HomeMy WebLinkAboutPermit Building 1987-07-136
CTION LII,IE
769
CITY OF SPRINGFIELD
COMBI IIATI ON APPLI CATION/PERMII 726-37
Job Address /tt AOa/ ilo"t
Lesal Descniption gr'/f,q F;./l €..nol"lonJ l.,later Heater
Ranqe
EIIERGY SOURCES:
Hea t
owner g7rl^/ {'./4 Sc-Aoo1 Drr+ E t 7
Val ue of l.lork:
?2. pe. ??
Sq. Ftg. Access._
Sq. Ftq. 0ther_______2__
I'lew Add AI ter y'Rep .
_fence_Oemo_Change/ U s e
0ther
n
Bu i'
Fam'
:e., Build SingleAddres s vhone /q7-j!)l6lL)5it
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Descr'iPernrit In 0
Vaxo tzrr':/F6a' # lrcar,Der.>
Constructi on Lender ,7Zrr72S.6z*-o
W
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N
Addre s s Phone
DES I GN TEAI.,!addre s s )ohone no-name
Pri mary
q2 /t o ZStructura l
El ectri ca.l
!"lec han i ca I
CONTRACTORS n ame add res s I ics. no.exot res ohone no.
>?€^.t 7t()
rl
nl
El ectri cal
ELECTR I CAL MECHAN I CALPLUIlB I NG
FFF I'HA PGF N0 FFF l^HARGFNOFEECHARGENO
furnace/burner to
BTLI, S
Each single fixture Residence of
FTSQ
Relocated building
(new fix. additional )
New c'i rcui ts al ts.
or extensions
Floor furnace
and vent
SERV I CES
Recessed wal l
Snace heatcr and vent
S . F. Res i dence(l bath)
Duplex (l bath) each
Additional bath Temporary Construction Apol iance vent
seDarate
e in exi sti n_q
pncP
C hang
reqid
Stationary evap
coo i erI,later servi ce
multifamily, comm
Tndrrctrial
0r Vent fan with
sinole ductSewer
Storm Sewer 0f am ps.part from
c.
Vent systern a
heatinq or A.
Mechanical exhaust
hood and drrctCOI.1I.l. / IND. FEEDERS
Instal I /al terlrelocate
dictrih- feedprs l'Jood stove/heater
0f gmp s.
ISSUANCF OF PFRIlIT
TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES
I,IHERE ST,I not be
ATE LAt,l REQUIRES that the Electrical wo
vali'l until the label has been signed
rk be done by
by an Electri
an Electrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Buiiding DivisionshaI
r oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certif_v that any and all work performed shall be done in accordance with the 0rdinances of the City
of Springfield and the Laws of the State of 0regon oertaining to the work descnibed herein, and that NC OCCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that m.y registration r,rith 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 ernployees who are in comcliance with 0lls 70i.055 wi'lI be used on this Dro,ject.
VE EFULLY 0nIcaED the comp ete ap!')
Flood Plain Stories 0cc.y Group Sq. FtS.
f'f\
Val ueX
x 47tar-*r
ts Sq.Ftg . l'lain
Sq. r tg Access
lue
lo
ToTAL VALUATI0N_
Value0ccy Load
yoe/ Con s t
Fire Zone Bedrooms
rqe ( 1.5%
Svs
Cha
tems Deve'opmentPlan Ck. Cornm/Ind
65%/B1do Per Fee /D.//
Plan Ck. Res
30%/81do Per Fee
Charges anC
Su rcharges
?___
7a)-
_?7?-BUILDING PERI'1IT
Fence
Demo
PLUI4BING PERMIT
Charges and
Surcha rges
Si dewa I k
Total Cornb. Permit 282, zo
ELECTRICAL PERIlIT
Charges and
Surc ha rges A/C Paving
Curb Cut laf.stNECHANICAL PERMIT
Charges and
Surc ha rge s
TOTAL
r,rAtrE(prease p"int) Oral4 /4 /.Laaos srGN^ruRE d v jry&- DATE?-/3 -t?
coMBrNATr0N AppLrCATr0N/PERMIT (CAp)
I. Appiicant to furnish
A. Job AddressB. Legal Description
l. exampie- 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.
2.E. Squa
examp-le- heat/electrical cei l ing/
exarlp I e- waterhea ter/el ec tri CaT-/ore footage or vaiuation, etc.
or forced air gq!r sol ar
II
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct s'ingle fami)y house with an
attached garage
2. example - remodel existing garage jnto family room3. example - convert single family res.idence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructurai Specialty CodeH. DESIGN TEAII AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, l,lechanical, & 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 Eiectrical Schedules
are available at the Building Div.ision1, 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 WILL 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 electricaisupervisor. The general contractor .is not authorized
III to sign the electrical label
Appl icant to sign and date
IV
Hhenever possible, the .in.itial appi.ication will be used asa.worksheet only. l^/here possible, Building Division Staffwill prepare a type written copy and return.it to theappiicant at the time the actual permit is issued for his
s ignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. 41l other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
/b4s{'
Perm'it Cl erk
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 i gnatur date =-g