HomeMy WebLinkAboutPermit Curb Cut 1983-08-24IN
72 COMB I APPLI TIO IT
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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."
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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
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CTNRS
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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
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IV
V
PERMIT VALIDATION
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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
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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.
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Notary Pub ic or Oregon
My Cormnisston expires: 8-10-67
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