HomeMy WebLinkAboutPermit Building 1980-09-23IIiJtt6
BUILDING PERTIIT
Charges and
Surc harges
E
cotlB I i APPL I CATI ERMIT 726-3753
Job Address
l-egal Description
EIIERGY SOURCES:
Hea t
l,Jater Heater
Ranqe.
Sq. Ftq. l'Iain.
Sq. Ftg. Access.-----
Sq. Ftq. Other__
llew Add Al ter Pep.
_]e n-e_Derno C ha-n ge/ U se
0ther
B
\$qtlrl?,'a'rtr=Owner
Address I". tr \Phone-S2s Bufl
Farn'i
c,inly
q Perntit Inf
Res i dence l,li
o: Describe'rlork(th Attached Garaoe
e., Build Single
'T),rrJ'no I t ,po.L ^,, L->
Construction Lender I V t
i\ddres s Phone
na c5 no i
Pri mar
Structura l
El -"ctri cal
l"|ec ha n i ca I
COi]TRACTORS n ame adciress )(l ics. no.exoi res ohone no.
P umbin
El eclrical
:.lech:nical
PLUiIB I NG ELICTRICAL I,iECHAN I CAL
i FEE Ci-iARGE i FFF {:HA RGF ir0 -FFF CiJAECF;
Each single fixture
Relccated buildinq
(new fix. additional )
Residence of
cn FT
furnace/burner to
ETit' s
llew ci rcui ts al ts
or...ex ten s i on S
Fl oor furnace
and vent
S. i--. Pes i dence(l bat,h )
SIRVICES RecesseC wal I
Soace heatpr and vcnt
Duplex (l bath) each
Addi tional bath Temporary Construct ion Apol iance vent
seDarate
rrlater servi ce Chanqe in ex'i stinq
resirlence
Stati onar,v evap
cool er
I
i Se,.rer
I
mul ti fami 1y, conrrn or
Indrrstrial
Vent fan with
sinole duct
Storm Server 0f a[]ps.Vent systenn apart from
heat'i no or A. C.
C()MI.!./IND. FEEDERS iulechanical exhaust
hood and duct
Instal I /al ter/re1 ocate
distrih. fperler<l'lood stove/heater
0f S.
TOTAL CHARGES
ISSUANCF OF PFI],i,1IT
|J l hL LnHXbC )TOTAL CHARGES
I^IHERE STATE L1l'J REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division
L I li t D the co mp I eted a p p ,]'l C at o n for DC rml t and do h
hal I be
work de
furthe rf exempt
.055 ri i l
er eb.v ce rt I tv th a t a I j n forrna I i o n he re0 n i s true
the CityI be made
i l der's
and that
a n d CO rrec t a nd i fu rth e r cer t f -V t ha t a ny a nd a I I 1^/O r k DE r fo rmed s do ne I n a cc 0 rda NC th L he 0r d ,j nan ce s IofSDrn9f'I e I d a nd t he L WS o f th e S te of 0re gon DC rta 'l n I ng to t h S C r 'l DC d here i n a nd th a t ilc 0c CU PAI,i CY tvr Iolany s
aro i s
t rU ct u re wi t ho ut t he pe rmi S 5 '1 n of the 3u i I d I n8 D I 5 i cer t i fy th a t my 1 S t ra t I 0n v/l th the Bu
Bo ,]fu I l fo rC e a nd ef re LL a s req u 1 red by 0 tls 0 1 055 tha t I the ba s I S f o r ex emp t i 'I s n ot ed he reo n
I ubco tr to nd I rvho Ion,v S n ac (s a emT)oyees a n comD an CE i L h OR S 7o I b e u S e d o n th I S p ro,j ec t
l,lAilE(please print)I CiIATURE TEc/-)3.-go
FON (IFF]CT USE OIILY (
Zone Tyoel Ccns r Uni tsi So. Ftq. l4ain Value
Fire Zone 8eo ro ons
Stories
Load Sq Ftg
Ftg
Acces s
0the r
X Val ue
Flood Plain G roup !q
-
,'4' -*1-B t7f x Val ue
P;/vr-.n Pr=r7/a, f *'rV<crt I TOTAL VALUATION ?:€ra
Plan Ck. Comm/lnd
65'i,/B1dq Per Fee
Systens Develocment
Charqe (i.5q)
Plan Ck. Res
30i1lBldo Per Fee ,11*.ut -:.siVep
PLUUBiNG PERNIT
Charges and
Surcharges
Fence {uXa.=<nayrr,.&=-4{ aa
Demo
ELECTRICAL PERIIIT
Charges and
Su rcha rges
Sidewalk
AIC Pavi ng
Curb Cut
r'lA €A
?1-/'Total Comb. lermit
14ECHANICAL PERMIT
Charges and
Su rc harges TOTAL 2Yf,*
.\
O.'
