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Home My WebLink AboutPermit Building 1991-03-08CTION LINE 769 COMBI TI ERMIT 726-3753 Job Address Hea t l,later Heater Range Ftg '| Ftg. Access._ Sq. Fto. Other_ _-1lew Aaa RlT-ilflep. - _Fence_Demo_C hange/ U se 0ther Lesal Desffiption / tOnSD(Y) (YOff) Value of tlork 0wner Address Phone Builciir Fami l.y nq Permit Info: Describe Work( Residence t,lith Attached caraqe :e., Bui)d Single UI Cen€+Fuc++er"-tead€r I r e DESIGN TEAI.{name addre s s tcs. no.exD l res phone no. Prirr.vJh { C ?1il /,rlln I Structura I El ectri cal Mechan i ca I s'I El ectr nl I PLUI{BI NG ELECTR I CAL MECHAN I CAL FEE CHARGE NO FFF r HARGF NO FFF CHARGE 1 Each single fixture Residence of sQ. FT. furnace/burner to BTU' S Relocated buiiding (new fix. additional ) New c i rcui ts al ts or extensions Floor furnace and vent S.F. Residence(1 bath)SERV I CES Recessed wal I Soace heater and venl Duplex (1 bath) each A Additional bath Temporary Constructi on Ipol iince vent I seDa rate I5'l.later servi ce Chan res i ge in existing dence Stationar.v evap. cool er uD'Sewer multifamily, comm. or TndrrstriaI 3 Vent fan with sinole duct Storm Sewer 0f Vent system a heatinq or A. part from c. ?d r?iF€ Llaa COMI.I,/IND. FEEDERS Mechanical exhaust hood and duct Insta l I /al ter/rel ocate dictrib. feeders llood stove/heater 0f c 1 n0f I \! fYllrr;lL-\,ISSUANCE 0F PFRIlIT TOTAL CHARGES ,*t rr*e o TOTAL CHARGES l.IHE RE ST AT E LAt.l REQU I RES unti I the tha t the E I ec tri c a '|wo rk be done by an Electri Electrical SuPervi ca 1 Con tractor th I ect rl ca 1 port 10n of th 'I S permi t ha 1 I ot be VA I ,l t I a be I has bee n s 'I g ned by a n sor a nd retu rned to t he u1 I d 1 ng Di vl s 'I on s n Y EXAMI NED the comp ted apr)I ca t on r rml t do hereb.y certify that all inf rmation hereon i s t rue wl th he 0rd '|of the CityI be madeand correct, and I further certify tha t any te of and alI work 0regon oerta the Building shall be done in accordance t na nce s of Springof a'ny st Board is only subc fi e I d and th e La ws of the S ta 1 n I ng to th wor k descr 'I bed he re 1 n an d t ha t 0ccu PAI,,ICY wl I ru ct ure wl thou L t he perm '|s s 'I 0n D I ,l s I I fturt he r ce rt 'I fy +ha t my reg i s tra t I 0n v,t +h the Bui I der s I n fu I I force a nd effect a S reclu 'I red by ORS 7 0 1 05 5 tha +'I f exemp +the bas 'I s for exempt 'I on 'I s no ted hereon and tha t th 'I j ect0ntractorsandempoyeeswhoare1nc0mDI'I ance wl th 0r?s 7ot 055 tll 'l I be s p ro, t{AtlE(please print)SI TE { Zone Con S t Uni ts Ftt: Ftg Ftg 'I Val ue Fire Zone Bedrooms 0ccY Load . Access - 0ther x Val ue Flood Plain Stories.c,y x Val ue ToTAL VALUATI0N_ Sq BUILDING PERNIT Charges and Surcha rges Plan Ck. Comm/Ind 65%/Bldo Per Fee 6 Svster,ls Deve chu.qe (1'5q opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMiT Charges and Surcha rges __f,Fence Derno ELECTRICAL PERIIIT Charges and Surcharges. Si dewa I k A/C Pavi ng Tota'l Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut ,Y6 ,e$-^-.,'<./7f'u'^'al/rz/ry4 n_ "<s/ft rtOO 9), ., loK lz q COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. glaTplq: Tax Lot 100, Lane County Map Reference L7 03 432. example- Lot l. Block 3, 2nd Addition toSpringfield Estates Name, etc. of owner and construction lender Energy Sources1. examole-^+l. examD I e-E. squaiE-Tto:otag c D atr 2 example-. exampj e- check add ga it rage ion,, etc. II III. F. Building permit information:l. example - construct singie family house with anattached garage ?. examp]e - remodel existing garage into family room3. example - convert single iamily-resiOence inio_ restaurant (change of use)G. Value of work as defined in Section 303 (a) of the.. Structurai Spec.ialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contalt appropr.iStepersons.regarding design information or job iitecorrections, etc. Abbreviated plumbing, Mechanical, & Electrical SchedulesA. txcept where biank spaces occur in the descriptionportion of the Mechanical and Electricat Scneauiei,the applicant need fill-in only the No. Boxes iOjaient_ to the appropriate item(s) to Le insta.lled8. Full pjumbing, Mechanicil, ana-ifeltrical Schedutesare available at the Building Divisionl. To conserve space on the-permit form the scheduleshave been abbreviated2. II ttg item(s) to be installed are not covered onthe abbreviated schedu'les you should consult theful I schedulesC, BUILDING DIVISiON STAFF l^lILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CA?, the label must be delivered to theelectrical contractor for signature by his electricai - supervisor. The general contractor ii not authorizedto sign the electrical IabelApplicant to sign and date Whenever possible, the in.itial