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Home My WebLink AboutPermit Building 1987-10-22tr-'{ ., If INSPECTION LINE 726-37 69 m COHBI HATI ON APPL I CATI ON/PERI'{IT TNFORIIATIOil LINE 7?6-3753 \\ \, N \ Job Address S 5^ 5f Legal Description EIIERGY SOURCES: Hea l,later Heater Ranqe Sq. Ftg. I'lain_ Sq. Ftg. Access._ Sq. Ftq. 0ther_ _l{ewaddal ter_Rep. _Fence_Demo Change/Use -other- Va l ue of l,lork: /occ *Owner CL,uck oE Ckr,-sf Address /3ot /1/ ;rth t+Phone |^lo rk 'I ence l,li A .e., Build Single 2t/6 //tz fei,"{rr..- 5/r r-c{u-o lru ln 4ai/r--. Construction Lender Ccrsk Jqfu-e lr"-rr^ /o t c.e e cr/ 9pa.-t cLe.?a€S Addre s s Phone DESIGN TEA}.!name 'ICS- nO-ohone no. Prima a-f 2-o;g 3 Structural El ectri cal l4echan i cal NATIIIB I ics- no-I (cvni rps ohone no. 1 P I P!-UN8NNtr ELECTRI CAL MECHANICAL FFF CHARGE I\to-FFF CHAAGF NO FFF CHARGF Each stngle firture Residence of sQ FT furnace/burner to BTU, s Relocated building (new fix- additiornal) New circuits alts. or extensions Floor furnace and vent S.F. nestd€ne(l bath)SERV I CES Recessed wal l Soace heater and vpnt Dupler (I bath) each Additiomal bath Temporary Constructi on Apol iance vent qpna ra t p Ilater sewtce Chan res i ge in existing dence Stationary evap. cool er Sewer multifamily, conrn or Industria l Vent fan with sinole duct Storm Serer 0f s.Vent systern apart from heatino or A.C. COMH./IND. FEEDERS Mechanical exhaust hood and duct z t t4 Insta l I /al ter/re1 ocate distrib. feeders lrlood stove/heaterrl 0f .amps ISSUANCE OF PFRIIIT TOTAL CHAREES TOTAL CHARGES TOTAL CHARGES WHERE SIATE n-$jl REQIJIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be waliC qmtitr the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFIILY EXAIIIiNED the completed apnlication for oermit, and do hereby certify that all information hereon is true and corect., and I furttaer cert'ify that any and all work oerformed shall be done in accordance with the 0rdinances of the Cityof Springfie'0d ar*d tIrc d-aurs of t,he State of 0regon pertaining to the work described herein, and that NC OCCUPAI'ICY wilI be madLof any structure witimrt th.e pennission of the Buitding Division. I further certify that m.y registration vrith the Builder's Board is in fultr force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with 0l?S 701.055 will be used on this project. I'lAllE (p I ease E S IGNATURE DA'rc Lt; 2*Y Zone_____Ty.oelCons 5--x i ts Sq. FtS. l,la in x Val ue_ Fire Zone Eedrooras Load Sq. FtS. Access _ x Valuee"*pf,sq. Ft;. orn""5Wuur r"@ ToTAL VALUATI0N_ Flood Plain Stories - Occy BUILDING PERI{IT _/2Charges and Surcha rges ).2a Plan Ck. Conrn/Ind 65%/B1do Ppr Fpe va Svstems Deve charqe tl.57 opmeot PIan Ck. Res 30%/B1dq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICAL PERTIIT Charges and Surcharges SJ dewa 1 k A/C Paving Tota'l Comb. Fermit HECHANICAL PERHIT Charges and Surcha rges Curb Cut TOTAL ??.% iul :am escri fa chor )e I (address PYnl rp< CONTRACTORS I addroc< t-/Y FOI? OFFI \.- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. Block 3, Znd Additjon to Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION s E. F. Building permit information1. exampl e a t tac hed - construct single family house with an garage II 2. example - remodel existing garage into family room3. example - convert single iamily-resiAence inlo restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Speciaity CodeH. DESIGN TEAM 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. Abbreviated Plumbing, Mechanical, & Electr.ical SchedulesA. Except where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedu'les, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful I Plumbing, Mechanical, and Electrical Schedules are available at the Building Divisioni. 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 ANO CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date I'lhenever possibie, the initial application wilI be used asa worksheet oniy. I'lhere possible, Building Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actual perm.it is issued for hissignature. Fees and Charges Plan 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. FOR OFFICE USE ONLY III. IV v Permit Clerk PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI.ICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name Si gnature date lA-?