HomeMy WebLinkAboutPermit Sidewalk 1980-10-23
I IrISPECTIOtl LitlE
726-3769
'.
CITY OF SPRlIlGFIELO .
COMBlIlATION APPLICATION/PERMIT d....
EilERGY SOURCES :"....
Meat
Hater Heater
owner~\")I'r'O ~ "f\Q (\[\\(\0{)
Addressp.n~ (11(1 t 1 U IJ. Q J Ph~;;;~ -
Or)N~l) ~Ul-!rY1S -
construction~n~ UU\..
Range.
ValuE of Harle
INFORllATION UNt
726-3753
Sq. Ftq. 1.la;n
~q. r:tg. Access.
Sq. Ftg. Other
lIew Add Alter P.ep.
--Fence Demo Change/Use
-Other- --
I
BUlldlOQ Permit Info: Descrlbe I'Jork( 1.e..
Familv ~esidence Uith Attached Garaoe)
Build Single
'~
V
~
I~
Job Address ff)CC), ill ~ f\ 1.JJ'_n_, "-
Legal Dmription ~ ro 1 \rlb31-1(\.'!:'
{name} .
Phone
(address 1
~)\f'\U~ ~O
Address
OtSIGN I tAl,'
(lies. no.)
(exoires)
(chona no./
Primary
Structura 1
Electrical
t1echanical
COIITRACTORS Inamel
General, ~l \)\) , LffiC""rJl 0
(address)
(li~s.. no.)
(exoires)
(ohonp nn )
Plumbino
Electrical
~~echanical
PLUltB !:IG
ELECTRICAL
MECHANICAL
::0.1
Each single fixture
I FEF
CHARr,F tin
CCF
rI-lAR(.;F NO.
I Frr
n4AIH~F
Residence of
SQ, FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Add it i ona 1 ba th
1~later service
I Sewer
I Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
I Recessed wa 11
SOnrp np~tpr ~nrl wpnt
I
ITempOrary Construction
IChange in existing
rp".; denc("
multifamily. comm. or
Inrluc:..trial
Of amps.1
CDMM./IND. FEEDERS I
Install/alter/relocate I
ni<:trih_ fppnpr<:
I Appl iance vent
"eo" ra tp
Stationary evap.
cooler
Vent fan wi th
"inole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud.
Wood stove/heater
Of
amps. I
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valij until the
TOTAL CHARGES
that the Electrical work be done by an"Electrical
label has been signed by an Electrical Supervisor
ISSUANCE nF PFRilIT
TOTAL CHARGES
Contractor. the electrical portion of this permit
and returned to the Building Oivision
I HAVE CAREFULLY EXN11NED 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 oerformed 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 UC OCCUPAf~CY will be made
of any structure without the permission of the [luilding Division. I further certify that my registration \>lith 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 ORS 701.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
_ _ ~IG;I^TlIRE
J'O"R OFFICE USE mlL'r'
Sq. Ftg.
'-
rtL
DATE 10...'1.'18"
1lA/.IE(please print)~_ '-2.-{l-IJ-
,
Units
V
t1ain
x
x
Value
Value
Value
Occy Load
Occy Group
Sq. FtD. Access
Sq, Ftg. Other
x
TOTAL V ALUA Tl ON
BUILDING PERI.IJT
Charges and
Surcharges
Plan Ck. Comm/Ind
6S1:/Bld{l Ps>r Fpp
Plan Ck, Res
3D%/Bldq Per Fee
Fence
I Demo
I 'Sidewalk
I A/C Paving
I Curb Cut
I
Syste~s Development
Charo. (1.5%)
PLUI~BING PERMIT
Charges and
Surcha rges
I
L
~ :__,;'h IfllCXJ
ELECTRICAL PERi~IT
Cha rges and
Surcharges
Total Comb. rermit
,MECHANICAL PERMIT
Charges and
SurCharges
.-,'
TOTAL
10'00
.
.
,.
..
''1 ~If I
;'1
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
m
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference
1I 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal!or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq.' foot house, 500 sq. foot garage
2. example- if new project, check-n€w - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - 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 f;11-;n 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
O. 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 OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.n,. 1
i
l'
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
,
PLANS REVIEWED BY:
name
signature
date