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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