HomeMy WebLinkAboutPermit Building 1983-10-23INSPECTION LINE
7?6-37 69
TTTY OF SPRINGFIELD
COHBi ITATI ON APPLI CATION/PERMIT
INFORIiIATION LINL
726-3753
Job Address t1 fL A/, S.Z . Sfriarhttlzl
Legal Description
Ranq
EIIERGY SOURCES:Heat Ardy'{
l,later Heater ,,rAru/ t
e .4a-/f
0wner ,g a
6OVal ue of,il,l,lork:
loDO.
sq. Ftq. l4ain l7b
Sq. Ftg. Access._
Sq. Ftg. Other--
l,lew Add Al ter Rep.
_-Ten-10emo C han ge / U se
0ther
.e., Build Single
Ga ra
e t c
cooo'"" l7u L / t t& -r*nnttqrilY"w-lft
,o'>r*4 r y'LJq-v
DQ
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lv
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l\Addres s Phone
exDI resaddressnonameDESIGN TEAI4
Prima
Structura l
E l ectri cal
I'lec han i ca I
rical
MECHAN I CALELECTRI CAL \)lLPLUT,TBTNG Nl\_
furnace/burner to
BTU' sRes idence of
FTSQEach single fixture
Floor furnace
and ventNew circuits alts
or extens.ions
Relocated building
(new fi x. add i ti ona l )
Recessed wal I
SDace heater and ventSERV I CESRes
I
Duplex (l bath) each
Apol iance vent
seDa rateTemporary Constructi onAdditional bath Stat onary evap.
cool erthange in existing
resi denceblater service Vent fan wittr
sinole ductmultifamilY, comm. or
I ndustri a ISewer lentsystem aPart from
heatinq or A.C. --amps.0f
Storm l,techan ica l exhaust
hood and duct
-
coMr.!./IND. FEEDERS
!'lood stove/heaterInstal I /al ter/re I ocate
di stri b. feeders
0f amps.
ISSUANCE 0F PFRlllT
DA.TE
IGNATURE
l,lAl'lE (p1 ease Pri nt
s terisInd
__\G oo
Per3Gq
xFtg0ther
Sq
IPB\ Sq
l".oad
lue
Dermi t
rformedny
of fy
exempt
t55 wi I
HARGEScALTOTSHARGEALTOTLSHARGEcTOTAL s t1nthf'IL''|Ia rt perm ieec'I trthe p0ratctor1IConctraEnedow0'I be byrkEeILctria 1 1 notthatIre'I d'l 'I 1 sDRESIthengBuSETETAREQULANtoI,lHER 'I an0r returnedds1Saupecectr'IEIan1bybeeSnIbeahas'I gnedtheuntI'I,ltvabeI'thasIIno
uetr'I sn'It no hereoIao rrna1nfrtthartcefydohedanreb.vcIatnofor1aI Ipr)the e ctheofcompNEDn'I tyancesLUL0rdththeEncedawlaccor'IIIdonebeshaworIkndaIape madetabeIIwltithacerfurtherOCCUPANCYtNCthatndafyI'I andcorrecandIrherebedwoscrkdentothe'I Irta ngon soe0regStetatheBuI'I derthLaofwsvllththeefid'I and e traS 1t on1fngSpr'Irt that regifuthrceremyIV1ISonI'I 'Id DJ atBungofthethandsson'I hereoteduthotheonIs'I noctruwluretpermif0atsud'IS forS exemptnythet'Itha0s5701'I 0RsascturedbyaereqndefffunI'I forceaBO'Ird 1s 'I ecusthproJed0nIbe7010wlht0RsIIncea'Iwho comDnIstorsracoyeeand,l
on SU onbc t empv
T'yoe/ Cons t
an Ck
Ftg. Access.
Uni t Val u
opment
an Ck
0%
Zone
BUILDING PERNIT
Charges anC
Surcharges
Ftq. t{ain
F lood pl a.in
--
stori es I 0cc-v Grou
Fire Zone
-
Bedrooms
e. /tPsa-
, Val
TOTAL VALUATI
Fence
Dcmo
PLUI4BING PERMIT
Charges and
Surcha rges
Sidewal k
Tota'l Comb. Permi tELECTRICA.L PERI1IT
Charges and
Surcha rges
L\.A/C Paving
Curb Cut
1
G.{I,IECHANICAL PERMIT
Charges and
Surc harges
I
zr\,*
TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl' 9Cry.19-: Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, ?nd Addition toSpringfield Estates
9. Name, etc. of owner and construction lenderD, Energy Sources1. exampi e- heat/2. ExEEilE water
Square-?6oTage or
el ectrical forced a!r gastereecor solar
E vaiuat on1. example- 1250 sq. foot2. exampE: JT--new project
EIEET-I-dd, etc.
house, 500 sq. foot garage
, check new - if addition,
II.
F. Bui lding permit information:1. Ci,irnp]_g - construct single family house with anattached garage,". .I9lp]" - remodet existing garage into family roomJ. exaTpte - convert single family residence inio
- restaurant (change of use)G. Value of work as defined in Section 303 (a) of the.. Structural Specialty CodeH. DESIGN TEAM AND CON1RACTORS
To avoid design or construct.ion delays, Bui)dingDivision Staff must be able to contitt appropriate, persons.regarding design information or jbU ilt.--corrections, etc.
Abbreviated PIumbino,. Mechanical, & Electrical SchedulesA. Except wrrere blink ;p;;;;-;;;r; ;;';;: <rescriptionportion of the Mechanica.l ana eieitricat Scneauies,the applicant need fiil_in..ly in.'lto. Sor., adjacent_ to the appropriate item(s) to "U.-inrtift.OB. Fuu prumbin!, Necnaniiiil i.a-ir.iiricar scheauiesare available at the Building Division1. To conserve space on.the"permii ilrm ilre scheduleshave been abbreviated2. ].f tt,:. item(s) .to be-instal.led are not covered onthe abbreviated schedule, yor-rhoJtO consult theful l schedu.lesc. qllllqlNc DrvrsroN..STAFF l,/rLL FrLL Our ALL FEES AND- CHARGES ON THE SCHEDULESu. As noted on the CAp, the label must be delivered to thee'lectricaj contractor fo. iignuir.. i, nr, e.lectricalsupervisor. The general .oni"iito. ii not authorized
^ -to sign the electiical Iabe.l. ----'
Appttcant to sign and date
Ih..!"y.I possibie, the initial application will be. used asa.-worksheet only. l,Jhere possibl!, eriiii;g Division staffI]lJ.?i.p.": 9. type written copv inJ-retr", it to theapptlcant at the time the a.tri-f p."rii-ir'is.r"a for hiss i gna ture.
Fees and Charoes
Plan.check feis are due and plJable at the t.ime of theapplication. and no oruni ,iii'[;';";;.;i; unti] thesefees, are paid. nlt btner r.., iro-.ii;;;;".". due andpayable when the permit ts iiir"J. vrrs'|vsJ
FOR OFFICE USE ONLY
III.
IV.
V
PERMIT VALIDATION
Permit Clerk
lo
t
t-[L%
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Pe rm t'l .II canpap t CX ft romemp re 'l ts tra 't ngo w1 ht ht Be u de r S Boa berd ac u es
Additional project Information:
PLANS REVIEWED BY:
date\L zff{rs't gna tu
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