applicat.ion will be used asa.worksheet only. Where possibtb, guilding Division Staiiwr l.prepare a type written copy and return it to theapprrcant at the time the actuar permit is issued tor triss i gnature. Fees and Charges Plan.check fees are due and payable at the time of theapplication, and no plans wiit-Oe proceiied until theseTees are paid. All other fees and charges are due andPayable when the permit is issued. FOR OFFICE USE ONLY IV v PERMIT VALIDATION \q4s5 Permit Clerk \3 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: cant exempt from registration with the Builder,s Board because:Permit appl i Additional Project Information : PLANS REVIEWED BY: name date'F GAs'l gnatu re 225 FIFTII SItsBEf, SPRTNGrIEID, ORBGoN 97 477 INSPBGTION REQUESTz 726-3769 OBPICE: 726-3759 1. LOCATION OF INSTALI./\TION 3. COHPI..BTB I'BB SCIIBDUIJ BELOV A. New Residentlal-Single or Uutti-nurtlY Per dvelIlng unit' q-v ELECIRTCAL PBRHIT APPLICATION Clty Job Number Service Included: Items Cos t $ 8s.001500 sq;ft. or less Bach addltional 500 sq. ft or Portlon thereof Each Manuf 'd llome or Modular Dvelling Servlce or Feeder s 1s.00 $ 3s.00 L00 amPs or }ess 101 amPs to 400 amPs -. 40L amPs to 600 amps - 601 amPs to 1000 amps-- 0ver L000 amPs/volts __ Reconnect 0n1Y :;"'T'N<;f:,ELT) One Circuit Tvo to ten Circults Each Addt'I ten or portion thereof SIIDTOTAL OF AI}OVB 5Z State Surcharge TOTAL ) - ) ) o Sum ( JOB l Permtts are non-transferable and explre if vork ls not started vlthln 180 days oi i.tu"nce or lf vork ls suspended for 180 days. 2. COT{TR.T\CIOR INSTALIATION ONLY Electrlcar contracrcc AC €u:6ac' (?o eddress Pcr Bax 37 Cl ty EdA^ I RA Phone I {-7(!?{ Supervlsor Llcense Number 34 bA S Explratlon Date Cons t r Contr. Number ? Explratlon Date 6-,/-?/ Slgnature o[ Supervlslng Blectrician ^0 Servlces or Feeders (L0 Branch Circults i""f"J"Ol. Installatlon, Alteratlons or Relocation: $ 3s.00 $ 60.00 $ 90.00 $130.00 $300.00 $ 3s.00 I / CI ty Phone c. D. B 5 l* TemnorarY Services or Feeders ill;}i"ilon, Alteratlon or Relocation o""r-+br to 6oo u*'Pt - $ Bo'oo 0ver 600 amps or fbOO voIls see rrBrr above Dranch Circuits Nev, Alteratlon or Extenslon Per PanelOvners Name Address OIINBR INSTALLATION The lnstallatlon ls belng made on property I ovn vhlch ls not lntended for sale, Iease or rent' 0vners Slgnature: Itiscellaneous (Servlce/feeder not included) $ 35.00 $ so.oo s 1s.00 $ 36.00 $ 36.00 -.$ 36.00 -Each installation Pump or irrigatlon Sign/Out1ine Lighting- Slgnal Clrcult or timited energy Panel DATE: RBCBIVED Zone p L Tyoe/Const Fire Zone Flood Plain Stories. rU!( UIIICE USE cy Load Ftg 'ln uA Ftg Access x Val ue Ftg. 0ther x Val Ip T0TAL VALUATT0N_=-_._=- Plan Ck. Conrn/Ind 65%/8ldq Per Fee 6 Svs cha tems Deve rqe ( 1.52 opmentBUILDING PERIIIT Charges and Su rcha rges Plan Ck. Res 30%/B1dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Dgmo Sidewal kELECTRICP.L PERI1IT Charges and Surcharges.Total Comb. PermitA/C Pav.i ng Curb CutIlECHAI'IICAL PERMIT Charges and Surcharges )/o F€ ,oror6/i7,. ; 0c c.y Group. =-==-..-- 7 2 A7? COMBINATION APPLICATION/PERMIT (CAP ) I ApPlicant to furnish A- Job Address B. Leqal DescripltonLot 100, Lane county Map Reference l - examPle- lax L7 03 43 ?. example- Lot 1' Block 3' 2nd Addition to SIFi;gField Estates c. t'tame,'etc] of owner and construction lender D. Energy Sources 1. 2.t. 5qua exampl e- examp I e- re foota hea t,/el ectri c I ceili or forced air qas WA e ec ca or solai ge or valuat o[, II 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exampie- if new project, check new - if addition, check 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 the Structural Specialty CodeH. DESIGN TEAM 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. Abbreviated Plumbing, Mechanica'1, & Electrical SchedulesA. Except where biank spaces occur in the descriptionportion of the Mechanical and Electricai Schedules, the app)icant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Fu'll 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 onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the Iabel must be delivered to theelectrical contractor for signature by his electricalsupervisor. The generai contractor is not authorizedto sign the electrical label.Applicant to sign and date l,lhenever possible, the initia'l application will be, used asa worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is.issued for his s i gna ture. 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. FOR OFFICE USE ONLY III IV V PERMIT VALIDATION Permi t Cl erk \3b \q435 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit app'licant exempt from registration w'ith the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name sig na tu re da te ?.Sz?/