ohone no-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furn'ish
A. Job Address
B. Legal Description
l. glamplg: Tax Lot 100, Lane County Map Referenr a1/ UJ +J
2. example- Lot 1. Block 3, 2nd Addition to
5p7-i n'gfi el d Estates
C. Name, etc. of owner and construction lenderD. Energy Sources i \
PERMIT VALIDATION
CITY OF SPRINGFIELD (
Ciry Holl
Springfield, Oregon
Deporlmenl of Public Works
OFFICIAL RECEIPT
No. B 54S70 (
l9
Rec'd F
Address
ir \s
For
Amounl Received
,\r IJL\J
S'GNATURE
EUGENE OR 97{OI
F
1 . examo I e- hea t2. exan6lE rvate
SquaFe-Tootage or
/electrical cei l in or forced air
eater ca or soTar
-
e CC
va i uati on, -eTE.
(
,\
1. examole- 1250 sq. foot house, 500 sq. foot gar2. exafiple- Tffiew project, cheik-nEw - if addit:
EIEE?-a-dd, etc.F. Building pernit information:i. exanple - construct sing)e famiiy house with itttaaEed garage
?. exanole - remodel existing garage into family3. efqllrlE - convert single iariily"resiOence intciEIrlurant (change of-use)G. Value of lvork as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGi.J TEAi,i AIID COIITRACTORS
To avcid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regard ing desr-gn information or job sitecorrections, etc.
Abbreviated Plunbin_o, l'lechanical, & Electrical SchedulA. Except r.rhere blank spaces occur in the ciescript.iorpor^:ion of the i4echan.i cal and Electr.ical Schedulesthe appl icant need fi ll-in oniy the i,io. Boxes adjeto the aopropriate item(s) to be installedB. Full Plumbing, I'lechanical, and Electrical Scheduleare available at the Building Divisjon1. fo ccnserve space on the pernrit form the schec
have been abbreviated?. If the item(s) to be installed are not coverec:he ibbreviated scnedules you shbulC consult tful I schedulesC. BUILDIiIG Oi,iISION STAFF l,JILL FILL OUT ALL FEES ANT
CHARGES Oii iiii SCHEDULESD. As noted on the CAp, the label must be delivered telectnicai contractor for signature by h.is electrisupervisor. The general contractor is not authorito sign the electrical label.Applicant to sign anci date
Hhenever possibie, the initial application will be usea norksheet on)y. i,lhere possible, Buiidine Division Swi'll prepare a type written copy and reru.n it to theapDlicant at the tinre the actual permit is issued for
s i gna tu re.
Fees and Charges
Plan check fees are due and payable at the time of theapp)ication, and no plans vrill be processed until thesl_tees are paid. All other fees and charges are due andpayable vlhen the permit is issued.
FOR OFFICE USE OIII.Y
R
ll
lr1.
I
BY
SHELION.TURNAULL PCINiEES
(
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
Permit applicant exempt from registration uJith the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name da teS'I g nature
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