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HomeMy WebLinkAboutPermit Signage 1980-06-24LI lob Address Legal Oescription Z 69 4d 4 Hea aV EIIERCY SOURCES l,later Heater Ra of Sq. Ftg. Access._ Sq . Ftg. other__ _l'lew-AddJl ter-ReP. _Fence_Demo_C h a n gel U s e 0ther l.lai nSq. Ftg Owner ng eBuiltin Farni'l y o Permit Info: Descrit Residence liith Attache<A dtess=t = 4/' -?a4 Phone -. -- 7s-?7 LConstruction Lender I Address Phone exDlres ohone no.address cs. no.DESIGN TEAI.I name Primary Structura I El ectrical l'lec hani ca'l ohone no-address (lics. no.) (expiresRSname El ectrical f'lechani cal 14ECHAN ICALELECTR I CALPLUIlB I NG FFF CHARGFFFFCHARGFNNFFFCHARGFNO furnace/burner to BTU' S Each single fixture Floor furnace and vent New ci rcu i ts al ts or extensionsaI) Relocated bui lding (new fix. addition SERV]CES Recessed wal I Soace heater and vent S.F. Residence(l bath) Duplex (l bath) each Apol iance vent seDa ra tPTemporary Construct i onAdditional bath Change jn existing residpnce - Stationary evap. coo I erI.later serv ice mul tifami 1y, cornm. Tndrrctria I 0r Vent fan with sinole ductSewer 0f s.apart from .c. Vent systern heatinq or AStorm Sewer Mechanical exhaust hood and ductc0r,[.1./IND. FEEDERS Instal l /a1 ter/re1 ocate di stri h fppdprs l'Jood stove/heater 0f s. ISSUANCF OF PFR!,!IT TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES WHERE STATE Lltl REQUIRES that the Electrical wo shall not be valil until the label has been signed rk be by an done by an Electrical Contractor, the e1ectrical portion of this permit Electrical Supervisor and returned to the Building Division the completed apolication for oermit, and do hereb.y certify that a and correct, and I further certif-v that any and all work performed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Orelon Dertaining to the work described heiein, and that NC 0CCUPANCY 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 only subcontractors and ernployees who are in comcliance with 0l?S 701.055 will be used on this Droject, l,lAl.lE(please prin S IGi{ATUR DATE I in tion hereon is true its Stori es Val ue ToTAL VALUATI0N_ x Sq. Ftg .0ther ISo Load Ftg. Access Gro Zone TyoelConst. Un Val ue FIood Plain BedroomsFire Zone Fto. l,lain PIan Ck. Conrn/Ind 559{/Bldo Per Fee rqe ( i. 5z Sys Cha terns Deve opmentBUILDING PERIIIT Charges anC Su rcha rges _5 Fee Plan Ck. Res 30%/Bldq Per FencePLUI'4BING PERMIT Charges and Surcha rges Demo SidewalkELECTRICP.L PERI1IT Charges and Surcharges Total Comb. PermitA/C Pavi ng Curb CutI,IECHANICAL PERMIT Charges and Surc harges TOTAL 5fi )e t,,lork (I Garaoe cn}tO t J Residence of SO. FT. ).- PERMIT VALIDATION Permit Clerk COMBINATION APPLiCATION/PERMIT (CAP) I. APP]icant to furnish A. Job Address B. Legal DescriPtion 1. example- iui"uot 100' Lane County Map Reference T7-O3-432. example- Lot 1' Block 3, Znd Addition to Spr'fiqfi el d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. exampl e- heat/2. ExEfrElE- waterE. SquaiE-T6-otage or1. example- 1250 sq. foot house, 500 sq. foot garage2. exampl": JT-[ew project, check-new - if addit.io;, check add, etc. Bui lding permit information:1. example - construct single family house with an attached garage2. example - remodei existing garage into family room3. examplE - convert single iafrily-residence inlorestaurant (change of use) Value of work as defined in Section 303 (a) of theStructural Specialty Code 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 correcti ons , etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except r,rhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Bui lding Divisionl. 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 thefulI 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 theeiectrical contractor for signature by h.is electricalsupervisor. The general contractor is not authorizedto sign the electrical labei.III. Applicant to sign and date llhenever possible, the initial application wil l be used asa worksheet only. Where possib.le, 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 .IV. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY !rr gas F tl H. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Addit'ional Project Informatjon : PLANS REVIEWED BY: da tenamenatureSig ON INE -.-COMBl I{ATI ON APPL I CATION/ PERMIT 7?6-37s3 Job Address e*?t?EIIERGY SOURCES Hea l^later Heater Range So. Ftq. l'lain-- !q. Ftg. Access.--- Sq. Fto. 0ther_ _ _l{eu, Addrqlter_Rep. _Fence_Demo Change/Use -other- se fi dl l-egal Description Val ue of l,lork Owne r fu?