HomeMy WebLinkAboutPermit Sidewalk 1988-3-18
Owner ,7:;~;7" '7' MAZ p~W .,
Address -=..,.,., ./" _. . '=-. Phone
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F(.../"~.#~n~_ "77 Y'?"9'
I IrISPECTION LINE
726- 37 69
Job Address
Legal Description
Construction lender
Address
LJr.~lbri I tAr"!
Primary
Structural
E1 ectr; ca 1
Mechanical
CONTRACTORS
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INFOR/1ATiON UNt
726-3753
Sq. Ftg. f.la;n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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CITY OF SPRINGFIEeO
C0/1BINATiON APPLICATiON/PERMlT
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EIIERGY SOURCES:
Heat
\~ater Heater
Ran!1e_
;
Valu€ of \'Jork:
SO&:9. ..--
Buildinq Pernlit Info: Describe Workli.e.. Build Single
Family nesidence With Attached Garaoe)
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. (, \ ~/"D?':;/;/.c:.<<' -,,?' Wfl:?~ /R/vc;?-
(~~\~~""'4c:~T6.?S- .
\ (address) (1;('(;:. on,'1 (exo;res)
lnamel
(nhal'lp no.1
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(~)'l! Sl,VU
(name)
(address)
(Dhnnl'> no.
(l ;cs. no.)
(PXO; res)
Genera 1
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Relocated building
(new fix. additional)
S.F. Residence
(I bath)
Duplex (1 bath) each
Additional bath
Plumbina
Electrical
~1echanical
NO.
Each single fixture
Hater servi ce
Sewer
Storm Sewer
PeUllBHIG
EeECTRICAe
MECHANICAe
FEF r.HARGF Nn
~~~ r~AQ~~ NO.
~~~ r~AQr.f:'
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~~p hp~tpr ~nn vpnt
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Temporary Construction
Change in existing
rp<;.inpn~p
multifamily, comm. or
Tnnll<;.trial
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Of
amps,
COMM./IND. FEEOERS
1~~~~;~~~a~;:~~~~locate
IOf amp~1
I
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l~ REQUIRES that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
ISSUANCE OF PFR'lIT
, TOTAL CHARGES
'Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPAtKY 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 employees who are in compliance with OP.S 7Dl.055 will be used on this project.
IW1E(please print)
Zone .::::: ~
Fi,re Zone
Flood Plain
BUIeOING PER~IIT
Charges and
Surcharges
PLUt1BING PERMIT
Charges and
Surcharges
EeECTRICAe PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
~d,
;VI c.1f/. Cd <
SIGIIATURE .-:r.:f ,/1L..,2-.. OATE'?;;RIrF
FOR OFFICE USE OI~L Y I
Sq. Ftg. riain x Value
Sq. Ftn. Access x Value
Sq. Ft9. Other5/~~~~C. Value 5~,~
TOTAL VALUATiON
I
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
. Plan Ck. ConmlInd
65%/Blda Ppr Fpe
------------ Plan Ck. Res
30%lBlda Per Fee
Fence
'Systems Development
Charqe (1. 5%)
D~mo I
____________ .Sidewalk ~t::>1 \"1
A/e Paving I
____________ Curb Cu~ ~; DI
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/b.........
Tot~l Comb. Permit
I
I TOTAe
11.3'5'
'27?~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, lane County Map Reference
1/ uj 43
2. examp-le- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examp-le- heat/electrical ceilin9/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible, the initial application will b~ used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
12REIP, #
Permit Cl erk
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.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
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