HomeMy WebLinkAboutPermit Building 1987-03-02..--:-*
CITY OF SPRINGFIELD
COHBI NATI ON APPLI CATION/PERHIT
Job Address 7-A7 52
Lesal Description /2^O-_=Z-<2 O qL/O/llater Heater
EIIERGY SOURCES
Heat
r.Yalue of llork:1ae(---a
Ftc. l.lai n-- __
Sq. Ftg. Access._
Sq. Ftg. Other
n n 5C .e., Build Single7r'"Phone
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Construction Lender
Address Phone
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DESIGN TEAI.I name address exDr res ohone no.
Structura I
El ectri ca I
Hechanica l
name addres s (lics- no exot res ohone no-
Genera I
Pl umbi nq
E l ectri ca l
i'lechanical
PLUI,IB I NG ELECTRI CAL HECHANICAL
FEE CHARGE NO FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
sq. FT
furnace/burner to
BTU, s
Relocated buildino
(new fix. additional)//-New circuits alts
or extensionsOm€ ast(?{o"
Floor furnace
and vent
S.F. Residence(l bath)SERV I CES Recessed wal I
Snacp hpetpr and vent
Duplex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seDarate
[.later servi ce in existing
CE
Change
res i den
Stati onar.v evap
cool er
Sewer multifamily, conrn. or
I ndu stri a l Vent fan with
sinole duct
Storm Sewer 0f s.Vent systern apart from
heatins or A.C.
COMI.{./IND. FEEDERS Mechanical exhaust
hood and duct
Insta l I /al ter/rel ocate
distrib. feeders l,lood stove/heater
0f
ISSUANCE OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES ./9.""TOTAL CHARGES
ricai work be done by an Electrical Contractor, the electrical portion of this permit
signed by an Electrical supervisor and returned to the Buildin! Divis.ion
oertaining to the work described herein, and that NC OCCUPANCY will be
Flood Plain Stories ,/ Occy eroup/Q_sq. Fts
(please print)I GNATU RE
Value
rE3-e -97
luexrVa
Ci ty
made
caap r)
0reoon
its
ED the comple on for permit,certify that all information hereon is trueand correct, and I further certify that anyof the State of
and all work performed shall be done in accordance with the Ordinances of theof Springfield and the Lawsof any s
Board is
tructure without the permission of her certify that my reqistration vrith the Builder,sthe Bui I ding Division. I furtin fulI force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and employees who are in compiiance with ORS 701.055 wi used on this nroject
WHERE STATE LAt'l REQUIRES that the Electshall not be valiC until the label has been
soA)
Zone ___€ 1____I ypel Co n s t.
TOTAL VALUATION
lu"-@-_oP._
Ftg . t'la i
Fire Zone Bedrooms Ftg. Access
PIan Ck. Corm/Ind
65%/B1do Per Fee 7/.s;Systeris Deve
Charqe (1.57 opmentBUILDING PERI'IIT
Charges and
Surcha rges
_-fu-&_z-62 Plan Ck. Res
30%/Bldq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcharges D5rmo
Sldewal kELECTRICAL PERIIIT
Charges and
Surcha rges .(e
456
A/C Paving Tota'l Comb. Permit 6A./z
Curb CutHECHANICAL PERI.,IIT
Charges and
Surc harges TOTAL /oo. 7,
CONBINATION APPLICATION/PER',IIT (CAP)
{. Appticant to furnishA. Job AddressB. Legal Descriptionl. examole- Tax Lot 100, Lane County Map Referencer-7T3 4-432. example- Lot 1. Block 3, 2nd Addition toSpfing-Field Estates
!. Name, etc. of owner and construction lenderu. Energy sources
{ - ctTY OF SPRTNGFTELD
Ctty Ha[
Sprlngffeld, Oregon
Dcpertment ol publlc Workt
OFFICIAL RECEIPT
No. B
I
I
(6787
19
From
I exampl e-
examp I e-
re foota,
Address
2.