*-)- "o-,.1--A- Address A*> -7/'*-d. *gd-Phone Bui I Fani CIly nq Pernrit Info: Describe llork(' Residence l,lith Attached Garaqe ,e., Build Single Constructi on Lender Addre s s Phone DES I GN TEAI.I name address exDl res ohone no. Pri mary St ructura I El ectri cal l"4ec han i ca I TACTORS n ame exDt res 'ohone no- Genera I Pl umbi nq El ectri cal o 4 PL UI1B I NG / ELECTR I CAL ut" 14ECHAN I CAL FFF CHA RGF NN l-l-f CHARGF NO FFF CI,]ARGF Each single fixture Residence of SQ FT .) furnace/burner toYrC.Cfl BTU,s-l-qn-al 1.sc /n oC\1-l3A Relocated building (new fix. additional ) I'lew c i rcu i ts al ts or extensions Floor t'urnace and vent S. F. Res i dence(l hath)SERVICES Recessed wal I SDace heater and vcnt Duplex (l bath) each Additional bath Temporary Construct j on Apol iance vent seDa ra te l,Jater service Change in existing res i dence Stati onar.v evap cool er Sewer multifamily, comm 0r Tndust-rial Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatino or A.C. c0r,1r.1. /IND. FEEDERS Mechanical exhaust hood and duct- Instal l /al ter/rel ocate distrih. feeders tr'lood stove/heater 0f s. rssuANCF oF PFRtfir I o TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES ,9?,:r) I^,HERE STATE LAll REQUIRES that the Electrical work be done byshall not be valiC until the label has been signed by an Electri an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division CARE FULLY EXAI1INED the comple apP and ca 0n DC rml L and d o he reb.y ce rt 'I fy t ha t a 'l I 'I n f orrna t 'I 0 n n s tr ueand correct, of Springfieof any struc Board is in only subcont and I further cert i f-v tha t any te ofnof a I I work per fo rmed S ha I I be d on e 'I n accordanc e wl t h the 0rd 'I n an ces 0 f th c 'I ty I d a nd the Laws of thet the permi and effect ernpl oyees S ta 0reqo n DC rta 'I n I ng to t he t40 rk d e S crl bed herei n and tha L NC OCCUPAI'I CY WI I 1 be madeturewlthouss'l the Bu 'I I di ng Di v.l s 'I on I fu rt he r cert I fy tha t m.y re g I s tr a t 'I 0 n 1 t h the Bui I derfuIIforceasrequIredbyORS701055that1exemptthebaSIsliorexemptIonIsnotedhereonand th at rac t d0rsan who a re 1 n comD I ,l an wl t h 0 I?S 7 01 055 t{1 I I be us ed 0n t h I s P ro,j e ct 0fiEsr/c 7F G/)5 llAl.lE(p1ease print)L IGiIA TEI./-nD FI Zone__Type/ Con s t Uni ts Ftq. l'la in X Val ue Fire Zone Bedrooms Load !q. r tg Acce s s x alu Fl ood P'l ai n Stori es Group Sq X Val ue TOTAL VALUATION . Ftg. 0ther_ BUILDING PERI'lIT Charges and Su rc ha rges PIan Ck. Comm/ind 65%/B1do Per Fee Svs Lna teris Deve rqe ( 1.52 0pment Plan Ck. Re 30%/81dq Pe srF ee PLUI^4BING PERMIT Charges and Su rc ha rges ELECTRICAL PERI1IT Charges and Surcha rges Fen ce Dgmo Sidewal k A/C Pavi ng Total Comb. Permit I,IECHANICAL PERMIT Charges and Su rc ha rges .Soqq--3 Curb Cut TOTAL St1 .u+ S COMBINATION APPLICATION/PERMIT (CAP) i. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources PERMIT VALIDATION 1. 2.E. Squ 1. ?, example- heat/ example- water are footage or e l ectrical cei I i or forced air gas ter ec tr ca or solar val uation exampl e- exampl e- check add 1250 s q. foot se, 500 sq. foot gait rage -i f new project, check new - if add ion,, etc II 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 .into ' restaurant (change of use)G. Value of work as defined in Sect.ion 303 (a) of theStructural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS To avoid design or construction delays, Bu.iId.ing Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where b)ank spaces occur jn the descript.ionportion of the l"lechanical and Electrical Schedules,the applicant need fiII-in only the No. Boxes adjacent B to the appropriate item(s)Full Plumbing, Mechanica), to be installed and Electrical Schedules III 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 thefulI schedulesC. BUiLDING DIVISION STAFF I^IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to theelectrical contractor for s'ignature by his electricalsupervisor. The general contractolis not authorizedto sign the electrical label. Applicant to sign and date Whenever possibie, the initial app)ication will be used asa worksheet on)y. Where possible, Building Division 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 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 IV Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Perm'it appl'icant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s't g nature da te L I ON LICATI ERMIT ON .<0t,1BI 726-3753 Job Address )22 v l-ega1 Descr tion EIIERGY SOURCES Hea t llater Heater Ranoe So 5q Ftg l'1a i n Ftg. Access Sq. Ftg. Other_ _f'lew Add AITaT-Rep. - _Fence_Demo Change/Use 0therVal ue of ljork Owne r Ztn ^,1- D /lA_ Address A?