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Home My WebLink AboutPermit Building 1983-01-17INSPECTION LINE 725-37 69 m COMBI NATI ON APPLICATION/PERMIT Job Address l-egal Descri ption EIIERGY SOURCES t^later Heater Range Sq Sq Ft9 l'la i n . Ftg. Access Sq. Fto. Other_ _l'lew_AddJltei-flap. _Fence_Demo_C han gel U se 0ther t\ \s aq \^ 00 / I I Value of llork: -il. A <rw.ooOwner Address 4 ZO =L A g phone Zq6 _BLilr Farni'l n t Info scr I.li Attac d ;0., Build Single I 7 construdtion 1;4,1J )illktr) rt-^rl Addre s s Phone UU I]E5IGN TEAI.1 name address exDr res ohone no- Pri ma ry Structura I El ectri ca I Mechani ca I $ame addres s 'lics- no-)exD't res ohone no. 6eneral Pl umbi nq El ectri ca i I'lechan ical PLUI{B I NG EL ECTR I CAL MECHAN I CAL N0.FEF CHARGF NN FFF CHARGF NO FFF CHA PG F Each single fixture Residence of SQ. FT furnace/burner to BTLI' s Rel ocated bui 1 ding (new fix. additional ) New ci rcui ts ai ts or extensions ^2 a2- Mil.E sa FIoor furnace and vent S . F. Res i dence(l bath)SERV I CES Recessed wal I Soace heater and vcnt Duplex (1 bath) each Additional bath Temporary Construct i on Apol iance vent separate l,later servi ce Change in existing resi dence Stationary evap cool er Sewer multifamily, comm. or Tndrstrial Vent fan with sinole duct Storm Sewer 0f Vent systern apart from heatino or A.C. COMI.I./IND. FEEDERS Mechan i cal exhaust hood and duct Instal I /al ter/rel ocatedistrih- feeders ['lood stove/heater 0f ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES /se TOTAL CHARGES WHERE STATE LAI,I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penilitshall not be vali:l until the label has been signed by an Electrical Supervisor and returned to the Building Division and I HAVE CAREFULLY EXAI'IINED the completed application for oe perfo rmit, and do hereb.y certify that all information hereon is truecorrect, and I further certify that any Springfield and the Laws of the State of and al l r^rork rmed shall be done'in accordance with the 0rdinances of the Ci ty madeof0regon oertaining to the work described herein, and that NC OCCUPANCY will beof any structure without the Board is in full force and e permission of the Building Division.ffect as required by ORS 701.055, tha I further certify that my registration r,rith the Builder'st if exempt the basis for exemption i s noted hereon, and thatonly subcontractors and ernployees who are in compliance with 0l?S 701 . 055 wi'l I be used on th i s I'lAl'lE( pl ease pri nt)S S IGNATURE ./ zone -/ll/---_J tpe / const. € llR.ffin: ts Fire Zone Bedrooms Occy S o. Ftq. l,lai lv xVa 1r" ?54-f Load So. Fto e"oro@sq. Fts Acces s 0ther x Val ue Flood Plain S toni es x Value il- ,/rv/xg fr# l"qtn rorAL VALUATIoN- BUILDING PERI'IIT Charges and Surcharges OE Plan Ck. Cornm/Ind 65%/Bldo Per Fee )s. a9 3^/,Svsteris Deve Charqe ft.sz opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence D6mo ELECTRICAL PERtlIT Charges and Surcharges aa ,@ Sidewal k A/C Pavins Tota'l Comb. Permit qo.# I,IECHAN I CAL PERMIT Charges and Surcharges Curb Cut TOTAL 4yo.,% ]IoRS COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1. Block 3, 2nd Addition to Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. example- heat,/electrical ceil!19/or forced air gas2. exanrpTe- waterheaTerZelEtrlEilTor solar - E. Square footage,or valuation, eTc.-1. 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 single family house with an attached garage 2. example - remodei existing garage into family room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Speciaity CodeH. DESIGN TEAII AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electr.ical SchedulesA. Except where blank spaces occulin 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 avaiiable 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 on the 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 electr.icalsupervisor. The general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date lJhenever possibie, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant 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. Al1 other fees and charges are due andpayable when the permit is issued. PERMIT VALIDATION Kl- bq/37 t/r71er V. FOR OFFICE USE ONLY 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 .sign ature date /-/€*# Et