HomeMy WebLinkAboutPermit Sidewalk 1984-2-7
I INSPECTION LINE
726-3769
.
CITY UF SPRiNGFIELD
CDMBIIIATION APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
Hater Heater
.
iNFDRtIATION UNo
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
~
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8
)lWS tJ()J{ Y Q:t->
Legal Description \I()'~~~'=<,~ \CDC)~
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Job Address
Range
ValuE of Hork:
Construction lender
Builriina Pernlit Info: Describe Work{i.e., Build Single
Familv Residence With Attached Garaae)
6d eADo-.U:- vvU:L
3'5' ~
-=
...
S'
Address
Uo~I~N rEAr~
(name)
Phone
(address)
nics. no.)
(exnires) (ohone no.')
At
~
.~r.
'4
Primary
Structural
Electrical
Mechanical
CONTRACTORS
lname)
(address)
(lics. no.)
(p.xnire~) (nhone no.)
General U fI t.-
Plumbina
Electrical
~lechanical
PLUllBI NG
ELECTRICAL
MECHANICAL
Each single fixture
FEE I CHARr,E NO ... rHAOr,. NO. I
Residence of furnace/burner to
SQ. FT, BTU's
~I='I=' rl-lARGL
NO,
I
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
I SERVICES
I
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Recessed wall
SD~~P hp~tpr ~nrl vpnt
~Ia ter servi ce
I Temporary Construction
IChange in existing
res i dence .
ImultiiamilYt camm. or
Inrlustrial
IOf amps.
ICOMfl./INO. FEEDERS
I Install/alter/relocate
r1i,trih. fpprlpr,
lOf amps.
I
I
I
Appliance vent
seDar~tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood "nr! dud
Wood stove/heater
Sewer
Storm Sewer
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANCf OF PFlum
TOTAL CHARGES
that the Electrical work be done by an. 'Electrical Contractor, the ,electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
[ HAVE CAREFULLY EXMIINED the completed aprlication 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 NO OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further "certify that my registration with the Builder1s
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 OP.S 701.055 will be used on this project.
IWIE(p1ease print)" , SIGUATUREX
MARcf'!.......~ C}/RIST.....o.J<~.v ~ n.n. ~ OJVUJ
FO~ OFFICE USE OULY
Zone Tyoe/Const. Units So. Ftg. t1ain
Fire Zone Bedrooms Occy Load Sq. Ft9. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
~::t.~~ DATE{ ~ -7-'?!i..-
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERNIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr ~pp
------------ Plan Ck. Res U
30%/B1do Per Fee
Fence
Systems Development
Charoe (!.5~) "
PLUt~BING PERMIT
Charges and
Surcha rges
Demo
ELECTRiCAL PERI~IT
Charges and
Surcharges
flECHAN I CAL PERMIT
Charges and
Surcharges
'Sidewalk
A/C Paving
'7 :>0
I
ITotal Comb. rermit
I
I TOTAL
-1! 1100
Curb Cut
..
.
...
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xamp'le- Tax Lot 100, lane County Map Reference
17 U3 43
2. example- Lot 1. Block 3, 2nd Addition to
sprlngfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examyle- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-n€w - if addition,
el1ee Ie add. etc.
F. Building permit information:
1. examyle - construct single family house with an
attached garllge
2. example - remodel existing garage into family room
3. examole - convert single family resJdence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM1 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. ---
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.
(p;)382...
. &
V
V. FOR OFFICE USE ONLY
Permit C1 erk
em~
,.;2-7-pj
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