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HomeMy WebLinkAboutPermit Curb Cut 1983-08-24IN 72 COMB I APPLI TIO IT Ibo 5.Lv 0wne r ,! Legal Descri ption Job Address Val ue of l,lork lJater Heater Ranqe EIIERGY SOURCES: Heat Sq. Ftg. Access.--- Sq. Ftg. 0ther_ llew AddLAlter Rep. ce_Demo_Cha n ge/ U se rer -Fen _ott, . Ftq . l.la i Builriinq Pernrit Info: Describe [^lork(' Farnily Residence I'lith Attached Garaqe e., Build Single ) tzl-t.Il otrL Address ono"?gfl-(v2t-p C (r .5 l-*il V,J Construction l8nJ." h) ^ I* r.,. -ir l- \ O- Ol Oo Addres s Phone addres s lics./r exo l res ohone no-DES I GN TEAI.{name Primary Structura I El ectri cal l''lec ha n i ca I P'I name I F E l ectri ca I I'lechanical PLUITBI NG ELECTRICAL MECHAN I CAL FFF .HAAG FFEECHARGENOFFFCHARGFNO Each single fixture Residence of FTSQ furnace/burner to BTLI' s Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent SERV ICES S. F. Res i dence(l batn) Recessed wal l Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seDa ra te rpq 1 Chan ge in existing dpncp Stationary evap cool er[.later serv ice Sewer multifamily, comm. or Industri a l Vent fan with sinole duct 0f amps.Vent system apart from heatino or A.C.Storm Sewer COMH./IND, FEEDERS Mechanical exhaust hood and duct- Instal I /al ter/re l ocate d i <t ri h feedcrc l'lood stove/heater 0f amps. ISSUANCF OF PFRI'IIT TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES WHERE STATE Lql'l REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Bui'lding Division and correct, and I further certif_v that any and all workof Springfield and the Laws of the State of 0reqon oertaof any structure without the permission of the Building Board is in full force and effect as required by ORS 701 only subcontractors and ernployees who are in comcliance for oermit, and do hereb-y certify that all information hereon is true performed shall be done in accordance with the 0rdinances of the City .ining to the work described herein, and that N0 OCCUPAI'ICY will be made Division. I further certify that my reqistration vlith the Builder's .055, that if exempt the basis for exemption is noted hereon, and that with ORS 701.055 wi'll be used on this project. I'lAl.tE( pl ease print)+^-- SIGNATURE DATE L comp e ap r)cat on Ftg Ftg Ftg x oel Con s t Fire Zone Bedrooms 0ccy Load Uni t s sq. 5q Group Sq l'lain x Value_ Val ue ToTAL VALUATI0N_ Val ue Zone Flood PIain Sto ri es Access. 0ther Plan Ck. Conrn/Ind 65%/Bldo Per Fee Svstems Deve' Charqe fl.51'opmentBUILDING PERI'IIT Charges anC Su rc ha rge s Plan Ck. Res 30%/B1dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Dgmo Sidewal kELECTRICP,L PERI|IT Charges and Surcha rges A/C Pavi ng Tota'l Cornb. Permi t Curb Cut \c,Do #lr, ao I,IECHANICAL PERMIT Charges and Surc harges u,?-o TOTAL n ', , ^^^I r CTNRS rpi! Oz(5'J.x \Ld J+ COHBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpTiilTielo EstaresC. Name, etc. of owner and construction lenderD. Energy Sources exampl e- examp I e- re foota heat/eIectricaI forced air gas wa e ec or soTarE. Squa ge or valuat 0n, l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. example - convert single iailily-resiaence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriatepersons regarding design informat.ion or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building D.ivision1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theeiectrical contractor for signature by his electr.icalsupervisor. The general contractor is not authorizedto sign the electrical labelApp'licant to sign and date l,lhenever possibie, the initial applicat.ion will be used asa-worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit.is issued for hissignature. Fees and Charges P'lan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY Ii III IV V PERMIT VALIDATION /) (+ 6\l(.o Permit Clerk C/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name S'I gnature date -\ o*)t. sEf p{t,r!. !J..1.I-yE& SBgEtrlI-U! KNJh AL'|, i"iEN Bt THESE PRE,3EiitS, That for and in conslderation or the CiLy of liprirrgfte-1-d, a nrunlcipal. corporatlon ln Lane County, SEai::: of O::egon, granting Eo the un<lersigned a walver of the ordiaancea of uhe City o' 1prtngfleld reqrrtrlng a eet back frorc the eente:; of Msrin Street of 60 feet, so that Ehe underslgned may construct and maintai[ an aci-,re::tising s:i. rrpon the following described real property, t,o-rvit,: Tax I ot # 4201 Map 17-3-36'3.2 160 South l4th Street, Springfield,0regon kno*n as number 160 of South l4th SLreet in the City of Springfield, Lane Couat,y, State of Oregon, but withln the prohlbited set back area as established by the ordlnances of the Clty of Springfield, but not closer than 26 feet to the center Line of Main Street, the undersigned applicant and permlEee doee hereby pronise anci agree Ehat in the event the City of Sprlngfteld deems it necessary for any reason, and st the Cityrs request the undersigned w111, at hls own expense, remove the abcve mentioned advertising sign prornptly, This agreement shaLl be btnding upon the undersigaed who are the ownef,s and/or lessees of the above described real properEy' and/or of said sl,gn, and upon Eheir successors and asstgns, and anyone having an interest in sald slgn and/or in the above described reaL properEy. This agreement shall be recorded in the deed records of Lane CounEy, Oregon, at the eost of the permltee for the purpose of raaking the provlsions hereof a matter of record, and notlce Eo all subsequent owners of Che above entiEled real property, and of sald slgn and the provlsions of this agreement shall be bindiug upon such successors or asslgns. Olirnef-8ee ovrner-lessee owner- Lessee owrer-lessee {6r-"1^* STATE OF OREGON, County of Lane, ) ) ) ss. Ou this 12 day of ,December , 196-J_, personally came before me, a notary public ln and for said counry, the withln named Lee Mi I ler, Safeway Stores, I nc. to me personally known to be the idenEical lndividual described ln and who execuEed the wlthin instrument, and acknowledged to me that he executed the same freely and voluntarily for the uses and purpooes therein named. SIIINESS my hand and eeal thls day and year last above written. vi--v .l -- - 'rr' Notary Pub ic or Oregon My Cormnisston expires: 8-10-67 -z-