HomeMy WebLinkAboutPermit Building 1980-11-05ON LiIIE C
ERMITCOMBI iIAT APPLICATI 7?6-]153
lLo
alSC il151" 'ouo?.*/-n led
lJater Heater I
Sq. Ftq.
Sq. Ftg.
Sq. Fta.
l'1a n
Joo Address Access._
0therl-egal Description l{ew ni ter ,q€p.
Ranqe C ha ng e/U se
Val ue of lriork:
{
he(
0'.rner
C
I
i nq Pernti
Res i den
t scri be l,lork j.e. 'no e
Addres s Farn i ce th l1d
\d
{)
Construction Lender
Addres s Phone
DiSiGN TEAiI ndne address Iics. no.)(exD l res Dhone no
Pri ma rv
Struc:ura I
El ec'uri ca1
l'ecnlnt ca I
:i;i; CIOAS I nai:
I
1l
rca I -t
'::t'^:i I
:LU,,f,lllu trt caTD!afl
i,
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MECHAI{I CAL
;.i . CHARGE i'ln I FE: rlr-iA9.GE F-FF I'HARGF
iacn singie fixiure Res'idence ot
sQ FT I
i
furnacelburner to
DTill -UIU J
,eiccaiec ouilcinq
(new fi x. addi ti ona I )
llew circu.i ts alts
or extensions
Fl oor furnace
and vent
lS.F. Pesidence
I (1 bath)SERVICES
Recesseci wal I
Soace heater and vent
Dupiex (l bath) each
Addi t'i ona l bath Temporary Construction Apol iance vent
seoarate
Llater servi ce C han
res i
ge i n exi sti ng
dence
Stationary evap
coo I er
Sewer multifamiiy, comrn, or
Indrrstrial
Vent fan with
sinole duct
Storm Ser.rer 0f amps.
Vent systern apart from
heatinq or A..C.
COI.II.I./IND. FEEDERS
Mechan i ca.l exhaust
hood anC duct
Instal I /al terlrel ocate
dicirih- fppders iJood stove/heater
0f amps.
ISSUAI.ICF OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
tiHERE STATE L.ll,t REQUIRES that the Electrical work be done by an [lectrical Contractor,
shall not be valij until the label has been signed by an Electrical Supervisor and returned
the e.lectricai portion of this permit
, to the Building Division
I L CAR UL L Y : )':l1t I t C omp e teci apr,l i cation
and alI work
Oreqron oerta
the Building
for DE rmi f,ne re b.v c e rt 'i fy t ha L a l I 'I n fro t on n e reon t rue
nd coffect nd i fu rthe r C er t t ha +an_v 0e r fo rrned s ha I I b e done 'I n AC co rdan .l t h the 0rd 'I n a nc of the ci ty
ofS ringfield and the Laws of the State of i n I ng to the r k desc r .I bed ne re ,i n and th a t il 0 OCCUPA t,lc Y ,vl I I be mad e
o f a ny s t ruc re wi th 0u r J.he 0 ermi s s i on cf D 'i j S on I r the r c e rt 'I fy t ha t my re g S tr,a t i 0 n v,l th I he Bu 'I I der s
Board is in full force and effect as required by ORS 70 055 tha L i c xempt ba i J for 1 on i s noted he re0n nd tha t
on I ,v s u bc on tractors a nd en 1 oyee s rvho a re i n comc I a nce wl t n 0Ps 101 05 5 US ed L 'I D r0 j ec t
LtlAl'1E(please print)f S IGNATU DATE
Zone Tyce/ Co ns t its rtoL{ta '!n x va I ue-
Val ueFire Zone Bedrooms 0c cy Load Sq. Ftg.
c.y Group _ Sq. FtS.
