HomeMy WebLinkAboutPermit Signage 1980-06-24I
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ZLegal Description
Job Address EIIERGY SOURCES
Hea t
l/ater Heater
Ranqet1 b83bt4
owner rs2-r' ,u ,27.2-t e ,/
Va I ue of l,lork :*,,.) 4
Ftg. Access.-=--
Sq. Ftg. 0ther_
_l,l ewrAd drq I t e r--I e p'
_Fence_Demo Change,/Use
0ther
Sq
t9. I'la n
.e., Build SinglePhone - .-ooo"tt:-2= z/' -?a4
Bui ltli no
Fami'[v lle
Permit Info: Describe llork(
sidence I,lith Attached Garage
7s-?7
Construction Lender -l
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Address Phone
name addre s s I i cs. no.exDr res phone no.
P ri mary
St ruc tura l
Electricai
l'lec ha n i ca I
T n ame (l ics no {pxnirps)(ohonc no )address
Plumbin
E l ectri ca l
ilechani ca I
ELECTR I CALPLUtlB I NG MEC HAN I CAL
FFF {:HARGF itn FFF CHAP/:F NO FFF CHARGF
Each single fixture Residence of
FTSQ
furnace/burner to
BTU' s
Relocated bui Iding
(new fix. additional)
New ci rcui ts a l ts.
or extensions
Floor furnace
and vent
S. F. Residence(l barh)SERVICES Recessed wal I
Soace heat-pr and vent
Duplex (l bath) each
Additional bath Temporary Con structi on Apol iance vent
separate
l.later servi ce rpc i dpncp
Change.in existing Stationary evap.
cool er
Sewer Industrial
multifamily, conrn. or Vent fan with
sinole duct
Storm Sewer 0f .amps.
Vent systern apart from
heatinq or A.C.
COI.IN./IND. FEEDERS Mechanical exhaust
hood and duct
instal I /al ter/re1 ocate
distrib. fepders l'lood stove/heater
amp s.0f
ISSUAIICF OF PFRI.IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I{HERE STATE LAI,I REshall not be valiJ unt
QUIRES that the Electrica'l work be done by,iI the label has been signed by an Electric
an
al
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
S I GiIAT DATEllAi,lE (pl ease p.i nt)/
fy
90n
Bui ' exempt
055 r.ri I
xAfl NYE ED het eLL c ta n0comp trml he re rtce hat atdo nfo rma t onap r)DE b.y h ereon ts erufy
o trrec a nd rfucand cether rt hat t nd aa rvo r DCk frr rmedo h a b doe ne an cordancc e ht 0rdthe n nca ofes het ci ty
o r f ad thnd
any
ofSongLaeowsthSeteta 0 re rta n to het rWO desck r hebed n thand apenqre t 0iln UPCC'At,lc mad ebe
s rt tuUC wlre th ttof0u permihe s 0 ofnny the d Di s on f rtu cher ert t rngtharets t n0 thvJl het u rde sfymyg
aBo rd s fun erc nda frfoef aect s u dreqre ORS 07 05 5 tha t f het sbabys for on s hnoted re0n ha tandtexempt
0n SU 0nbc ract t andvrs awhoemr)oyees re n cean ht 0Pscomc 701 be sedu n0 hit s ro ctep
IL
Uni ts
0cc.y Group
ToTAL VALUATI0N--
!q
!q
Zo ne
Loa d
oel Cons t lue
Val ue
Val ue
Fire Zone Bedroom
Flood Plain Stories
. Ftg. Access
. Ftg. 0ther
Ftq. l'la in
Plan Ck. Conrm,/Ind
65iilBldq Per Fee
Systems Develocment
Charqe (1.57^)'
BUILDING PERI'IIT
Charges anC
Su rcha rges
_5
Pl an Ck Re
Pe30%/81dq ee
srF
FencePLUI4BING PERMIT
Charges and
Su rc ha rge s D6mo
Si dewa l kELECTRICP,L PERIIIT
Charges and
Surcha rges Total Comb. PermitA/C Paving
Curb Cut
I,IECHANICAL PERMIT
Charges and
Su rc ha rges TOTAL n5
t0#,(
UN I LAI'1
COMBINATION APPLICATiON/PERMIT (CAP)
I. ApPlicant to furnish
A. Job Address
B. Legal DescriPtion
1.- erurpl"- Tax Lot 100, Lane County Map Reference
17 03 43
PERMIT VALiDATION
( clrY oF SPRtNGFtELD2. examole- Lot 1. Block 3, 2nd Addition to
Spr-ingTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical ce.ilinq/or forced a.2. exan:ote- waterheaceilelEcEilcilTor s6TaF-E. Square-T6otage or vaiuation;-eTE.-
1. example- tl50 sq. foot house, 500 sq. foot gz. example- if new project, check-iEw - if addiEIEEI add, etc.F. Bui lding permi t information:1. example - construct singie family house withattached garage2-. examp]e - remodel existing garage jnto familJ. example - convert single famiiy resjdence ir_ restaurant (change of use)G. Value of work as defined in Section 303 (a) of IStructural Specialty CodeH. OESIGN TEAI'I AND CONTRACTORS
To avoid design or construction delays, BuildinrDivision Staff must be able to contatt'appropri,persons.regarding design information or job s.itcorrections, etc.
Ciry Holl
_ Springfield, Oregon
Deportment of public WorksOFFICIAT RECEIPT
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No"B 53820
te (
ress
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For:(
III
III
Abbreviated Plumbing, Mechanical, & Electrical ScheA. Lxcept uhere blank spaces occur in the descr.iotportion of the Mechan.ical and Electrjcal Schedu (the applicant need fill-in only the No. Boxes a_ to the appropriate item(s) to be .instal ledB. Full Plumbing, Mechanical, and Electr.ical Schedare available at the Building Division (1. To conserve space on the permit form the schave been abbreviated
0
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6;
?. If the item(s) to be installed are not cov(the abbreviated ,schedules you shou)d consu.full schedulesC. BUILDING DIVISION STAFF l^llLL FILL OUT ALL FEES
CHARGES ON THE SCHEDULES
IV
V
D. As noted on the CAP, the label must be deliver helectricai contractor for s.ignature by his e1esupervisor. The general coniractor .is not autto sign the electrical labelApplicant to sign and date
Hhenever possible,, the initial applicat.ion will be (
a.urorksheet only. l,Jhere possible, Building Divisiwill prepare a type written copy and returi it toapplicant at the time the actual permit is issued f h
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time olapp)ication, and no plans will be processed unti l esefees are paid. All other fees and charges are dur ,f;;-payable vrhen the permit is issued. - f.
FOR OFFICE USE ONLY
Amount Rece ived CC
AUTHORIZEO SIGNATUREa*aato* rr"n"raa r",*raa]€
Permit Clerk
_(,)
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name da teSIgna tu re
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