HomeMy WebLinkAboutPermit Building 1987-07-28.
CC)MBI IiATI OI.I APPLI CATION/PERMIT 7
Job Address a,
Ran qe
l^,later Heater
EIIERGY SOURCES
Hea t
l-ega1 Description ov-2 8a
Owner
Value of l,lork:9q.ffin
!q. Ftg. Access._
Sq. Ftg. Other__
_liewrAddrql ter_Rep.
_Fence_Demo_Cha n ge/ U s e
0ther
Sq. Fto. l'1a
r\ddress I n-4 Phone ng Permit- Info: Describe t^lork(i.e., Build Single
Residence l,lith Attached Garaqe)
Bui I cli
Fami'ly3{//SL,b 3 a
aa
N
N\-N
Construction Lender /:
Addre s s Phone tr/-
DESIGN TEAI.I name addre s s CS. NO exDr res ohone no-
Primary
Structura I
El ectri ca l
Mechanical A
name a ddres s 'l ics. no. ) (expires)ohone no.
IPl umbi nq
El ectri cal
Itlechanical
PLUI,lBI NG EL ECTR I CAL MEC HAN I CAL
NO FFF CHARGF NO FFF THARGF Nn FFF CHARGF
/Z Each single fixture 7sb 7a,-oI
I
Residence of
FTSQ
furnace/burner to
BTU' s
3*
Relocated building
(new fix. additional)New ci rcui ts al ts.
or extensions22rq iaerl€
Floor furnace
and vent
S,F. Flesidence(l bath)SERVICES Recessed wal i
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
[,later servi ce Change in existing
resi dence
Stati onar.y evap
cool er
Sewer IndustniaI
multifamily, comm. or /Vent fan with
sinole duct -rv1
Storm Sewer 0f .amp s.apart from
.L.
Vent systern
heatinq or A
COI,II.1,/ IND. FEEDERS l,lechanical exhaust
hood and duct
Insta l I /al ter/rel ocate
distrib. feeders l'lood stove/heater
0f amp s.A <zzn Dx>uzan 7/1 6.
ISSUANCF OF PFRII,IIT
TOTAL CHARGES 2?-s-TOTAL CHARGES /Vby. /S o'
l,lHERE STATE LAI'I REQUIRES that theshall not be vali,l until the label has
Electrical work be done by an Electrical Contractor, the electrical portion of this permitbeen signed by an Electrical supervisor and returned to the Buildinb Division
TOTAL CHARGES
I HAVE CAREFULLY EXAI1INED the
and correct, and I further certifvof Springfield and the Laws of theof any structure without the permi
Board is in full force and effect
only subcontractors and ernployees ,
I work performed shall be done in accordance with the 0rdinances of the cioertaining to the work described herein, and that NC 0CCUPANCY will be ma
llAl.'lE(please pri nt)S iGNATURE 76ED,5R TE
ty
de
55
completed apnlication for permit, and do her'eb.v certif.y that all information hereon is truethat any and a1
State of Oregon
further certify that m.y re-oistration r.rith the Builder,sssion of the Buil ding Division. I
as recluired by oRS 701.055, that if exempt the basis for exemption is noted hereon, and thatwho are in comcliance with OPS 701.0 'I i be used on this
Tyoe/Const. {-/v Unlts
Yalue 251 ood,
x
ry
0c cy Load
0c c.y croup B- 2 Sq
Sn Ftg
Flood Plain S tories /
TOTAL VALUATION-_--7
Zone f'la i n Value
Val ueFire Zone Bed ro oms Ftg. Acces
Ftg. 0ther
PIan Ck. Cornm/Ind
65%/B1dq Per Fee / / 0,83 ?-t5$',o pmen trS vs
Cha
I
)
tems Deverqe (1.52 /y4.BUILDING PERTIIT
Charges and
Su rcharges
f,o
Plan Ck. Res
30%/B1dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges
AD
/Demo
Sidewal kELECTRICAL PERIlIT
Charges and
Surcha rges ---?3.25"--A/C Paving Total Comb. I'ermit
Curb CutI,IECHAI'IICAL PERMIT
Charges and
Su rc harges
6-A
75 TOTAL 3/2.7/
COMBINATION APPLICATiON/PERMIT (CAP)
I. Appf icant to furnishA. Job AddressB. Legal Descniption
l. exampje- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. exampl e-2. exampl e-
Square footag
heat/electrical ceiI in r forced air gas
sol arl^/a te ea ter e ec tr ca 0r
E e or valuation, e
II
1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Bui lding permit informatjon:1. example - construct single family house with an
attached garage
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 the
Structural Specialty CodeH. DESIGN TEAI,I AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbrev'iated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanical and Electrjcal Schedules,
the applicant need fill-in only 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 should consult the
ful I schedul esC. BUILDING DiVISION STAFF t^IILL 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 is not authorjzedto sign the electrical label
Appl icant to sign and date
Whenever possibie, the initial app)ication will be used as
a worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actuai permit is issued for his
signature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wi l1 be processed untiI these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
III
IV
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
lBbr 615' 1- )g'8/)
Permit Clerk
PROJECT CONDITIONS TO BE SATiSFIED BEFORE OCCUPAI'ICY:
Permit applicant exempt from registration with the Builder's Board because:
Addi t'ional Project Informati on :
PLANS REVIEI,JED BY:
name sig nature date .?)