Acces s x
Flood Plain Stories 0c x Val
TOTAL VALUATION
0the r
5.CoBUILDING PERiIIT
Charqes anC
Su rc ha rges
P.l an Ck. Comm/ind
65)l/B1dq Per Fee
s teris eve opmen
rqe (1 EI
Plan Ck. Res
30%/81dq Per Fee
PLUI4BING PERMIT
l- la-Lp_Cnarges and
Su rcha r-oes
Fence
Dgmo
ELECTRICAL PERI:IT
Charqes and
Surcharqes
CC Sidewalk
A/C Pavino Total Comb. Permit
I,lECHANICAL PERMIT
Charges and
S u rc ha rges
Curb Cut
]OTAL 5/,oo
L,A(L 1t.{qila
'I
:ITY OF SPRINGFIELD
Ciry Holl
_ Springfield, Oregon
Deportment of public WorksOFFtCIAt RECEIPT
ved
PERMIT VALIDATION
IIo.B 5509
c) c;
OC
COI4B I NATi ON APP L I CATION/PERI,IiT
I. Applicant to furnishA. Job AddressB. Legal Description
(cAP)
C
D
f. iIuI?tg: Tax Lot 100, Lane County Map Reference17 03 43?. Sxample: Lot 1. Block 3, Znd Addition toSpringrield Estates
Name, etc. of owner and construction .lender
Energy Sources
examcle- heat
examo I e- watere footage or
,/el ec r cal 'I in rfo ed ai2eaeCCor soE. Squa valuation
2.
examo I e-
examp I e-
1250 s q. foot house, 500 sq. foot garage- if addition,l7rr-ew project, check-nEr,rcheck add
F Build ing perrni t info:mation:1.
=gqlg
- construct s'ingie family house with anatttcnec qaraae
:. ++4e --renrooet :Ijrling sarase into lamiiy roomJ. exaiirie _ convert single family r"esidence jnto
,,,, res!euranE (change of use)iaiue or work as defineC in Section 303 (a) of theStrucrural Specialty Code vvv \q.
OESIGii TEATi AIID CONIRACIORSTo avoid design or construct.ion delays, Buildingtivrsjon staff mus-. be abte t; .;;;;;;'uiJ.oo.iu:.persons. regard.ing Cesign information o.-j6f s itecorrec!ions, eEc.
I
H
II Abbreviatec Flumoing, ilechanical, & Electrical SchedulesA. Sxceo! y,here ct;;k s;a;;;-;;;r; in'in. o.r..ipricn::r!ion of:n3 l,lecnanical anA eiectricaf Scnei,ries,the,ipDjicanc neec fi.ll_in ""fy in.'iio. Boxes ao.;acent- :c tne aoorocriate item(s) lo Le installedB. Futl plu,rcino, liechaniciil Jra-if".irical Schecutesare avai lable at the Buiiding Division1. fo ccnserve space on.the permii io", the scheciuleshave been abbreviated?. Ii the i;ein(s) to be installed are not covered onthe abbreviated schedule, yor-rf]orfa consult thefu I I scheCulesC. BUILDiiic DIVISIOii STAFF I,,JILL FILL OUT ALL FEES AND. CHARGES Oi,I THE SCHEDULESD. As noted on the CAp, ah; label must be delivered to theelectricai contractor ro. iignu;r". i, nr, electricalsupervisor. The generai .oni.uiio. ii not authorized- -to sign the electrical ]abe]ApptlcanE to sign and datewhenever possible, the initial application will be used asa.urorksneer only. Hhere possibtl, Sriiji;g Division Staffwill preoare a tvoe written .opy-jnJ-""iurn .it to thel?lll:um ar the iime the u.irli p""rii"is'irsreo for hiss I gna ture.
Fees and Charqes
Plan.check fees are due and payable at the time of theapplication. and no otans wiii"O" i""."Jr"a until thesefees. are paid. iU btner fees and charges are due andpayabie wnen the permit is lssueJ. -'-'r-r
FOR OFFICE USE O}ILY
III
v
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
rmPe i t I n dtpp t nfromxemp e S
.I
lt ta 0 n ti thg Duhe iU I d re S oB ra d be C ua eS
Additional project Information :
PLANS REVIEWED BY:
da tenameSIgna tu re
.lnt Received
Permit Clerk
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