HomeMy WebLinkAboutPermit Sidewalk 1983-9-28
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"/2/ /(0 /1 --tl- "0 Ph ,/ Buildina Permit Info: Descnbe Work(Le., Build Single
/0 U ~~/ one1~~1S~;3 Family ~esidence Hith tlttached Garage)
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Construction Lender. I
'I INSPECTION LINE
. 726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
. ENERGY ,SOURCES:
Heat
Hater Heater
Job Address } ~\ ~~ .
Legal Description \~D3ZS~Lf' DU.suo
Range
Owner'
Address
Address
DESIGN TEAr~
. ('name)
Phone
(address)
Primary
Structural
"
Electrical
Mechanical
CONTRACTORS
(name)
(address)
General
Plumbinq
El ectri ca'l
, ~'echanical
PLUtlB I NG
ELECTRICAL
NO.
FEE 'CHARGE NO,
Each single' fixture
Residence of
SQ. FT.
Re 1 oca tedbuil ding
(new fix. additional)
New ci~cuits ~lt~.
or extensions
S. F. Res i dence
(] ba th)
Duplex (1 bath) each
Additional bath
SERVICES
ITempOrary Canstructian
IChange in existing
residence
'I multifamily, carnm. or
Industrial
Of amp's.1
COMM./IND. FEEDERS I
I~~~~~~~~a~~:~~~~locatel
10f a~ps.1
II
I 1
I I
~Jater servi ce
Sewer
Storm Sewer
INFORt1ATION UNt
726-3753 '
Sq. Ftg. r.lain
:g. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other-: --
I\J
"'-
\0
N
,A-)
~
(lics. no.)
.
(ohone na.)
(exoires)
(lics. no.)
(exoires)
(ohone no.)
MECHANICAL
FFF . nHARGF NO.
'FFF "r.HARGF
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
Soace heater and vent
1
I
1
I
I
1
I
1
,I
I
I
I
1
I
I
1
1
I
I
I
I
I'
Appliance vent
seoarate
Stationarv evao.
caoler" ,
Vent fan with
sinale duct
Vent system apart from
heating or A.C.
'Mechanical exhaust
hood and duct
Wood stove/heater
ISSUANCE OF PFRr1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an,Ilechical Contractor, the electrical portian" of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CARE FULL YEXAMINED the compl etedappl i cati on for permit, and do hereby certify that all information hereon is true
and carrect, and I further certify that any and all wark oerformed'shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the wark described herein, and that NO OCClIPAfKY will be made
of any structure without the permission of the Building Division. I' further 'certify that my registration ~Iith 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
anly subcontractors and employees who are in compliance withORS 701.055 will be used on this project.
NAME(please print)
.
#! 1Z-t.f!j/lJ
vJE~t/aL SIGNATUR(J;;.d___/~
FOR OFFICE USE ONLY
D~,TE ?/zp 3
Zane
Fi re Zone
Flood Plain
Type/Cons t.
Bedrooms
Stories
Units.
Occy Load
Occy Group
Sq. Ftg. r1ai n
Sq. Ftg.. Access
Sq. Ftg. Other
BUILDINGPER~HT
Charges and
Surcharges
Plan Ck. Cornm/Ind
65%/Blda Per Fee
Plan Ck. Res
30%/Bldq Per Fee
Fence
PLW1BING PERMIT
Charges and
Surcharges
D~ma
ELECTRICJl,L PERr1IT
Cha rges and
Surcharges
,
\..$ ? ~.-o
I
I
I
MECHANICAL PERMIT
Charges and
Surcharges,
Sidewalk
------------, A/C Paving
, I Curb Cut
--------'----1
x
x
Value
Value
Value
x
TOTAL VALUATION
Systems Deve 10Pl11ent
Charge 0.51,) , '.
ITotal Comb. Permit
1-
IIOTAL
I
I
I
-Jt'
'7,0 ()
I
_ 1 ~I, .. III III I'" IIlI II
.:. ;""
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp le- Tax Lot 100, Lane Caunty Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
'1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. faot house, 500 sq. faot garage
2. example- if new project, check-new - if addition,
check add, etc.
F.Building permit information:
1. exam~le - canstruct 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 af work as defined in Section 303 (a) af 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 ar job site
carrections, 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 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 canserve space an the permit form the sc"hedules
have been abbreviated
2. If the item(s) to. be installed are nai cavered on,
the abbreviated schedules you should consult the
fu 11 schedu 1 es
C~ BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As' noted an 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. ---
Applicant to sign and date
Whenever possible, the initial application will be, used as
a warksheet only. 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.
Fees and Charges
Plan check fees are due and payable at the time afthe
application, 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.
'~\ -; toO
q/ f)ft83
~'-' CLJ
III.
V. FOR OFFICE USE ONLY
Permit Clerk d~'lN
PROJECT CONDITIONS TO BE SATISFIED BEFORE dCCUPANCY:
,
Permit applicant exempt from registration with the Builder1sBoard because:
Additi ona 1 Project Iilformati on:
PLANS REVIEWED BY:
name
signature
date