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Home My WebLink AboutPermit Signage 1987-06-04IN 72 ON LII{E ELECTRICAL PERI,IIT Charges and Surcha rges I,IECHANICAL PERMIT iharges and ,rc ha rqes COI1BI IIATI ON APPL I CATI ON/ PERMIT 726-37 Hea Ranqe EIIERGY SOURCES: t,later Heater Job Address Owner l-egal Description / ) ^6V. rH 2- vatue oryf,,JSD Sq. Ftg. Access.-- Sq. Fta. 0ther__ _l{ew_Add--_-.A I te r_Pep . _Fence_Demo Change/Use 0ther Addre s s Phone7H Constructi on Lender -9,uild Singie Farni I Ga ra n t n A Address Phone DES I GN TEAI.I name address rcs. no.ex0 r res Dhone no. Pri mary Structura I El ectri cai l''lecnanical RS n dme a ddres s (lics, no-)FYnr rpq ohone no. 4ral 'I Ge PI E l ectri cal l'lec ha n i ca I PLUtlB I NG ELECTR I CAL MECHAN I CAL FEF CHARGF Irn FFF CHARGF NO FTF rHA RG F Each single fixture Residence of SQ. FT furnace/burner to BTLI' s /r-Relocated buildinq (new fix. additional)I New ci rcui ts al ts. or extensi ons FI oor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Snace heal-pr and vpnt Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sepa rate [^later servi ce ge in existing dence Chan res i Stati onar.v evap cool er Sewer multifamily, comr,n or Industria l Vent fan with si nol e duct Storm Sewer 0f s.Vent system apart from heatino or A.C. c0r,ff.!./IND. FEEDERS Mechanical exhaust hood and duct Instai I /al ter/re1 ocate di st-ri b. feeders I'lood stove/heater amps0f ISSUANCF OF PFRIlJT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be vali,l until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apnlication and correct, and I further certify that any and all rvorkof Soringfield and the Laws of the State of 0regon oertaof any structure without the permission of the Buildinq Board is in full force and effect as required by ORS 701 only subcontractors and empioyees who are in comcl.iance , for oermit, and do hereb.v certify that all information hereon is trueperformed shall be done in accordance with the Ord'inances of the Cityining to the work described herein, and that NC 0CCUPAI,ICY will be madeDivision, I further certify that m.y reqistration vrith the Builder's .055, that if exempt the basis for exemDtion is noted hereon, and that Pro.j LI with 0l?S 701.055 wilI be used on thi l,lAl.lE( pl ease pri nt) I Access x Vanrn""Wru TOTAL VALUATION Type/ const FtgBed roomsi occy Load lue p Ftg Zone I a i n Stori es Occ.y Grou lue ne?:faz2 ts Sq. FtU. l,lain x Va Fire Zo Flood P Plan Ck. Conm/Ind 65%/B1dq Per Fee 6.0s 3.a-t1 Svstems Develocment Charqe (1.52)/y.4 .BUILDING PERt'IIT Charges and S u rc ha rges _3 5;o.5 Plan Ck. Res 30%/B1dq Per Fee FencePLUi,IB ING PERMI T Charges and Surc ha rges Dgmo Sidewalk A/C Paving Total Cornb. Fermit a.6 .@ Curb Cut ff.avTOTAL n 7 0 t( a g. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. elample- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construct.ion lenderD. Energy Sources1. example- hea2, example- wat Square footage o t/el tri ca ceiI i r forced air gas ea e ec tr ca or sol ar E r valuation, e II. 1 example- 1?50 sO. foot house, 500 sq. foot garage?. elample- if new project, check-i-ew - if additio;, check add, etc.F. Building permit information:1. example - construct singie family house with anattached garage 2_. example - remodel ex.isting garage into family room3. example - convert single fam.ily residence intorestaurant (change of use)G. Value of work as def.ined .in Sect.ion 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 informat.ion or job s.itecorrections, etc. Abbreviated Plumbing, Mechan.ical, & Electr ical SchedulesA. Except where blank spaces occur in the description - portion of the Mechan.ical and Electrical Schedules,the applicant need fill-in only the No. Boxes aOjaientto the appropriate item(s) to be.installedB. Full PIumbing, Mechanical, and Electrical Schedulesare avaiiable at the Building Division1. To conserve space on the permit form the schedules have been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consu'lt theful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES P.ND 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 authorizedto sign the electrical labelIIIApplicant to sign and date Whenever possible, the initial application will be used asa.worksheet only. Where possible, Bu.ilding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is.issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY IV V PERMIT VALIDATION Permit Clerk CU 6n312 a-Ll -tr, PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Perm'it applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: 7->-62da tenameSigna tu r dq$1 COMB I LICATI D PERMIT 726 Job Address rtl l,later Heater Ranqe EIIERGY SOURCES: Heat Legal Description / ) ^6V. Owne r a-o?