HomeMy WebLinkAboutPermit Building 1988-07-11r---.C,;ON LINE
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COHBI NAiION APPL I CATION/PERMIT
Job Address
Legal Descri ption
EIIERGY SOURCES
Hea
l,later Heater
Ranqe
Sq. Ftq. I'la n--
Sg. Ftg. Access._
Sq. Fto. 0ther_
llew Add Al ter P.ep.
-Fence DE-mo
-0ther-_Change/ U se
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o
Owner LL
Value of llork:
Vz aa' -o
Address v---qqz w z6t' 5J Phone
-TuTlefnq Perflit Info: Des
Family Residence l,lith Atta
cri be t^lork ('
ched Garaqe.
i., Build Single
-a
Construction Lender
Addre s s Phone
Pri ma
Structura l
la/t t
El ectri cal
Mechanical
namte addres s lics. no.exoi res (ohone no.
Genera l
Pl umbi
l'lechani cal
ELECTR I CAL MECHAN I CAL
FFF CHARGE NO FFF CHARGF NO FFF CHARGE
/Each single f,irhrre 2ra Residence of
SQ FT
furnace/burner to
BTU' s
Relocated build'ing
(new fix- additional)t-/-New ci rcui ts ai ts.
or extensionsz o.3 ,zaO€=&
F'loor furnace
and vent
S. F. Resl-dlemce(l bath)SERV I CES
Recessed wal l
Soace heater and vent
Duplex (tl bath) each /71 c:rYt 7"Dct<7Uor7tl 6,*
Additionatr ha-th Temporary Construct ion Apol iance vent
seDa rate
Llater servrice Chan
rpc, i
ge in existing
dence
Stationary evap
cool er
Sewer multifamily, comm or
Tndrrstrial 2 Vent fan with
sin-ole duct a.*,GE)'
Storm Seuer 0f amp s.
Vent system apart from
heatino or A.C.
COMI'{./IND. FEEDERS
Mechanical exhaust
hood and duct
I nstal I /al ter/rel ocatedistrib. feeders lrJood stove/heater
0f amp s"
ISSUANCI OF PFRI1IT
TOTAL CHARGTS AD TOTAL CHARGES TZBZ>roTAL cHARGE s ,VZry. /S *
WHERE STATE LAIJ REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shal'l not be vali.l unt'il the label has been signed by an Electrical Supervisor and returned to the Buiiding Division
ddohereb.ycertifythata]l.informationhereonistrue
and correct, amd I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oreqon pertaining to the work described herein, and that NC OCCUPANCY will be made
of ahy structur.e wjthout the permission of the Building Division. I further certify that my registration vrith the Builder's
Board-is in funl force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and ernployees who are in comoliance with 0l?S 701.055 gi11 be used on this proiect.
tlAt'lE(please print)$s r..r S t-teNNofi)S I GNATURE
: USE 0l
i@Eu7_tyoe/const. f,r'l tJnits ;G4 ila x 'I ue
Fire Zone Bedrooms Loa dsq
upF Z s,1
Ftg Access x Value
Flood Plain Stories 2 pccy Gro Ftg tu" /2a-
(i) Qret* ilA3t-- u&TOTAL VALUATION
BUILDING PERIUIT
Charges and -Surcharges *
{a-{e PIan Ck. Conrn/Ind
65%/81dq Per Fee 7.33 4-t'g ter,1s 0pmen
rge 1.5 //..4 .
Plan Ck. Res
30%/BIdq Per Fee
PLUI'4BING PERMIT aa
Charges and
Surcha rges s -2f
Fence
Dgmo
ELECTRICAL PERI,IIT
Charges and U
Surcha rges
Z-S>7
Sldewal k
A/C Pavi ng
Curb Cut
Total Comb. Permit
IlECHANICAL PERMIT
Charges and
Surc harges U TOTAL /6./6
ACTORS
3T
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. glamplg- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
example- heat/electrical ceil inq/o
exampIe- waterhEEtEiTEfEEtriEi ruare footage or valuation, eE'-
r force{ air gas
E. 5q
sol ar
examo I e-1250 sq.if new p
foot house, 500 s g. foot garage
examp.l e-
check add
roj ect, check new - if addition,, etc.F. Buiiding permit information:1. example - construct single family house with anattached garage
?. examp]e - remodel existing garage into fami,ly roomJ. exampte - convert singie family residence into
^ restaurant (change of use)G. Value of work ai defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bui.ldingDivision Staff must be able to contait appropr.iitepersons.regarding design information or job iitecorrections, etc.
Abbreviated Plumbing, Mechanicai, & Electrical SchedulesA. Lxcept where b)ank spaces occur .in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes iajiient_ t0-the appropriate item(s) to 6e instal.ledB. Full PIumbing, Mechanica), and Electrical Schedulesare available at the Building Division1. To conserve space on the-perm.it form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. EUILDING DIVISION STAFF tllILL 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 electricai -
supervisor. The general contractor .ii not authorizedto sign the electrical label
Appf icant to sign and date
}Jhenever possible, the initial application wil.l be used asa.worksheet only. Where possiblb, Bu.ilding Divisio; staiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai 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 wiil-be processed until thesetees are paid. All other fees and charqes are due andpayable when the permit .is issued.
FOR OFFICE USE ONLY
ItQs*
1-t( -gg
II
III.
IV
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name s'l g nature date /-7;AB