HomeMy WebLinkAboutPermit Building 1979-11-21ON HE
COMBI CATI T
Job Address
. -.......'....'..-_
-37 53
[)-
Legal Description
Ranqe
I nmr;v souRcEs
Hea t Sq. Ftg. Access._
han ge/ U se
Sq. Ftc 0ther
d
Sq. Ftq. l4ai
Va'l ue of llor:k:\ri*Owner
.e., Build SingleBuilclinq Pdrnrit Info: Describe Work('
FaniIy Resldence liith Attached GaraqeAddrePhone'cs[Ng__-,
t\
\\.n(Construction Lender
OJ
$
IUAddre s s Phone
ohone no.I ics. no ( exoi resaddressDES I GN TEAI.I name
Pri mary
Structura I
El ectrical
Mechanical
ohone no.I ics. no. ) (expiresaddress )IACTO RS n ame
Genera l
C-o a>Na--\.--P I umbi nq
r1
l'lec ha
MECHAN I CALELECTRICALPLUHB I NG
I
FFEFFFC HARG F NOFFFC HARGE NO furnace/burner to
BTU. s
Residence of
Each single fixture
)Floor furnace
and vent\0,0\
New circuits alts
or extensions
Relocated building
(new fix. additional)
Recessed wal I
Snace heat-er and ventSERV I C ESS. F. P.esidence(l bath)
Duplex (1 bath) each
Apol i ance vent
seDa rateTemporary ConstructionAdd.i ti onal bath
Stationary evap
coo l ere in existing
ence
g
d
C han
res i[^later servi ce
Vent fan with
sinole duct0rmultifami ly' comm
IndustrialSewer
Vent sJrstetn apart from
heatinq or A.C.0f amps
Storm Sewer Mechanical exhaust
hood and ductCOMI'I./IND. FEEDERS\
i'lood stove/heaterInstal I /al ter/rel ocate
di st-ri b. feedersq(D
amp s.0fI
ISSUANCF OF PFRI{IT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES oc
by
triREQU
unti l
on of th s tcatnipermietheporttodLrctriaCOntrEecant^/0 r donbe eEecctriatheREStthaSTETALAI,I onEI^IHER B ul d Ditthe0ngr'eturneddranac5urvlEecpeanhasbeesnnedbeasbytheva.lbehastno
I GNATUREtlAl'1E(please Print
ng
reb.y
CARE
any
of
of
used
s
rmation hereon is true-ertify that all it, and do heon for oermapnl i catcompl eXAMINED the 0rdinances of the CitYin accordance withshall be doner,vork performedand al Iand I further certifY thatand correct,NC 0CCUPANCY will be madehe work described herein, and that0reoon oertaininq to t
the Building Division.tion r,rith the Builder's,ld and the Laws of the Statefieof Spri that my registraI further certifYructure without the Permission 'i s noted hereon, and thatof any
Board i
is for exemPtionif exempt the basORS 701.055, thati red bys in full force and effect as requ on thi s rrroiect.Iiance with 0l1S 70i.055 vrilIbcontractors and ernployees who are in comconly su
FI
Uni ts
Ind tems
1
VC
5%
TOT AL VALUATION
S rl. Ftg. t4ain
3
lue
s
Zo lue
Load
an Ck
Pl an
0the rFire Zone Bedrooms.
Tyoe/ Con st
Val
BUILDING PERMIT
Charges and
Su rcha rges
Res
Per F
Flood Plain Stories 0cc'Y Gro !q. Fts
Sq. FtO. Acces
Total Cornb. Permit
i
I
Derno
Sidewa'lk
Curb Cut
A/C Paving
PLUI4BING PERMIT
Charges and
5urcha rges
ELECTRICAL PERI1IT
Charges and
Surcharges
T1ECHANICAL PERMIT
Charges and
Surcharqes
IUIAL 13. tsz
l.Jater Heater_
SQ. FT
, rrf\o \I\\ -
A\e\ q
Fence
PERMIT VALIDATION
TY OF SPRINGFIELD 0
CitY Holl
Springfield, Oregon
Deportmenl of Public Works
OFFICIAT RECEIPT
No. B 52134
r9
;d For
AUTHORIZED SIGNATURE
SHELTON-lURNBUTL PRINT€RS EUGEIE OR 97'O!
Perm'it Cl erk
r
Received (
COMBINATION APPLICATlON/PERMIT (CAP)
Applicant to furnish
A. Job AddressB. Legal DescriPtioni:'-;-;;;i;-'iax Lot 100, Lane Countv Map Reference
17 03 432- example- Lot 1. Block 3, 2nd Additton to
Springfield EstatesC. Name, etc- of owner and construction lenderD. Energy Sources1. example- heat/electrical ceil jno/o
z. example- waterheater/electrical/orE. Square footage or va.l uation, etI-
r forced air
so ar
II
iII
IV
l. example- 1250 sq. foot house, 500 sq. foot garagez. exarnple- if new project, check new - if addition,
check add, etc.F. Bui'lding permit information:1. example - construct single family house with anattached garage2. example - remodel existing garage into family room3. examole - convert single family residence intoiElTiuFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Spec ial ty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, Bui)dingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Piumbing, Mechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedu.les,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedu'lesare available at the Building Division1. To ccnserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedul esC. 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 is not authorizedto sign the electrical label.Applicant to sign and date
l.lhenever possible, the'initial appl.ication will be used asa.r,rorksheet on)y. l,Jhere possible, Building Div.i sion Staffwill prepare a type written copy and return.it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theappiication, and no plans wi ll be processed until thesefees are paid. All other fees and charges are due andpayable vihen the permit is issued.
FOR OFFICE USE ONLYV
PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPANCY
t
Permit app)icant exempt from regjstration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
date
\-
name Si gna tu re
I