> 2/,-1-/1 TYr/-Phone Builllino Pernrit Info: Describe tJork(i.e., Build SingleFamilv llesidence l.lith Attached Garaqe) Construction Lender Addre s s Phone DESIGN TEAII name addres s tcs. no.exoi res phone no. Primary Struc tura I E l ectri cal l'lec ha n i ca l n ame address I i cs. no.exn i res ohone no- ) Genera I Pl umbi nq E l ectri ca l l'.1ec ha n i ca I Drnnr-t;, Q.,.L,Z-*/ckn .? 65 /// 9e4- ,*-1r"4-"r/;LU 'lLtto SZIZ-' PLUIlB I NG / ELECTRICAL MECHAN I CAL FEF CHARGF NN FFF IHAPGF NN FFF l^HA PGF Each single fixture Residence of SQ FT n C/ furnace/burner to,al,CCt) BTU,s-|q) r-1.lzf-t 1.sct cL'l-{3n Relocated building (new fix. additional ) I'lew ci rcui ts al ts or extensions FIoor furnace and vent S. F. Fles i dence ( l barh)SERV I CES Recessed wal I Snacp hpatpr and vent Duplex (1 bath) each Addi ti ona l bath Temporary Construct i on Apol iance vent s eDa ra te [,later service Change i n exi sti ng rp< i dpnrp Stati onar_v evap. cool er Sewer multifamily, cornn. or Tndrrctrie l Vent fan with sinole duct Storm Sewer 0f s.Vent system apart from heatino or A.C. COI4I'!./IND. FEEDERS Mechanical exhaust hood and duct Insta I 1 /a l ter/rel ocate di stri b. feeders I'lood stove/heater 0f amp s. rssuANcF oF PFRtffi [o TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES -Qzv WHERE STATE L1N REQU sha lI not be val i'l unti I IRES that the Electrical work the label has been signed by be an done by an Electrical Contractor, the electrical portion of this permit Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAIIINED the completed apolication for oermit, and do hereb.y certify that all inforrnation hereon is true and correct, and I further certif-v that any and all work oerformed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0relon oertaining to the work described herein, and that NC 0CCUPANCY will be madeof any structure without the permission of the Euilding Division. I further certify that ny reqistration vrith the Builder's Board is in full force and effect as required by ORS 701.055, that if exemot the baiis for bxemr-ttion is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with 0?S 701.055 vrill be used on this pro,ject. ONEST/C rft G//5' t,lAl'lE ( pl ease pri nt )L i GiIATUR DAIE / -/" -sP) FON OFFICg USE OIILY / Zone oe/ Co ns t.Uni ts Ftq. t'lain x V al ue Fi re Zone Bed rooms 0c cy Load !q. r tg Acces s x Val ue FIood Plain Stories 0c c.y Group Sq Ftg.0ther_Val ue TOTAL VALUATION BUILDING PERI'IIT Charges and Surcha rges Plan Ck. Corun/lnd 65%/8ldo Per Fee Svs Cha tems Deve rqe (1.52 opment Plan Ck. Res 30i6lBldo Per Fee PLUt4BING PERMIT Charges and Surc ha rges Fence Demo ELECTRICAL PERI,IIT Charges and Surcha rges )^ t. Sidewalk A/C Pavi ng Curb Cut Total Comb. Permit I,lECHANICAL PERI',IIT Charges and Surc ha rge s j ,SOqLt -'TOTAL Qq.u+ :TORS COMBINATION APPLICATION/PERMIT (CAP) I. Appl'icant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference1713-432. Fxample- Lot 1. Block 3, 2nd Addition toSpringfield Estates 9. Name, etc. of owner and construction lenderD. Energy Sources II III. IV l. 2.E. sql. 2. exampie- heat/electrical ceilinq/or forced air oas examo I e- wa terEEITETelGETrJZIlTor sofEF-uaF-T6-otage or valuati6i]GTi - ::iij- examp]e- 1?50 sq. foot house, 500 sq. foot garage example- if new project, check new - .if additio;,EfiEl-add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?. example - remodel existing garage into fam.ily roomJ. examDte - convert single fam.i)y residence intoFesti'uFant (change of"uie)- "" '- G. Value of work ai defined in Section 303 (a) of the .. Structural Specialty CodeH. DESIGN TEAI.I AND CON1RACTORS To avoid design or construction delays, Buitding0ivision Staff must be able to contatt appropriitepersons regarding design information or job s.itecorrections, etc. Abbreviated P)umbing, Mechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaient _ to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare avaiiable at the Building Divisionl. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consuit thefull 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 authorizedto sign the electrical label.Applicant to sign and date lrlhenever possible, the in.i t.ial application w.i ll be used asa.worksheet only. Where possible, Building Djvis.ion Staffwil'l.prepare a type written copy and returi it to theapplicant at the time the actuai 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 w.ill be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLYV PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name da tes't g na tu re PERMIT VALIDATION CITY OF SPRINGFIELD CitY Holl Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT No. B 525?3 4 r t. ( ( ceived For: ( -+ lount (sHELTOi TuRHBULL PilNtERs _ EUGExE OR 97'or 3t3l!'aAUTHORIZED SIGNATUFE I Pe I IL (.