HomeMy WebLinkAboutPermit Building 1984-10-09I NSPECT I I
726-37 69
LINE
COMBI AP ERMIT 7
a
7q6
Job Address
Legal Description
EIIERGY SOURCES
Hea t
llater Heater
Ranqe
Owne r /n-r-o,l 'u*_il'H?".rn
Sq. Ftg. Access.--
Sq. Ftg. 0ther_
-l'lew
AddalGER-eE-
_Fence_Demo_Chan ge/ U se
-other-
S-o. Ftq.l'1a n_
t
Address u,3 Phon 7-Builriinq Pernrit Info: Describe Work('
Farnily Residence [,lith Attached Garaqe
.e., Bui ld Single
7 a
derConstru ()A'y79.' A
I
ol
N
c
\"
DC
Addres s =,Phone
DES I GN TEAI,I name address 1CS. nO exD'res phone no.
Structura l
Pri ma
El ectri cal
l"'lec han i ca I
address lics. no.exD I res ohone no.CONTRACTORS.nrame
70 /6/
E l ectri ca l
l'lechani cal
ELECTRI CAL \rN MECHAN I CALPLUI.lB I NG \ru-
FFF CHAPGFtttCHARGFNOFFFcunRi]r NO
furnace/burner to
BTU' SEach single fixture
Floor furnace
and vent
New circuits alts
or extensions
Relocated building
(new fix. additional)
Recessed wal I
Snarp hpatpr end vpntSERV I C ESS.F. Residence(1 bath)
Duplex (l bath) each
Apol iance vent
seoa rat-eAdditional bath Temporary Constructi on
Change i n exi sti ng
rpc i dpncp
Stationar-v evap.
cool erl^later servi ce
Vent fan with
sinole ductI ndu stri a I
multifamily, comm. orSewer
0f amps.apart from
.c.
Vent system
heatinq or AStorm Sewer
COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct
l'Jood stove/heaterI n sta I I /a I ter/ rel ocatedistrib. feeders
ISSUANCF OF PFRI1IT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
WHERE STATE L1Il REQUIRES
shall not be valii until the
that
label
the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
has been signed by an Electrical Supervisor and returned to the Building Division
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPAI,ICY will be made
of any structure without the permission of the Building Division. I further certify that my registration with 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
t,lAt'1E ( p1 ease pri nt)I GNA DA
only subcontractors a empl /d-
CAREFULLY EXAMINED the comp I information hereon is trueeted apolication for oermit, and hereb-y cert fy that a
liance with 0l?S 70i.0 wi'l I be on thi ects who are i
Ftg
Ftg
Ftg
TOTAL VALUATION
(l
x
I
.!1}--unit,Zone C C ttpelConst
Val ueFire Zone.-. Bedrooms
Flood Plain < Stories \
Load Soc*,ffi50 Access.
0ther
l,lain x Value_
Svsterns Deve
Charqe (1.5q opmentPlan Ck. Conrn/Ind
65%/B1do Per Fee UN
Plan Ck. Res
30%/Bldo Per Fee
BUILDING PERMIT
Charges and
Su rc harges r0---
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewal kELECTRICP.L PERIlIT
Charges and
Surcha rges A/C Paving Total Comb. Permit
Curb Cut14ECHAI'IICAL PERHIT
Charges and
Surcharges TOTAL qo
\
'lr/ l
Plumbino
/a
Residence of
s0. FT.
0f amps
COMBINATION APPLICATION/PERNIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. glample- Tax Lot 100, Lane County Map Reference
17 03 432. e-rample- Lot 1. Block 3, 2nd Addition toSprTngfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
p # bzr7&
fl "/'/'n 41
i
?
S
1
2
, example- he. example- wa
quare footage
a t,i el ical or forced air gas
e or sol ar
E or vaiuat 0Il'. example- 1250 sq. foot house, 500 sq. foot garage. exampje- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage2. example - remodel existing garage into family room3. example - convert single family residence intorestaurant (change of use)G. Value of work as defined 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 information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electr.ical 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 Electrical Schedulesare available at the Building Division1, To conserve space on the permit form the scheduleshave been abbrev.iated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES0. As noted on the CAp, the labe'l must be delivered to theeiectrical contractor for signature by his eiectricalsupervisor. The generai contractor ii not authorizedto sign the electrical labelll1. Applicant to sign and date
I'lhenever possible, the initial application will be used asa.worksheet on1y. Where possibie, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit.is issued for his
s i gna tu re.IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans w.il1 be processed until thesefees are paid. AII other fees and charges are due andpayable vrhen the permit is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registrat'ion with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
da teSIgnature