HomeMy WebLinkAboutPermit Building 1987-08-05Y +o ,6-\
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726-37 69
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COMBI iIATI ON APPL ICATION/PERMIT 726-37
Jolj Address /os.&EI]ERGY SOURCESHeat GA Sttut.@
Ran
l-egal Description 7o 3 2-
'ffifl$sq
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So. Fto. 0ther't,le!,'AddXAlIer--Eep. -
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owner fioAbe_lJ Cg em a <A L
Builciinq Pernlit Info: Describe Work(
Family Residence l,lith Attached Garaqe
e., Build SingieAddres s ><Z!We r
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LSgofuc\-roR r'Constructi on Lender - --
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Addres s Phone
exot res ohone no.DES I GN TEAI.,I name address
Ss.trPri ma ry
Structura l
l''lechan ical
\
a ddres s I i cs. no.exot res ohone no. )CONTRACTORS name
?€LfF-Genera I
Pl umb i nq
El ectri I
l''lechanicai
MECHAN I CALELECTR I CALPLUI{B I NG
FFF CHARGFFFFCHARGFNNFFFCHARGFNO
7;o 77.r?
Residence of
FTSQ
furnace/burner to
BTU' S.s Each singie fixture
Z.P Fl oor furnace
and vent
Relocated building
(new fix. additional)L
New circuits alts
or extensions
Recessed wal I
Snacp hpatpr and vpntSERV i CES
S. F. Res idence(l bath)
Duplex (l bath) each
Temporary Constructi on Apol iance vent
seDa rateAdditional bath
Change i n exi sti ng
rps i dpncp
Stati onary evap
cool er[,later servi ce
Vent fan with
sinole ductI ndus tri a I
mul t i fami ly, comm. orSewer
Vent systern apart from
heatinq or A.C.Storm Sewer
/-*?axc0r.il'1./rND. FEEDERS ot Mechanical exhaust
hood and duct
l'lood stove/heaterInstal I /al ter/rel ocate
distr.ib. feeders
I Arrcr- fl/dq../ aa@.0f
ISSUANCF OF PFRI'IIT
/f,o"IOTAL CHARGESTOTAL CHARGES 2=?-5:>J?-f,PTOTAL CHARGES
I"IHERE ST,I not be
ATE LAll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
vali'l until the label has been signed by an Electrical Supervisor and returned to the Building DivisionshaI
EXA}IINED the completed apnlication for oermit, and do hereb.v certify that all information hereon is true
and correct, and i further certif-v that any and all work oerformed shall be done in accordance with the 0rdinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that ll0 0CCUPAI'ICY will be made
of any structure without the permission of the Building Division. I further certify that m.y registration vrith the Builder's
ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and ernployees who are in comcliance with 0l?S 701.055 will be used on this
DATEI GNATURE <>
Board is in full force and effect as required by
I HAVE CAREFUL
l{Ai'lE(please p.int)-Ztonr AS }1, Htr)rlr S(^€- / s
, FO,.r]FFICE USE ONLY
+/ T-1its sq. Ftr]. l,lain x value-
TOTAL VALUATION
0c cy Load
0cc.y Grou p2-2--:q. Fts. otherStoriesFlood Plain eASfu*
Type/ Con s t
BedroomsFire Zone
Zone
Ftg. Acces
?* ZszzE* Bzf At sl,{4
s x Valu
@^t"
Y/0,1r2 f qqrl Svsterils Deve
charqe (1.51 opment ly,4.Plan Ck. Conm/Ind
65%/B1dq Per Fee ftCharges and
Su rc ha rges
_ez-_,e__BUILDING PERI'IIT
.lv Plan Ck. Res
30%/Bldq Per Fee
FencePLUI4BING PERMIT
Char.ges and
Surcha rges -86__)_:;>
Demo
Sidewal kELECTRICAL PERI,:IT
Charges and
Surcha rges
2?- fo
A/C Pavi ng Total Comb. Permit
Curb Cut ///.37I,IECHANICAL PERMIT
Charges and
Surc ha rge s
P
7g TOTAL
''_/
El ectri cal
0f amps
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
Iz--o3-Ts2. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. exampl e-2. exampl e-E. Square footag
heat/electrical I /or forced air gas
WA ea e ec t@e or valuation, e
II
1. example- 1250 sq. foot house, 500 sq. foot garage2. exampje- if new project, check new - if addition,
check add, etc.F. Building permit information:1. examplg - construct single family house with anattached garage
?, example - remodel existing garage into family room3. example - convert single fam.i ly res.idence.into
restaurant (change of use)G. Value of work as defined in Section :03 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bu.ildingDivision Staff must be able to contact appropriite
persons regarding design information or job sitecorrections, etc,
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Ejectrical Schedules,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 perm.it form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF l.IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theeiectrical contractor for signature by his electricalsupervisor. The generai contractor ii not authorizedto sign the electrical label.
App)icant to sign and date
Whenever possible, the initial application will be used asa.worksheet onjy. Where possible, Building Division Staffwill 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 time of theappiication, and no plans wil) be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFF]CE USE ONLY
+I c co t
III 17IZ
IV
V Perm'i t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Perm'it appl icant exempt from registrat'ion with the Builder's Board because:
Additional Project Informat'ion :
PLANS REVIEWED BY:
name s i gnature date 8-,/?<)
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