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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, I 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 sHEltoN.iui(8U!! pitHt€RS _ EUG€nE oR 97aOlIV i i