HomeMy WebLinkAboutPermit Building 1983-06-20EIISPECTIOII Li
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Job Address 5
Legal Description
EIIERGY SOURCES:
Hea t
Ranqe
l^later Heater
Val ue,of l.lork:fl ts,no o
Sq. Ftg. Access.-.-
Sq. Fto. 0ther_
_l{ew_Add_Al Ter-[ep. -
_Fence_Demo Change/Use
-other-
Sg. Fto . l.lai n
naOwne r lr)ava /,, ess -F^^in a,€ri
Address
Fami I
t Work :e.r BUild Single
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Construction Lender 6t dJ.40 I
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DL5iGN TEAM name address tcs. no.J exDt res ohone no.
un<-fel 7v{
Structura l
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E l ectri ca I
Hechani cal
name addres s Iics- no- )FXDl reS ohone no.
El ectr i ca 1
l.lechanical
PLUI{B I NG ELECTR I CAL MECHANI CAL
N0.FEE C HARGE NN FFF CHARGF NO FFF NHARGF
Each single fixture Residence of
SQ. FT.
furnace/burner to
BTU' s
/#Relocated building
(new fix. additional)X
New ci rcui ts ai ts
or extensions2 6P hDR€
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES
Recessed wal i
Soace heater and vent
Duplex (l bath) each //q+r ?cxt>,Ge.
Additional bath Temporary Constructi on Apol iance vent
seDa ra tP
Change in existing
rpc i dpncp
Stati onar,v evap.
cool erl.later servi ce
Sewer multifamily, coriln. or
I ndu stri a I
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent system apart from
heatino or A.C.
c0Mr.r./IND. FEEDERS
Mechanical exhaust
hood and duct
Instal i /al ter/re1 ocate
di stri b. feeders l'lood stove/heater
.r*a0f amps.X ,ktA QtaZ
D-rcZtcaft<
ISSUANCF OF PFRI,IIT ./d.E
TOTAL CHARGES ??..6TOTAL CHARGES TOTAL CHARGES /sn"
WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereby certify that all information hereon is true
and correct, and 1 further certif,v that any and all work rrerformed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Ore1on oertaining to the work described herein, and that NC 0CCUPAI,ICY will be made
of any structure without the permission of the Building Division. I further certify that my registration vlith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees r.rho are in comDliance with 0l?S 701.055 wi'll be used on this rrroject.
I'lAl"tE( p lease print)r/a<t-{j'I
Fire Zone!.,{-;---Bedroons l|*i , occy Load Sq
Flood Plain/{12-stories / 0cc.y croup 7-? sq
Ftt:
Ftg
Ftg
'I n
x
no-l.r-4"* 8(toon <-11'
t,ta
rcJs*E:
r x Value_
ValuAcces s
0ther
o2 T0TAL VALUATION
zone CC lyoelconst. uni ts
Svstems Deve'
Charqe (1.5.%'
opmentPlan Ck. Comm/Ind
65%/B1do Per Fee
BUILDING PERI.IIT
Charges anC
Su rc harges
__22_'_:_
Plan Ck. Res
30%/Bldq Per Fee
FencePLUI4BING PERMIT
Charges and
Surc ha rges Dgmo
Sidewalk
Total Cornb. Permit // v.v6
ELECTRICAL PERI,IIT
Charges and
Surcha rges
__-/fr:-_-
,<a A/C Paving
Curb Cut //9. =6
TOTAL
MECHANICAL PERHIT
Charges and
Surcha rges .aa
6a
J
Nt\
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qi,, zoQe'
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, 2nd Addition toSEffiETield EstaresC. Name. etc. of owner and construction lenderD. Energy Sources
PERIVIIT VALI DATION
l. examol e-2. ExamETe-E. Square foota
gas
1. example- 1?50 sq. foot house, 500 sq. foot garagez. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. examp_le - remodel existing garage into family room3. exampie - 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 appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechan.ical, & 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 adjaient
_ to the appropriate item(s) to be installedB. Full Plumbing, Flechanical, and Electrical Schedulesare avai labie at the Building Divisionl. 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 I.IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the labei must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general conaractor ii not authorizedto sign the electrical labelApplicant to sign and date
l'/henever possible, the initial application wilI be used asa.worksheet oniy. l,Jhere possible, Building Division Staffwil'l.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payabte at the time of theapplication, and no plans will be processed until thesefees are paid. Al l other fees and charqes are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
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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 s'l gnatu date 6-t?-8-,3