HomeMy WebLinkAboutPermit Curb Cut 1986-9-26
j INSPECTION LINE
726-3769
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Job Address
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CITY Uf SPRINGfIElD
COMBINATION APPlICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork:
INFDR/1ATlDN UNt -I
726-3753
Sq. Ftg. 1,la;n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
Other- -
.
legal Description
Owner Br-IO\'\do0 c.or-r. (~"",-d,,- "J:.V1n \
Address 3S 4 (') c-,...J 0 l.) ~ Phone 72.k,
( 2. I '2--
Builtilna Permit Info: Oeser be Workll~e"
Family nesidence With Attached Garaae)
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Build Single
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Construction lender
Address
UtSIGN [tAM
lname]
Phone
{address}
flies. no,)
Cexniresl
I
(ohone no, )
Primary
Structural
Electrical
Mechanical
CONTRACTORS Inamel
General 1"l_~'~._L/
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(address)
f1 ;c~. no,l
(pxo;rpc:\
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Plumbina
Electrical
~'echanical
PlUI1BING
ELECTRICAL
MECHANICAL
NO. .
FEE 'CHARGE Nn
~~~ rHAR~~ NO_
. n.~ . r\..lAtu::~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
CO~~./IND. FEEDERS
Install/alter/relocate
di~trib, fppders
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sin~J1e duct
Vent system apart from
hea t i no or A, C.
Mechanical exhaust
hood rInd durt
Sewer
Temporary Construction
Change in existing
rpc;jq~Jlce
multifamily, comm. or
Industrial
~/ater serv; ce
Wood stove/heater
Of
amps.
ISSUANCf OF PFRlnT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\\/ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
shall not be valiJ until the label has been signed by an Electrical Supervisor 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 Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore(]on pertaining to the work described herein, and that UO OCCUPAUCY 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 compliance with ORS 701.055 :t?~ u~~ ~s projec:.
Im'lE(p1ease print) SIr,IIATURE-:7,1 ~~ OATff ~
FOP. OFFICE USE ~lY (
Zone Tvpe/Const. Units Sq. Ftg. tiain ,x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood,Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VAlUATIml
BUIlOING PWlIT P1 an Ck. Conm/lnd
Charges and ------------ 65%1B1do Ppr Fpp
Surcharges Plan Ck. Res
30%lBlda Per Fee
PlU!~BING PERMIT Fence
Charges and ------------
Surcha rges DetI10
ELECTRICAL PERr~IT .Sldewa 1 k
Cha rges and ------------
Surcharges A/C Pavi ng
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charae tt.5~) ,
Total Comb. rermit
ls .'2.S"'"
TOTAL
ts, '2S-
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference'
II 03 43
2, examole- Lot I. Block 3, 2nd Addition to
Spr,ngtield Estates'
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I. example- 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
a ttached garage .....
2. examole - 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 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. ---
Ill, 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.
l~'to If U,~
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date