HomeMy WebLinkAboutPermit Sidewalk 1990-8-13
"
, CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
.
I NFORl1ATlON 1I Nl
726-3753
Sq. Ftg. Hain
!:q. Ftg. Access.
Sq. Ftg, Other
lIew Add A Her pep.
-Fence Demo Change/Use
Other- -
jINSPECTION LINE
726-3769
.
Job Address 6?0::?; '/11 {(j;,.. Sl7W
Legal Dmr;ption /1, 1) ') '~?,;':? / -r L /);::Ji>:3'
i
7Lj1~ 1
Phon~Y5q
Valu. of Work:
Address
,7MIJ/A
0301;
IlYirfs1m
mrth ?n-UI-
Bufldinq Pennit Info: 'Describe Work( Le. I Build Single
Fam;lv nasidence With Attached GaraQe'
q() rr- /72 ')~
Owner
{namel
Phone
(address 1
(exoires)
I
no,l
Construction Lender
Address
Dl>lull llAH
{lies. no.l
(ohane
Electrical
j~'
~~
rJ'4'
Primary
Structural
Mechanical
CONTRACTORS
General
{namel
1fI J J'Yt1/V -
(addrf'ss'
(1 ir;<;.. no, \
(~xoiresl
(ohonp no. \
~
Plumbino
Electrical
Mechani ca 1
PLUrlBING
ELECTRICAL
MECHANICAL
-1!Q." I
Each single fixture
I FFF I CH~RGE Nn
~rr rH~ NO_
qj:' rHIlRGf.
SQ. FT.
furnace/burner to
BTU's
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps,
Appl iance vent
se"larate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
hea t i nc, or A. C.
Mechanical exhaust
hood and rluct
Wood stove/heater
Sewer
Temporary Construction
_~ Change in existing
res i qe]lCC.
multifamily, comm. or
"ndustrial
Water service
COMfI./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
TOTAL CHARGES
WHERE STATE L,'l~ REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANCE OF PFRlm
TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor. the electrical portion of this pemit
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 performed 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 OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard 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.
SI"IIATURE ~q 13.t,JcJs~
FOR OFFICE USE C lLr 1
51"!. ~. fiain
Sq. Ft~. Access
Sq. Ft9. Other
rW1E(please print)
jOl\l'\ II 8 . &Ja1soj,-..,
DATEtJ(. J,3.Q()
Zo~e
Fire Zone
Flood Plaln
Type/Canst.
6edrooms
x
Value
Value
Stories
Units
Occy Load
Occy Group
x
x
Value
TOTAL VALUATION
BUILDING PERflIT
Charges anC:
Surcharges
Plan Ck, Comm/Ind
65%/Bldo Ppr Fpp
------------ Plan Ck, lies
3D%'BldQ Per Fee
Fence
Systems. Development
Charqe O,5~) "
.n 'j';'
- tiL- i'~ I/r 1I~~7
If .
;';:;,;i"t)
PLUr~BING PERMIT
Charges and
Surcha rges
Demo'
Sldew'llk?f!}(f. 4/~> bD
A/C Pavi ng
Tota' Comb. Permit
ELECTRICAL PERIllT
Cha rges and
Surcharges
TOTAL
:;)-3, ~o
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to 'furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. lane County Map Reference
II oj 43
2. exa~le- Lot I. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrlcalior solar
E. Square footage or valuation, etc. -
J.. ,ex amp I e- 1250 sq. foot house. 500 sq, foot garage
2. example- if new project. check new - if addition,
. ,. check add, etc.
F. Building pennit information:
.,.1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examyle - 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 n~ed 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. BUILOING 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.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
"
PERMIT VALIDATION
v
~ #:: I~~zf
Permi t' Cl erk l!AJ..f2oM
,', Permit appl i cant. exempt from reg; strati on wi th the Buil de~' s Boa rq ,because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
.-