>-e) PECT I ON -37 69 COMBI AP ICATI ERMIT 7 Job Address 05 .ipt l-egal Description d EIIERGY SOURCES Hea t l,later Heater Ranqe n Sq. Ftg. Access._ Sq. Ftg. 0ther_ _l'lew_Ad d_A I te r_Pe p . _Fence_Demo Change/Use -other- \\ \' N \ Value of l,lork: /'o 0t *--0wner C /v^^ ck oF C krt'st Address /BO g 11/ 5:t4 s+Phone Bui Fanr Work( i'e., Build Sinqle Garaqe ) 2? 6 trz fe, ryAr.- )1r..-1u-o bu ln {{* iltno Construction Lender C a-s l,Jqfu-e Lurr- lo t+ee cr/ 9oa,,t 4!1.\?ai1 Addre s s Phone I]ESIGN TEAI.I natile addre s s s exril res 10ne n0 Pri ma 11 e 2o;g s Structural EI ectri cal Mechan i ca X lT0m:S naflE addres s I ics. no. ) (exoires ohone no- Genera I Oq4 n-Qr Pl umbi ne El ectri cal llechani catr Pt-t|jrlfsnlTiG ELECTR I CAL 14ECHAN I CAL rFF CiIiARGE Nill FFF CHARGF NO FFF .HAPCF Each sirrlrqXe fixt,ure Residence of sQ FT furnace/burner to BTLI' S Relocated huiTdirilq (new fix- addiltidan)New ci rcui ts ai ts or extensions Fl oor furnace and vent S. F. ,Resl'dance(l batfr)SERV I C ES Recessed wal i Soace heater and vent Duplex (l bat$r) each Additiomai hathr Temporary Construction Apol iance vent seDa ra t-e l,Jater ser.yice Change i n exi sti ng res i dencp Stationary evap. cool er Sewer multifamily, comm. or Industrial Vent fan with sinqle duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C. COMI.I./IND. FEEDERS Mechan i cal exhaust hood and duct Instal I /al ter/re1 ocate di stri h fppdprc I'lood stove/heater 0f ISSUANCE OF PFRIlIT TOTAL CHARBIS TOTAL CHARGES TOTAL CHARGES I.,HERE SrtArIE lL{J mf,SUtIRES shall not he ,ya:lid umtin tfte that the Electrical work be done label has been signed by an Elec by an Electrical Contractor, the electrical portion of th'is permittrical Supervisor and returned to the Bui lding Division I HAVI CARETTIJLX-V EXAI1IilED the completed a pnlication for oermit, and do hereb.y certi fy that all information hereon is trueand correct, a,rd I f,[irtiher centify that any and a1 of 0regonof the Bui I work performed shall be done in acc ordance with the Ordinances of the Ci ty madeof Springf,l'elld ar,rd .the il-aurs of the State oertaining to the work described herein, and that NC OCCUPAI,ICY will beof any stnucture i{r'rtfrmuit ttre penmission lding Division. I further certify that m.y reqistration vrith the Builder'sBoard is in f:ull forqe and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcomr'tnactor-s aurrd employees who are in comcliance with 0l?S 701 055 wi'll be used on this Droject. tlAl'lE(please E S IGNATURE DATE - 22- Zone Tyoe/Const.5--g Units So. Ftq. l,lain Value Fire Zo Flood P tsedroorms Load Sq. Ftg. Access_ x Va e"orp.hV-sq. Ft;. nrn""@ru TOTAL VALUAT I 'I a 1u" lbn' '-o ION- BUILDING PTR${IT Charges and Su rcha rges _/2_5?__"2a Plan Ck. Comm/Ind 65%/81dq Per Fee //va Svsterns Deve Charqe (1.52 opment Plan Ck. Res 30%/B1dq Per Fee PLUI'4BING PERMIT Charges and Surc ha rges Fence Demo ELECTRICAL PERIlIT Charges and Surcha rges Si dewa I k A/C Paving Curb Cut Total Comb. Permit 14ECHANICAL PERMIT Charges and Surc harge s TOTAL 2?.% COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. 2.E. Squa exampl e- examp I e- re foota air gas II 1. example- 1250 sq. foot house, 500 sq. foot garage ?. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct singie fami)y house with an attached garage 2. example - remodel existing garage into family room3, examp.le - convert singie family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in 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 available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal]ed are not covered on the abbreviated scheduies you should consult the ful I schedul esC. BUILDING DIVISION STAFF l^llLL 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 generai contractor is not authorizedto sign the electrical label Applicant to sign and date Hhenever possible, the initjal application will be. used as a 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 his s i gna ture. 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. FOR OFFICE USE ONLY III IV. V Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Permit applicant exempt from registration w'ith the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s't g nature date /ae >-e)