The URL can be used to link to this page

Home My WebLink AboutPermit Building 1986-09-16e ., n\3 ,,lllco ,7l lrU I I NSP 7?6-COMBI NATION RPPI-TCRTTON/PERMIT Job Address EIIERGY SOURCES: Hea t [,later Heater Ran n Sq. Ftg Sq. Ftg Ac cess 0ther oasb oO (N 6- Legal Description wt IJ-RM n LRUE 8,t)t Lro r \J (.-value of Hork:613Ot -owner 14 c, n Y rP e r:rpi;YQ -T-l t-ta Address Phone G-t l,lork Fami l d :e., Build Single 6ucr,.q1qol(AGre LJli 'r \ Qr)e.F\e--f ra n'I.6)/TBAr'e- oFG q-reJA€Do€ t-lt OD& L) l'rtJ u[ FrS: " A', t{ -PLY , vt()T- Addres s Phone a DESIGN TEAI,{name address exDt res Pri mary Structura I El ectri cal Hechani ca I CONTRACTORS name addres s 'I i cs. no.exot res ohone no- I rt PI Nechanical PLUI{BI NG { ELECTR I CAL MECHANICAL FFF CHARGF NN FFF aHA pAF Nn FFF l^HAAGF Each single fixture Res.i dence of SQ. FT furnace/burner to BTLI' S Relocated buildino (new fix. additioial)New ci rcui ts al ts or extensions Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Snaep hpatcr nnd vpnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDarate llater service C hang rpsid e in existing en ce Stati onar.v evap cool er Sewer multifamily, cornm. or Indrrstrial Vent fan with sinole duct Storm Sewer 0f Vent system a heatinq or A. part from C. c0Mr.1./rND. FEEDERS Mechani cal exhaust hnnd and drrct I n stal I /a l ter/ re l ocate distrih- feedprs ['lood stove/heater 0f amps. ISSUANCF OF PFRI,IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAI.I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NC 0CCUPAI,ICY will be made of any structure without the pe Board is in full force and effe rmission of the Buitding Division. I further certify that my registration r^rith the Builder's ct as required by ORS 701.055, that if exempt the basis Iiance with 0l1S 701.055 wilI be used o for exemption is noted hereon, and that only subcontractors and employees who are in comc nth proj ect. l.lAtlE(p1ease print)5Ir4 - Rsss S IGNATURE TE Zone st i ts Sq. Ftg. l4a i x Value Fire Zone Bedrooms 0ccy Load Sq Flood Plain Stories 0cc.y Group Sq Ftg. Access.x lue x Val ue ToTAL VALUATI0N_ Ftg . 0ther BUILDING PERMIT Charges and Surcharges ----Io-t s-Q-n, PIan Ck. Comm/Ind 55%/81do Per Fee sterns opmeilt Plan Ck. Res 3l%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Demo ELECTRICAL PERI,IIT Charges and Surcha rges Sidewa l k A/C Paving Total Cornb. Permit I{ECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL 7 l,a4 Constructi on Lender I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. exampl e-2. exampl e- Square foota air gas E 1. example- 1250 sq. foot house, 500 sq. foot garage2. exa,nple- if-new project, cheik-new - if aOaition, check add, etc.F. Building permit information:1. example - construct single fam.ily house with anattached garage ?. examp_le - remodel existing garage into fam.i 1y room3. example - convert single family res.idence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropr.iitepersons regarding design information or job sitecorrections, 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 adjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Buitding Divis.ion1. 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 I schedulesC. BUILDING DIVISION STAFF I,IILL 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 general contractor is.not authorizedto sign the electrical iabelApplicant to sign and date Hhenever possib)e, the initial application will be used asa.worksheet only. Where possible, Building Djv.ision Staffwill prepare a type written copy and return it to theapp)icant at the time the actual perm.it 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 pians will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is .issued. FOR OFFICE USE ONLY Zb1 cBL t (-zc 4b II III. IV Permit Clerk e 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 s't g nature date