HomeMy WebLinkAboutPermit Sidewalk 1990-11-19
I INSPECTION L1IIE . CITY Of SPRINGFIELD.. lNFORlJATION UN'
726-3769 . COMBIIIATION APPLlCATIDN/PERMIT 726-3753
Job Address ~ riM !, nl0. 8\ 1\ Q Q rJ >, ~~;~GY SOURCES: ~~: ~~~: ~~~~ss.
Legal De<cription \1 \~5\..-) \ D'3~ !~ater Heater Sq, Ftg. Other
j New Add Alter Rep.
- ~ Range -Fence Demo Change/Use
ow~\('~\\_,~~-T\OOQ1f(w Q 'Val~E\KH1f\-, Other- -
Address 1- r40>. f'("'o..~ C'~ Phone BU1101nQ P~nl11t Info: Oescnbe Work(Le.. Build Single
___ ~ , \l ~\_ .~\ Faml1v Ilesldence t~,t,h J1.ttachpd G('lr<lOP)
.' I'n ( ) .-- ..-
on ender I ~citu.1J4n ~ l.y L f2~ _! D_'1 0
Phone rt-- ~
(address) Clies. no.l (exo;res)
-0
o
~
Address
UI:.SIGr{ leAf"
(name)
(ohone no. I
Primary
Structural
Electrical
X\ r\n~\~\ hJ/\ C'r\\\Dtr:r~SS\u:A\ cfdlTn"('i
(~xo; rpc;)
~~~~\60
-"
~1echan;cal
PLUI1BING
ELECTRICAL
MECHANICAL
ND.
FFF
t.HARr.F
NO
I Residence of
'"
rI-lARr,~
NO.
",
njAIU~~
Each single fixture
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
[
Recessed wall
Soace heater and vent
Sewer
I Temporary
[Change in
rpc:, i dpnC':p
ImultifamilY, comm. or
Tnrlustri<ll
[Of
[COMH./IND. FEEDERS
[Install/alter/relocate
distrib. fpprlers
IOf amp~1
[
Construction
existing
Storm Sewer
amps.
Appl iance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart
hea t i no or A. C.
I Mechanical exhaust
hood and duct
I \'Jood stove/heater
[
[
I
from
Additional bath
Water service
TOTAL CHARGES ~ TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical
shall not be vali1 until the label has been signed by an Electrical Supervisor
ISSUANCf OF PFR!HT
I TOTAL CHARGES
Contractor, the electrical portion of this permit
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" IW OCCUPAIKY 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 comoliance with ORS 7nl.055 will be used on this DrOje~t. ~
!IAllE(Pleas~I,~jl;J /Iy k)JJVD SIG!IATURE~)!::h./~ DATE/j-/9-9c,
/
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
FOr. OFFICE USE..llrlL Y
,
Sq. Ftg. rialn
Sq. Ftg. Access
Sq. ftg. Other
/
Zone
Fire Zone
x
Value
Value
Value
x
Flood Pl ain
x
TOTAL VALUATION
BUILDI!IG PER~IJT
Charges an~
Surcharges
, Plan Ck.
6S%/Bldo
Plao Ck.
30%/Bldo
COIl1l1/1 nd
Per Fee
Res
Per Fee
'Systems Development .
Charqe (1. 5%)
PLUMBING PERMIT
Charges and
Surcha rges
Fence
O~RlO
ELECTRICAL PER!:IT
Charges and
Surcharges
Sidewalk
\\0 <::l )
A/C Pavi ng
Total Comb. rermit
MECMANICAL PERMIT
Charges and
Surcharges
Curb Cut
I
[ TOTAL
~.30
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
'1/ 03 43
2. example- Lot 1. Block 3. 2nd Addition to
Springtield Estates
C. 'Name, etc. of owner and construction lender
D. Energy Sources
'I. exarnole- heat/electrical ceilinQ/or forced air Qas
2. examyle- water'heater/electrica(/or ~
E. Square footage or valuation, etc.
1. examole- 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. example - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code I
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. BUILDING DIVISION 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 be 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 qFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
(/~ R ~CfO
~ 1%1 W 7
P,noit Cl", ~~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
, name
signature
..
date