HomeMy WebLinkAboutPermit Building 1985-05-13L
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P RING F I E L D
COHBI i{ATI ON APPLICATION/PERMIT
u-
Legal Description
Job Address Hea
EIIERGY SOURCES:
Ranqe
llater Heater
a
Sq. Ftg. Access._
Sq. Ftg. Other_
l.lew Add A l ter P.ep .
-0ther-FenE6 Derno Change/ Use
Ftq. f'lai
Value of llork:fu,*0wner
.e., Build SingleBuilciinq Permit Info: Describe
Farni I y Res i dence l'li th Attached I
l^lork (
Ga raqeAddress-.*ucn\Z?G*g7po.7 fr%Tti'.Be tUar* 70Construction Lender
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2ry7<€ BA/12/r%.Addre s s Phone
res ohone no.I ics. no.exDaddre s sDESIGN TEAM name
Pri mary
Structura I
El ectri cal
llechanical
( cxni res )icq- no- )ohone no-add res slACTORSname
Pl umbi nq
El ectri cal
I'techani cal
ELECTR I CAL MECHAN I CALPLUIlB I NG
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Residence of
SQ. FT.
furnace/burner to
BTU' sEach single fixture
Floor furnace
and vent
Relocated building
(new fix. additional)
New circuits alts
or extensions
Recessed wal I
Sn:ap hpitcr and vpnt
S.F. Residence(l hath)SERV ICES
Duplex (l bath) each
Temporary Constructi on Apo) iance vent
seDa rateAdditional bath
rcc i dcnre
Change in existing Stati onar-v evap
cool erfo'l.later serv ice /d,'o
Indrrctrial
multifamily, conrn. or Vent fan with
sinole ductSewer
/5nStorm Sewer I 0f lCA Vent systern apart from
heatinq or A.C.
hnod and drrct
Mechanical exhaust/fi&,qstow Der,2<€so'COI,III./IND. FEEDERS
Instal I /ai ter/re l ocate
di stri b- feeders llood stove/heater
amps0f
ISSUANCF OF PFRIIIT
TOTAL CHARGES ls'"TOTAL CHARGES /s'o TOTAL CHARGES
l.lHERE STATE L.ll,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernitshall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division
and do hereb.v certify that all information hereon is truehall be done in accordance with the Ordinances of the City
work described herein, and that NC 0CCUPAIICY wil'l be madefurther certify that my reqistration vrith the Builder'sf exempt the basis for exemption is noted hereon, and that
.055 wilI be used on this Droject.
DA.TEJI TJ.9I 'l{Al.tE(please print S IGi,IATURE
of any
Board
e ca trmrforonapl")comp DCtc0 rrecand an d cerfurther ti ttha a oerfowork srmedandfy
efi d thand La ofws Statheof
any
ofngteSpri rta n n thetooe0regonsructtwluretthouhetn0permSStheofBudV]Di s 0nng
s fu force nd ffec t uas red ORS 70t 55 tha treclby
SU tracbcon rsto nda sv arewho n ance thwl 7ot0l?sempoyeecomD
FireZoneBedrooms0ccyLoadSq.Ft9.AccessxValue-
Flood Plain Stories 0cc.y Group F-? Sq. Ftg. Otn""lfCtcWaraz&rry Uu1r. ?atG) ..
TOTAL VALUATIOH
Zone_--X?-4__rype/Const. r*/! un its Ftg . l'la i Value
Plan Ck. Corrn/Ind
65%/Bldo Per Fee
Svstems Deve
charqe (1.57 opmentBUILDING PERI'IIT
Charges and
Surcharges
ob
./d Plan Ck. Res
30%/Bldq Per Fee
FencePLUI4BING PERMIT
Charges and
Surc ha rges --.4-floo____t
Dgmo
SidewalkELECTRICAL PERI1IT
Charges and
Surcha rges
ao
-€a Total Comb. Permi tA/C Paving
Curb Cut
I,IECHANICAL PERMIT
Charges and
Surcha rges TOTAL {/;a
n-
COMBINATION APPLICATiON/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptr'on
l. glaTplg: Tax Lot 100, Lane County Map Reference17 03 432. gxarlplq- Lot l. BIock 3, 2nd Addition toSpringfield Estatesq. Name, etc. of owner and construction lenderD. Energy Sources
l. examp]e- heat/electr.ical ceilinq/or forced a.ir oas_ ?. exampje- waterrreitEiZeT6dtFTEi7o" ,offit. Square f ootage or vai uationlEE-
l. glgrq].- 1250 sq. foot house, 500 sq. foot garagez. example_.if new project, check-iEw _ if additio;,EIEI-f-dd, etc.F. Building permit .information:
1. C1]lp]S - construct single family house with anattached garage
1. llgrpJ" - remodel existing garage into family roomr. exarlpte _ convert single family residence intorestaurant (chanqe of use)G. Value of work as defined in iection 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CON1RACTORS
To avoid design or construct.ion de.lays, BuildingDivision Staff must be able to contatt appropriitepersons_regard.ing des.ign information or job iitecorrections, etc.II. Abbreviated plumb.ing, Mechanical, & Electrical SchedulesA. Except where blink spaces ociri in the a;;c;i;ii;;--portion of the Mechanical and Electrical Schedulei,the appticant need fiil-in on.ly the no. aoiei-iajaient
_ to the appropriate item(s) to be installedB. FulI Plumbing, Mechanicil, and Electrical Schedu.lesare available at the Building Division1. To conserve space on the permit form the scheduleshave been abbreviated2. If the .item(s) to be insta.lled 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 electricalsupervisor. The general contractor ii not autnor.izeato sign the electrical labelIII. Applicant to sign and date
llhenever possible, the initial application wi.lI be used asa.worksheet only. Where possible, Building Divisio, Staiiwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issuJJ io" f,issignature.IV. 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. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
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 Lqxa s'l g na ture oate S