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Home My WebLink AboutPermit Building 1984-10-03INSPECTION LINE 7?6-37 69 CITY OF SPRINGFIELD COMBI IIATI ON APPL I CATION/PERMIT INFORI4ATION LINE 7?6-3753 r(Xs> Sa Job Address t) n Z g, / 8, ZZ---EIIERGY SOURCES Hea t l,later Ranqe_ Heater Sq. Ftg. I'lain_ sq. Fts. Accesil- Sq. Ftg. 0ther_j{ew AddrA'lter-tep. _Fence_pemo Change/Use 0ther Legal Description Val ue rof tlork:# /;60o}wnet SV/e t t-c 6 F/€ *r- Cz 7t Z-t f / 7;! d.'iz'?42 Address z" a o /v. )1";i/€?87 Phone Builciint Farni I v f tln Desc Ga .e., Build Single I Construction Lender SL"/ fr {e) Address Phone name addres s exDr res Primary Structura I EI ectri ca l Mechanical ACTO RS n ame addres s l i cs, no.pvn i rps )Dhone no. I Plumbinq c/ 6> nt PLUTIBI NG ELECTRI CAL MECHANICAL FEE CHARGF NN FFF CHARGF t'I0 FFF THAAGF Each single fixture Res.i dence of sQ FT furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts. or extensions l5..oo Floor furnace and vent S. F. Residence(l bath)SERV I C ES Recessed wal l SnacF heatFr and vent Duplex (I bath) each {'1,. (to Additional bath Temporary Constructi on Apol iance vent seoa rate tlater service Change in existing rpci dpnce Stationary evap. cool er Sewer multifamily, cofifll 0r Industrial Vent fan with sinole duct Storm Sewer 0f Vent system a heatinq or A. part from c. COI.IH./IND. FEEDERS Mechanical exhaust hood and duct I nsta I I /a l ter/re1 ocatedistrib. feeders l'lood stove/heater 0f t(te I 4 o.q$tS Lb ISSUANCF 0F PFRtlIT TOTAL CHARGES TOTAL CHARGES t<o TOTAL CHARGES I.IHERE STATE LI\N REQUIRES thAt shall not be valiC until the label the E'lectrical work be done has been signed bY an Elect bv an Electrical Contractor, the electrical portion of this pemit rical Supervisor and returned to the Building Division t comp 'I eted ap l-)ca t on r perml t cert I fy tha +a 1 fo rmat 1 0n hereon s t rue lv1 th he 0rd 'I of the Ci tyandcorrect, Spri ngfi e any struc a nd I further certify the Laws of the thout the permis rce and effect a t ha t any and a I I work perfo rmed s h a I I be do ne 'I n a cc ordance +na nces f 1 d and Sta te f 0rego n DE rta I 1 n g to the wo r k descr 1 bed here I n and tha +NC 0ccuPAl,lc'w1 I I be made f ture w1 s I 0 n of the Bu 'I I d 'I ng Di VI s 'I on I fu rth er e rt 'I fy th a L my reg i s t ra t 'I 0n vJl th the Bu I I der s Boa rd '|S 'I fu 'I I fo s requ i red by ORS 701 055 tha t f exempt the ba s 'I s for exempt 'I o n '|noted he re0 n a nd th a t on 1y s ubcon tr ac to rs and emr)I 0yees who are '|n c0mD I '|an ce wi th 0r?s 7lt 055 l.Jl 1 I be us ed 0n thi s proj ect llAl.lE(please print)C,a.ere a1r ,A/<.<€.<.? SIGttA Zone_ Type,/Const Uni ts Ftq. l'lain x Val Fire Zone-pedrooms 0ccy Load Sq. Ftg . Access x Val Flood Plain Stories Group !q. Ftg 'I ue ToTAL VALUATI0N_ .0ther BUILDING PERNIT Charges and Su rcharges el(.) fa Plan Ck. Corm/Ind 65/ /B1dq Per Fee Svstems Deve charqe (1.51 opment Plan Ck. Res 30%/Blds Per Fee PLUI,IB ING PERMI T Charges and Surcha rges Fence Demo lepr< o7?N q .2d ELECTRICAL PERIIIT Charges and Surcharges -__/f-::_-€,O. Si dewal k A/C Paving Curb Cut Tota'l Comb. Fermit I,IECHANICAL PERHIT Charges and Surcha rge s TOTAL 4z 6- 20 I LAtl rnnp no COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. glalnple- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. Block 3, Znd Addition toSpringfieid EstatesC. Name, etc. of owner and construction lender0. Energy Sources PERMIT VALiDATION R# 6zfrv I 2 exampl e- examp I e- re footag hea t,/e l ec tr i ca I or forced ai ,n//rr wa ea e 0r so ar E Squa e or valuation, II 1. example- 1?50 so. foot house, 500 sq. foot garagez. elample- if new project, check-iFw - if additio;,check add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?, examp-le - remodel existing garage into family roomJ. exampte - convert single family residence intorestaurant (change of use)G. Value of work ai defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI,4 AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contait appropriitepersons.regarding design information or job i.itecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electrica'l Schedules,the applicant need fill-in only the No. Boxes adjaient - !o-!h9 appropriate item(s) to be insta.lledB. Full PIumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the-permit fonn the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDINC OIVISION 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 "i.ii.iiui - supervisor. The general coniractor ii not authorizedto sign the e'lectrical labelApplicant to sign and date lrlhenever possible, the .initia l appl ication wi.l I be, used asa.worksheet only. ldhere possible, Building Oivision iiaiiwil'l.prepare a type written copy and returi it to theapptrcant at the time the actual permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wiil-be procesied until thesetees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III. IV V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permi t app'licant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s i gnatu ate /) ->.-t.f