HomeMy WebLinkAboutPermit Sidewalk 1987-9-22
Job Address
I fo S-O
(,'o~"J)
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURC,ES:
Heat
Hater Heater
L-
INFORt1ATION L1N~
726-3753
Sq. Ftq. r'1a i n
~q. Ftg. Access.
Sq. Ftg. Other
Nel-l Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
09
-J
6
-..J
o
"Q
-'I INSPECTION LINE
726-3769
Legal Description
Owner'
, A
W~
~'.-tJ_~. . ~_jf)
/
Range
ValuE of l'lork:
Address
Phone
Buildinq Permit Info: Describe l~ork(;.,e., Build Single
Family P-esidence With Attached Garaqe)
..s~idtL1 iA ~ Ie s, )- 6uL6 (' AA 1;
Construction lender
,Address
DESIGN TEI\1>I
(name)
Phone
(address)
(l ics. no.)
(expires)
(phone no..
v-
'(
z;n~
')Cffc, -0037
I
,
a",'b
Primary ~
Structural 1/ /
Electrical Da4I/.C-h
Mechanical
CONTRACTORS
{ rrualJ1Je i
(address)
(] ics. no.)
(expi res)
(ohone no. )
General
Plumbinq
Q}~
S~DU
Electrical
~\echani cal
l?lilllffiBINt
ELECTRICAL
MECHANICAL
NO. '
;' fEE 'CHARGE NO.
, , ]
FFF rHARhF NO.
FFF rHARhF;
Each sfi~]e fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
Reloca~ ~!:lOi~'ding
(new fix. a~rlitional)
New circuits alts.
or extensions
Floor furnace
and vent
IS. F. Resilli!en.ce
(l bath)
I Duplex n !b.ot1h) each
I Addi tionau bath
!Hater servke
lsewer
ISERVICES
Recessed wall
Soace heater nnd vent
Storm Sewe>r
Of
I
I
I
or I
amps.1
I
I
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Temporary Canstructian
IChange in existing
residence
ImultifamilY, comm.
Industrial
COMM./IND. FEEDERS
I Install/alter/relocate
distrib. feeders
10f amp~1
I _ A I,
1 ~U \~"IJ
I I
ISSUANCE OF PERMIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
, WHERE STATE lAH REQUIRES that the Electrical work be done by an-Electrical Contractor, the electrical portion of this permit
sha 11 not be ViilU,j until the 1 a be 1 has been signed by an El ectri ca 1 Supervi sor and returned to the Buil ding Di vi si on
I HAVE CAREFLll:LY EXNlINED the completed app 1 i cati on for permit, and do hereby "certify that a 11 informati on hereon is true
and correct, a~ IT further certify that any and all wark performed shall be done in accordance with the Ordinances of the City
of SpringfieTIG iil~ the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAr~CY will be made
of any structiUll'e'wffthout the permission of the Building Division. I further certify that my registration with the Builder's
Board is in fuTI~ f<IDrce 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 ORS 701.055 will be used on this project.
NAME(,l,,,, .r;.t~()qE'f m :Jd.le.broo 1(, SIGNATUREC5(O ~ Dm') -=-87
FOR OFFICE USE ONLY
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedroams
Stori es
Units
Occy Load
Occy Group
Sa. Ftg. t1a i 0. X Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION
S~stems, Development
C arqe (1.5%)
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________ 65%/Blda Per Fee
Plan Ck. Res
30%/Bldq Per Fee
Fence
PLW~BING PERMIT
Charges and
Surcharges
I D!;ffio
I S i dewal k
I A/C Pavi ng
I Curb Cut
------------1
I
I~ I
I
1).1
I
( 1~ r 5
ELECTRICAL PERtm
Charges and
SurCharges
ITatal Comb. Permit
(q .(5 I
I TOTAL
3 f. 3()
14
MECHANICAL PERMIT
Charges and
Surcharges
.,
COMBINATION APPLICATION/PERMIT (CAP)
-I. Applicant to. furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates '
C. Name, etc. of owner and constructian lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot hause, 500 sq. faat garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit infarmation:
1. example - construct single family house with.an
attached garage "
2. example - remodel existing garage into family raom
3. example - convert single family residence into
restaurant (change af use)
G. Value af work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To. avoid design or construction delays, Building
Divisian Staff must be able to contact appropriate
persons regarding design information ar job site
correctians, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the descriptian
portian of the Mechanical and Electrical Schedules,
the applicant need fill-in anly 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 cantractor is .not authorized
to. sign the electrical label. -
III. Applicant to sign and date ;
Whenever passible, the initial application will be used as
a warksheet anly. Where possible, Building Division Staff
will prepare a type written capy 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
applicatian, and no plans will be processed until these
fees are paid. All ather 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
! () z-VCj
tJr-27'-f1
Permit Cl erk
Cc::-
Permit applicant exempt from registration wit~ the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date