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Home My WebLink AboutPermit Building 1980-11-05L --CITYCOMBI NATI ON OF SPRi APPL I CAT I I ELD ON/ PERMI T 726-375 l-egaI Description Job Address u t F ngnfo Hi lJater Heater 1n A1 ter-Tep: Change/ U se Attached Ga Descr Val ue of llork: Ranqe Sq. Ftq Sq. Ftg Sq. Ftg EIIERGY Hea t Access._ 0ther Owner Addres s )u},(k ildq?h Construction Lender Address Phone 'i cs . no.exo i res one n0addressn arneDES I GN TEAI.,! Pri ma ry Structura I El ectri cal ilec han i ca I I i cs. no.exDl res (ohone no. )address )n ame Gen ral i nn Elec ca 'act"anrcal MECHAN I CALELECTR I CALPLUIlB I IIG FFFFFTrHAPG F N0-C HARGE NOi FEE furnace/burner to BTLI' s Residence of FTSQI I Each singie fixture Floor furnace and vent ?elocated building (new fix. additional) New circuits alts or extensions Recessed wal I Snacp heater and vpntSERV I CESI S. F. Residence | (t uatn) Duplex (l bath) each Apol iance vent seDa rateAddi ti onal bath Temporary Construct ion Stati onar.y evap cool er ge in existing dence C han res i'vJater servi ce Vent fan with sinolp ductI ndustri a I multifamiiy, comn. orSewer Vent systern apart from heatinq or A.C.Storm Sewer 0f amps. c0t4t1./IND. FEEDERS Mechan ical exhaust hood and duct lJood stove/heaterInstal I /a l ter/rel ocate distril-r. feeders amp s.0f ISSUANCF OF PFRIIIT TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES I,JHERE STATE Lll,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valil untjl the label has been signed by an Electrical Supervisor and returned to the Build'ing Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the Cityof Soringfield and the Laws of the State of Oreqon oertainins to the work described herein, and that NC 0CCUPAI,ICY will be made of any structure without the permission of the Building Division. I further ce Board is in full force and effect as recruired by ORS 701.055, that if exempt t,lAl'1E(please print)DNE//s-60I GNATU R ( ify that m.y registration with the Builder's 'I Droj ectonly subcontractors and emnloyees who are in como 'I i ance wi th ORS 701 .055 ion is noted hereon, and thatbasi s for used on tl Fire Zone Bedrooms Val ue Flood Plain Stories Val ue Zone x x 5% 3 e/ Co ns t.1ue Gro x Va an 1n Load Sq ornm/ i TOTAL VALUATION 0pment 'i ts _ So sterirs rqe lan Ck BI Ft0 Ftg Ftg BUILDING PERI'IIT Charges and Su rcharges Res Per Fee Access 0ther FencePLUI4BING PERMIT Charges and Su rcha rges ,OO Dgrno Sidewal kELECTRICAL PERIlIT Charges and Surcha rges ---D-Q-a- A/C Paving Total Comb. Permit Curb CutI,IECHANICAL PERHIT Charges and Su rc ha rges 5/,q)]OTAL i€. t ln CCIiII aH A DCF I PERMIT VALIDATION Perm'it Cl erk COMBINATION APPLICATION/PERI,IIT (CAP) I. Applicant to furnishA. Job Address8. Legai Oescription1. example- Tax Lot 100, Lane County Map ReferenceI7-05T:2. gxalnple- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. examole- heat/2. examp I e- waterE. Square-76o:otage or el ectri ca 'i1i or forced air gas e or soTar- va I uat oot II 1. g1aqole- 125Q sq. foot house, 500 sq. foot garage2. examrTe- lE-new project, cneik-n-ew - if additio;, check add, etc.F. Building pernrit info:mation:1. examole - construct single family house wjth an;TtacIEd garage2. example - remodel existing garage into family room3. e,{mpfe - convert single iariity-resiaence inioiesTiurant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAII AND CONIRACTORS To avoid design or construction delays, BuildingDivision 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 descript.ionpcrtion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful'l PIumbing, Hechanical, and Electrical Schedules are available at the Buiiding Division1 To conserve space on the permit form the schedules have been abbreviated?. If the item(s) to be instailed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDIIiG DIViSION STAFF t,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theeiectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.Applicant to sign and date Hhenever possibie, the 'initial application will be used asa worksheet only. Where possible, Buiiding Division StaffwilI 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. III IV. V. FOR OFFICE USE ONLY 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 datenametu reSIgna