L COHBI AP IT
{
5
\
\
Job Address
Legal Description
Value of
Ranqe
-. FtqJ'laln-ll
!q. Ftg. Access.-1
I sq. rtq. other I
| _H."_rladjl ter-rP6'p. -{ _--Fence_oemo_Change/ U seI other
t-t_Owner
Address Phone
3
:e., Bu'i 1d Single
Fami I
n
@
Construction Lender
Addres s Phone //
DtSIGN TT.AI4 name address 'I CS. nO.exDt res (phone no.
Pri mary
Structura I qtfLJ /-<rt/l
El ectri cal
Mechani cal
Ge
PI
nical
PLUI{B I NG ELECTR I CAL MECHANICAL
FEF CHARGE NO FFF CHARGF NO FFF
/Z Each single fixture 7,t>t
a7a.:o
Residence of furnace/burner to
BTLI' s
2"2Fc
Re'located buildinq
(new fix. additionai)New circuits alts.or extensions2?r4
^2a)4E
Floor furnace
and vent
S.F. Residence(l baLh)SERV ICES Recessed wal I
SPace heater and vFntDuplex (l bath) each
Additional bath Temporary Constructi on I iance vent
l.later servi ce Change in
res i dence
ex i sti ng Stationary evap.
coo i erSewermultifami
Industria
ly, conrn. or
I /Vent fan with
sinqle duct 3-"Storm Sewer 0f
'I
Vent tSsy fromrtapa
c0r4H./IND. FEEDERS Mechanical eitriulT--
hood and ductInsta I I /a I te.Tiet ocitE-distrib. feeders l'Jood stove/heater
0f s.
/C'v.t c
O
ISSUANCE OF PFRIIIT
TOTAL CHARGES 2 D>IOTAL CHARGES
its Ftg
Ftg
Ftg
Flood plain Stories
ry
Value
Iue
TOTAL VALUA
stFire Zone . l,lain
Acces s
0ther
an ck Conun/
BUILOING PERIII
Charges anC
Su rcha rges
T
).1.5/,
opment
FenceE
PI.UI48IN6 PERMIT
Lnarges and
Surcha rges
o'a
Demo
Sidewa I k-.j->
Tota l Cornb . Perynit
A/C paving
Curb Cut
€e
>g IOIAL
3 /2,7/
CAL
and
IlECHANI PERMIT
k
EIIERGY SOURCES:Heat-
\,later Heater
sQ. rr.
TOTAL CHARGES
Load e-
-Jq.
c"orp__6-3_sq.
_/?_o_,_z?__
?2
--- -- a
__19_
ELECTR ICAL
Charqes andSurcha rges
PERI,'I T
Y
.a
I
I
PERMIT VALIDATION
Permi t Cl erk
lfl br b q5
" 1')g'8/)
COMEINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. if* OreO;
Tax Lot 100, Lane County Map Reference
2. gxample- Lot_1. Block 3, Znd Addition toSprTffiield Estaiei-"
!. Name, etc. of owner and construction .lender0. Energy Sources
l. example- heat/2. example- water
Square footage or1. example- 1250 sq. foot house, q0! sq. foot garage2. example- if-new project, check-new - if aadition,
Efieck-add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
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 TEAI,I AND CONTRACTORS
To avoid design or construction de)ays, Building
Div'ision Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto theB. Ful I Pl
appropriate item(s) to be installed
umbing, 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 the
ful 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 the
e'lectrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to sign the electrical Iabel.
Applicant to sign and date
l,lhenever possibie, the initial application wiII be used as
a worksheet only. t,lhere possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gnature .
Fees and Charges
Plan check feis are due and payable at the time of the
application, and no plans will be processed until these
tbls are paia. All bther fees and charges are due and
payable when the Permit is issued.
FOR OFFICE USE ONLY
air gas
E
II
III
IV.
V
PRoJECTCoNDITIONST0BESATISFIEDBEF0RE0CCUPAI.ICY:
Permi t eSaucdrberdeSBoa'lBu It1thehoiWn1rttaSfromtregtexempan1cIapp
Addi t'io nal Proiect Information:
PLANS REVIEI^IED BY:
date
si gnature
name
?