/a vatue orp!,95D Sq. Ftg. Access..--._- Sq. Ftg. 0ther _f,lew Ra6-qlGT-[ep. - _Fe nce_Demo_C han ge/ U se -other- Ftq. l'la n Addres s Phone7fl .gz 'e., Build Single Farni l n rk s t Info: Describe Construction Lender 0 Addres s Phone DESIGN TEAM name address rcs. no.exn i res phone no. Primary Structura I El ectri cal l'|ecnanical CONI RACTORS name a ddres s lics. no.) (expires ohone no. ,f El ectr i ca I l,lechanical PLUIlB I NG ELECTR I CAL MECHAN I CAL FEE CHARGE NO FFF CHARG F NO FFF C HAPGF Each single fixture Residence of FTSQ furnace/burner to BTU' s /r-Relocated bui lding (new fix. additional)I New ci rcui ts al ts or extensions Floor furnace and vent S . F. Fles i dence(l uatir)SERV i CES Recessed wal I Soacp heatpr and vpnf Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sepa ra te l,Jater servi ce ge in existing dence Chan resi Stati onar.v evap cool er Sewer mul ti fami I y, Industrial comm, 0r Vent fan with s i no.le duct Storm Sewer 0f s.part from C. Vent systern a heatinq or A. coMl.r./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/re1 ocate di st-ri b. feeders l'Jood stove/heater amp s.0f ISSt]ANCE OF PFRIlIT TOTAL CHARGE,S TOTAL CHARGES TOTAL CHARGES I^IHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be vali'l until the label has been signed by an Electrical Suoervisor and returned to the Buildinb Division I HAVE CAREFULLY EXAMINED the completed apfrlication for permit, and correct, and I further certif_v that any and all work performed sof Soringfield and the Laws of the State of 0regon pertaining to theof any structure without the permission of the Building Diviiion. I Board is in full force and effect as required by ORS 701.055, that ionly subcontractors and ernployees who are in comcliance with Ol?S 701 and do hereb.v certify that alI information hereon is truehall be done in accordance with the 0rdinances of the City work described herein, and that NC OCCUPANCY will be madefurther certi fy that m.y regi strati on r.ri th the Bui I der' sf exempt the basis for exemption is noted hereon, and that P ro,j LI 055 r.ri lI be used on thi llAl'iE(please print)GiJATU IE6, : USE ONLY Ftg Ftg Ftg Access x Valnrnu"Wru, Uni ts So Fire Zone Bed rooms Load Flood Plain Stori S q Zone / /Const Group UC ue TOTAL VALUATION l4ain x Value PIan Ck. Conrn/Ind 65%/B1do Per Fee 6.03'-l-a-rq Svsterns Deve charqe (t.51 opment )/y.4.BUILDING PERI.IIT Charges and Su rcharges €._O53_.5 Plan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Dgmo Sidewal kELECTRICAL PERIlIT Charges and Surcharges ae .&A/C Pavi ng Total Cornb. Permit Curb CutI,IECHANICAL PERI,IIT Charges and Surc harges ff.avTOTAL t( Plumbinq a COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Add.ition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION i. example- heat/eiectrical ceilino/o2. examp Ie- water[ea teFZiiEETIl cal-/or Square footage or valuationl-eTI- r forced airi gas E sol ar 2 example- 1250 sq. foot house, 500 sq. foot garage example- if new project, check new - if addition, check add, etc. F.Building perm 1. example - a ttac hed r'i t i nformati on : construct singie family house with an 9arage II 2, example - remodel existing garage into family room3. example - convert single family residence .into restaurant (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, Building Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, I'lechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you shouid consult theful I schedul esC. BUILDING DIVISION STAFF l,llLL 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 generai contractor is not author.ized /) 6 rrS31z a-Ll -r) -tr1 to sign the electrical label Applicant to sign and date IV Whenever possibie, the initial app)ication will be used asa worksheet oniy. Where possible, Buildinq Division Staffwill prepare a type written copy and return jt to theapplicant at the time the actuai permit is issued for his s i gna tu re. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wi l I be processed unti l thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY Permit Clerk CU PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration w'ith the Builder's Board because: Additional Project information: PLANS REVIEWED BY: name s i gnatu date 7-?-6,