exampl e-
examp I e-
EIecl-addF. Bui lding perm1. example -
a ttac hed
hea t/e cal cei
wa CC ca or solarIqqed air sa:
foot garage
if addition,
eE. Squa ge or valuat on,I
2
1250 sqif new
foot house,500 sq.project, check new -etc.it information
construct single family house with angarage
remodel existi ng garage into famil y roory residence into \/4 .7- convert si ngl e famil
&
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3
H. DESIGN TEAM
exampl e
exampi e
res ta ura
2
fa '-)ant (change o f use)G. Value of work as defined 'in Section 303 (a) of theStructurai S
A)
-/D "?opec i
AND
alty Code
CONTRACTORS (
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To avoid design or.construction delays, BuildingDivision Staff must be able to contiii appropriatepersons.regarding design information or jbO itte--corrections, etc.Abbreviated plumbing,. Mechanica.l, & Electr.ical Schedu.lesA. Except where otjnt ipiiei-;;r; in-ir,. o.r."iptionportion of the Mechanical and Electriiat Scneiujes,the applicant need fill_in onty iire lro. aorei-ijjaient_ t0 the appropriate item(s) to -Ue insiitteUB. Full Plumbing, t",techan.iCii, .ra-if ".iricat Schedulesare available at the Building Division1. To conserve space on the-perrnii iorm the schedulerhave been abbreviated2. II tt,:. item(s) to be installed are not covered onthe abbreviated schedu.les you should .onirit-tt"'ful l schedulesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES ANDCHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to ile'lectrical contractor for signaiur" Oy ti, .i"i[ri.ui'supervisor. The general coniractor i's not authorized- to sign the electrical labelApplicant to sign and date
I'lhenever poss.ible, the initial application will be used asa.-worksheet onty. Where possibt;; Buiidi;s Division ata;i
l]]j.0regarg ? typg written copy and returi it to theapptrcant at the time the actual permit is issueJ io" f,i,s i gna ture.
Fees and Charges
Plan.check fees are due and payable at the time of theapplication, and no plans wiit-oe proieilid until thesefees are paid. Alt btner fees and .f,i.g.i-u". due andpayable when the permit is .issued.
FOR OFFICE USE ONLY
16
II.
III.
a/2.
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BY-l
Amount
Perm'it Cl er
o.?5-
' Fr.t,trtbr gusrru€ss FoBMs. rNC (503)3a2.8r49 6:
IV
v
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
cant exempt from registration with the Builder,s Board because:Permit appl i
Additional Project Information :
PLANS REVIEWED BY:
datename /oz,lE 7c gnature ?-aFSA si
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ONL APPL ICA
l,later Heater
e2
ngle5*7r'"ami l
COHBI
ft-7
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0
A
27
Heao/Ftg. l'1a n
^22
3753
l-egal Descri ption
Job Address
Ranqe
Val
0wner
Address
r€. ePhone
EHERGY SOURCES
ERMIT
So. Ftq. Access.
Construction Lender
h!
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Addre s s Phone
Q4oa
Mechani cal
El ectri cal
Structura I
Pri ma
nhonp no - )exDl resaddres s (lics. no.lname
General
P l umbi nq
El ectri cal
I'lechani cal
ELECTRI CAL MECHAN I CALPLUI{B I NG
FFF .HAAGFNNFFFCHARGFNOFEECHARGE
furnace/burner to
BTU' sEach single fixture Residence of
FTSQ
/'New circuits alts
or extensionsbtvE <3;:t<?{o"
Floor furnace
and vent
Relocated building
(new fix. additional)
SERV I CES
Recessed wal I
Snacp heatpr and vpnf
S. F. Residence(l bath)
Duplex (l bath) each
Temporary Construction Apol iance vent
seDa rateAdditional bath
ge i n exi sti ng
dence
C han
resi
Stati onar.v evap
cool er[^later servi ce
Indrrstrial
multifamily, comm, or Vent fan with
sinole ductSewer
Storm Sewer 0f Vent system apart from
heatino or A.C.
