other _l,lewJddJlIer-nepr_ _Fence_Demo_C ha nge/ U se 0ther 0wne r E>o,(t>,.il ,Z ruC., vnone/J{; !/(Address .:_rn /) E Desc r i dence Ga n rB F A .€., Build Single ,ADzrno- /r'./'r'-*-n.< z>,R,Z,ry, zs*x Constructi on Lender r,r, ,, tJ 6--fr {zqre {TDza y'Sprzaae Addres s Phone ,4*.2 c0 N \ DESIGN TEAI.I name (address exo i res phone no. Primary =S<'L'F- aStructura I I El ectri cal Mechani cal CONTRACTORS n ame lics- no-)exoi res ohone no. S c-t L.-Genera l €Pl umbi nq El ectri I l,lechanical PLUI1B I NG ELECTR I CAL MECHAN I CAL NU.FFF NHARGF NN FFF CHARGF NO FFF l^HA AGF Each single fixture Residence of furnace/burner to BTLI' S Relocated building (new fix. additional),t New ci rcui ts ai ts or extensions ??J-c Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed walI Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate lnlater servi ce Change in existing res i dence Stati onar.v evap cool er Sewer Industri a I multifamily, comm. or Vent fan with sinole duct Storm Sewer .amps.0f Vent systern apart from heatinq or A.C. COMI.1./IND. FEEDERS Mechani ca l exhaust hood and duct I ns ta I I /a 1 ter/ rel ocate d i stri b. feeders l'Jood stove/heater 0f amps.41,-z,rB HuA<-Uzz./5- Sysnr':rr.l ISSUANCE OF PFRIlIT TOTAL CHARGES ??+;aTOTAL CHARGES TOTAL CHARGES /Ca-a WHERE STATE Ll\l,l REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this perriritshall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed apnlication for permit, and do hereb.y certify that all information hereon is truefy that any and ail work performed shall be done in accordance with the 0rdinances of the Cithe State of Oreqon oertaining to the work described herein, and that NC 0CCUPANCY will be , that if exempt the basis for exemption is noted hereon, and that tiAl.lE(please print)t tttsn fl3 nl<-zS L€,^rr&rb7IGNATURE ty made N and correct, and i further certiof Springfield and the Laws of sion. I further certify that my reqistration with the Builder'sof any structure without the Board is in full force and e permission of the Building Diviffect as required by ORS 701.055 only subcontractors and empl oyees who are in comcliance with ORS 701.055 rvill be used on this oroject. CE Ftg Ftg Ftg s q . o tn " " /rfm,*,'a,fuyYan u lue Z5@. "o zone L/D ee/const.5 /ZR-,?An 'i ts l'la i ()f zaD€fg"y ToTAL VALUATI0N.- Acces s Value ValueFire Zone Bedrooms Flood Plain Stories Load Sq eroup F'Z sq Plan Ck. Conrn/Ind 65%/B1do Per Fee Svs Cha tems Deve rqe (1.52 opment N4,BUILDING PER}IIT Charges and Surcha rges __,sE-€?_/-5/Fee Plan Ck. Res 30%/81dq Per FencePLUMBING PERMIT Charges and Surcha rges Dgmo Sidewa l kELECTRICAL PERI1IT Charges and l Surcha rges __33-_5?_-7a\Total Comb. PermitA/C Pavi ng Curb CutI,IECHANICAL PERHIT Charges and Surc ha rge s a- ZA 77.a yTOTAL l SQ. FT (-/ / _/53_ .' I COMBINATION APPLICATION/PERNIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. glqgplg- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, ?nd Addition toSpringfieid EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. exampl e-2. l,**EI"-E. Square foota heat/electrical ceili lqrced air qas water ter e ec or sol ar ge or va'l uat o[, l. exampje- 1?50 sq. foot house, 500 sq. foot garage'2. example- if new project, check new _ if addition, check add, etc.F. Building permit information:1. examp]e - construct single family house with an attached garage ?. exampie - remodel existing garage into family room3. example - convert single famiiy res.idence .into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructurai Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construct.ion delays, Bui)d.ing Division Staff must be able to contact appropriite persons regarding design information or job s.itecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electr.ical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the applicant need fil'l-in only the No. Boxes adjaient - to the appropriate item(s) to be .installed B. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. 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 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 theelectrical contractor for signature by his electricalsupervisor. The general contractor ii not authorizedto sign the electrical IabelIII. App)icant to sign and date lJhenever possible, the initial appl.ication wilI be used asa.worksheet only. Where possible, Bui)ding Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actuai permit js issued for his s i gna tu re.IV. Fees and Charges PIan 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: PERMIT VALIDATION Permit CIerk 4*\ f,4qb, b1 Permit app'licant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s f gnatu date 3-23-e)