HomeMy WebLinkAboutPermit Building 1981-10-22LI
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COI,IB I IIATI APPLICATION RMIT
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)-Ot4r-l-egal Description
Job Address EIIERGY SOURCES:
Hea
Ranqe
l,later Heater
Value of tlork
//Zlr>.'a
Sq. Ftg. I'lain_
Sq. Ftg. Access._
Sq. Ftq. 0ther
t,lervV Add Al tEF-TeD. -
-1_-enE-Oemo C hai-ge/ U se
_other-
owner 'fua 7e {ztqPr;H<,,
q Pernrit Info: Describe llork(
Residence l.,ith Attached Garaqe
Builclin
cFami I y
.e., Build SingleAddress Z3E l/<-w,.Dc-* t<ta .> - Phonei42:R.
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Construction Lender Ey. <2.;53-= ,?.,-,r*O /ru /pe.<l
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n,Address Phone
PXO res ohone no-DES I GN TEAI{name s
r )rz*tct lrta*-**')'24-<,/3fPri mary
PLUIIB I NG
l cunncr NN FFF !:HARG F
ELECTR I CAL iIECHAN I CAL
Structura l
l.lec han i ca I
El ectri ca l
Residence oi
SQ. FT
furnace/burner tc
BTU' s
lrcw ci rcui ts al ts.
or extensions
Floor furnace
and vent
ted building
Each single fixture
(new fix. additional)
Recessed wal.l
Snarp haatpr and vcnt
S. F. Residence(l bath)
Duplex (l bath) each
SF RV I CES
Temporary Constructi on Apol iance vent
seDa ra teAdditional bath
Stationary evap
coo l er[,later service in existingChange
res i dernce
Sewer Industria l
mul ti fam'i ly, comm. or Vent fan with
sinole duct
0f amps.Vent systern apart from
heatinq or A.C.Storm Sewer
c0r.[.1./IND. FEEDERS
Mechani cal exhaust
hood and duct
l'Jood stove/heaterI nsta I I /a I ter/ rel ocatedistrib. feeders
0f amps
ISSUANCE OF PFRI1IT
IOTAL CHARGESTOTAL CHARGES
TJHERE STATE LAt'l REQUIRES that the Electrical work be done L'i, an Electrical Contractor, the electrical portion of this pernit
shall not be valiJ until the label has been signed by an Electri:al Suoervisor and returned to the Building Division
TOTAL CHARGES
only subcontractors and ernployees who are in comcliance with 0l?S 701.055 r,rill be used on this Droiect.
Fire Zone Bedrooms 0ccy Load Sq. Ftg. Access.
Flood Plain Stories Occ.v Group_$q. Ftg
one iO :)e- trJllAl''lE ( p1 ease pri nt )S IGiIATURE
4ru)4.6c'#?*x
0the r Val
Ftg. l'lain x Val
0reg
the B
on hereon s trueacontiofrrtdoandhecertthaatnDerm'l reby fyapr)comp
work sha be don n nceaccorda thwl he na0rdi snce theof ctalndandrthe rfu ertc haL fndarrec tco performed tyf_v
rta n thto worke beddescri nherei and tha HC+wlOCCUPANCY madebeonfidndaLawstaSSof
any
ofthethete0r't oe gng
furt r ta rat onti thl.r'l Buthe der sofvlonrutrectuwltrmtudihecertithDisthoutheSSoofnfyregm.ype
Boa
any
rd s fu f rfo t 0n noted reonhe a nd th atfforceefandectsauredORS
ng
70L bas S empexthethat055reqbyexempt
sCon t.
TOTAL VALUATION
Val ue
tsZone
Plan Ck. Comm/Ind
65"/"/B1do Per Fee 6. f'-Svsterns Deve
Charqe (1.51 opmentBUILDING PERI.IIT
Charges and
Su rc ha rges yo
' aC>
Plan Ck. Res
30%/81Cq Per Fee
FencePLUi4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewalk
Total Cornb. Permit
ELECTRICA.L PERI,:IT
Charges and
Surcharges A/C Paving
Curb Cut d /G. go
TOTAL
I.IECHANICAL PERHIT
Charges and
Surc harges
I
il(trFF aHAAr:tr
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job Address8. Lega l Description
l' examDle- Tax Lot 100, Lane County Map RefeI7-0J 4-432. exqplg: Lot 1. Block 3, Znd Addition toSpringfield Estates
9. Name, etc. of owner and construction lenderD. Energy Sources
exampl e-
examp I e-
re foota
PERI,IIT VALIDATIoN
SPRINGFIELDCITY OF ()
Clry Holl
Springfield, Oregon
Deporlment oI Public Workr
OFFICIAT RECEIPT
()
2
hea t,/e I ectri ca li
waE. Squa ge or valua 0n,I
F ,o'".Nr[, .l !) ,eE(
No. B 574391
2
F. Building permI. example -
attached,
2 examp I e.
examp I e3.
exampl e-
exarnp I e-
EIecI- add
convert sin gle
or
ng garage ifamily res
forced
s6Ta-F
nto fam
idence Received For:
1250 s,
'I t new
q. foot house, 500 sq. foot
, etc
project, check-new if ad
it information:
construct single famriy house wi
ga ra ge
- remodel existi
I
()
:E
6
iI
,g
(
res ta uran t (change of useG. Value of work a s defined in Section 303 (a) ofStructural S
,l lJ,
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H. DESIGN I'EAI,,l
To avoid des 'ign or construction del ays, Bui IdirDivision Sta ff must be able to contact appropripersons regardi ng design infonnation or job sitcorrecti ons , etc.IL Abbreviated pl umbing, Mechanica I, & Electrical ScheA. Except wh
l,,lhenever possib le, the initial a pplication wilI be ua worksheet on ly. Where possibl e, Building Divisionwill prepare a type written copy and return it to thappl icant at the time the ac tual permit is issued fosignature
3HaLTOil.tUitluLL tiriTtha - EUG€iE ot tTaot 3a5I-6
pecialty Code
AND CONTRACTORS
ere blank spac es occur in the descri pfportion of the Mechan i cal and Eiectrical Scheduthe applicant need fil '| -in on'l y the No. Boxes ato the appr0p riate item(s) to be installedB. Full pl umbing , Mechanical, and Electrical Schedare avai lable at the Buiiding D 'tvtslon1. To cons erve space on the permit form the schave been abbreviated
2.If the i tern( s ) to be instal led are not ( overtheabbrevi a ted schedules you should consu IfulI scheduI es
c BUILDING DIVISION STAF F WILL FILL OUT ALL FEES ICHARGES ON THE SCHEDULESD. As noted on the CAP, .the label must be delielectricaI co ntractor for signature bythe general contractor ii h'is
vere( (
el ect
t Arnounl Receivedsuperv i sor.not authcto sign the e lectrical label.III. App'l icant to si gn and date
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BY-l
(s
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IV Fees and Charges LPlan.check fe6s are due and.payab.le at the time of theapplication, .and,no ptans wiii'0" i"iJ"il.o until thesetees. are paid. All other fees and .f,i"g.i-.r" due andpayable when the permit is issueJ. --e' reJ
FOR OFFICE USE ONLYV
Permit Clerk
PROJECT CONDITIONS TO BE SATiSFIED BEFORE OCCUPAI{CY:
at iI ac tn epp fromt ixemp tras 'lt onreg w't theth 1Bu dI er s rdBoa ubeca es
Additional project Information:
PLANS REVIEWED BY:
name i gnature<=.f sLq?*.date / a *>>
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Permi