COMI.I./IND. FEEDERS
Mechan i cal exhaust
hood and duct
Instal I /a l ter/re l ocatedistrih. fccders frJood stove/heater
0f
ISSIJANCE OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES ,/9.o"TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by an E]ectrical Contractor, the electrical portion of this permitshall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the completed application for permit, and do
and correct, and I further certify that any and all work performed shall beof Springfield and the Laws of the State of 0reoon pertaining to the work drof any structure without the permission of the Building Division. I furthe
Board is in full force and effect as required by ORS 701.055, that if exemp.only subcontractors and ernployees who are in comcliance with ORS 701.055 wi'
hereb.y certify that all information hereon is true
done in accordance with the Ordinances of the City
escribed herein, and that NC 0CCUPAI,ICY will be mader certi fy that m.y regi strati on vri th the Bui I der' st the basis for exemption is noted hereon, and that
liAt'lE(please print)IGNATUREAJ rEs -e -97oA-)
used on this oroject
Zone--E1---rype1const.5 /,4,.7. units So Ftg
Ftg
Ftg
'I llF
Fire Zone Bedrooms 0ccy Load
77
Val ue
Group
l'la i n
TOTAL VALUATION..__..--.-..--
Val u 276
Acces
Flood Plain Stories
Plan Ck. Conrn/Ind,\
65%/Bldq Per Fee / l.)7/.s;Svs
Cha
tems Deve
rqe (1.51 opment
Charges and
Surcharges -fu*P__z-62
^
BUILDING PERI'IIT
Plan Ck. Res
30%/B1dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewal kELECTRICP,L PERIlIT
Charges andSurcharges 4 .(o
<>6
A/C Paving Tota'l Cornb. Permi t 6A./z
Curb CutI4ECHANICAL PERMiT
Charges and
Surc harges TOTAL /oo- 7f
of l,lork:
/T.
---l!---
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coMBrNATr0N AppLrcATI0N/PERMIT (CAp)
I Applicant to furnishA. Job AddressB. Lega) Descriptionl. example- Tax Lot 100, Lane County Map ReferenceIz-T'3-T:2. gIgIp.lS_ Lot_l. Btock 3, Znd Addition to5prtngtield Estates
I, Name, etc. of owner and construction lenderD. Energy Sources
PtrR,NIT VALTOATION
T3 62822
I t/tri ca'l i I in or forced a
E. Squa
e or so arr valuat on, etc.I example- 1250 sq
example- if new
Eh-Eck--add, etc.
foot house, 500 sq. foot
2 proj ect, check new - if add
ga
it rage
ion,
F Buil ding permit informa
example - construct
attached garage
ti on
1 singie family house with an
2.example -
example -
res ta uran
remodel existing garage into family room2convert s i n 9le fami I y residence into
G. Value of work
t (change of use )as defined in Section 303 (a) of theStructura) Sp eci aity Code
CONTRACTORSHDESIGN TEAM AND
II
To avoid design or construction delays, BuildingDivision Staff must be able to contait appropr.iitepersons.regarding design information or jbU iit. -
corrections, etc.
Abbreviated Plumbing, Mechan.ical, & Electr.ical SchedulesA. Lxcept where blank spaces occur in the descr.ipt.ionportion of the Mechanical and Ejectrical Schedulei,the applicant need fill-in only the No. Boxes iajaient
^ !o_!h9 appropr.iate item(s) to Le instailedB. Full Plumbing, Mechanical, and eteiiiical Schedu.lesare available at the Building Division1. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consu.lt 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 electricalsupervisor. The general coniractor i! not authorizedto sign the electrica'l label
Appi icant to sign and date
lJhenever possible, the.in.i tial applicat.ion wi.l .l be used asa.worksheet only. Where possible, Bu.ilding Division Staifwill.prepare a type wr.itten 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 t.ime of theapplication, and no plans wiil- be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is jssued.
FOR OFFICE USE ONLY
III.
IV.
V Permit CIer
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
Perm'it applicant exempt from registration with the Builder's Board because:
Additional Project Information:
r(
PLANS REVIEWED BY:
nane /on,/y'Z fx F-S $s'l gnature date 5- +-A)