HomeMy WebLinkAboutPermit Sidewalk 1990-9-4
Owner' (i}m./r-[- e. I+a {,( //1 .R 50!
Address 6. =3 !>() /1,1/.1; ,)) '.C;.j-- . Phone7 L(7-
S(Jr'iv10fe./of. ()f2- C(7lf7'i 78&/
Construction Len~r
CITY U, SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of ('Iark:
.
INFOR/1ATlON UNl
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other - -
~
C)
--...
()
-S\
( lINSPECTlON LINE "') .
726-3769 / . .
Jli1lAiIilr';'; q~ "71') f/I10.'lv1 St-(CblUal0 '7f.,i/pf
Legal Oescription I} 0 '):z:z 'J....I - 0 loc;-o I
BuilGlna Permit Info: Describe Work(i.e..
Familv Residence With Attached Garaoel
].:2-7- ++ S;c!f'rua.JL
Build Single
Address
Ut~luN fE.AM
(name)
Phone
(address)
flies. no.l
(px.oi res l (ohone no. '\
~
~
Primary
Structural
Electrical
Mechanical
CONTRACTORS Inamel
General ('/''-'1 e.~.e}e- p.eddc'S--k-?
Plumbino
(address) (li~~. no.) (~xnire~'
j 4 S' G wI Q ,--'Y. t:;c,'t ("(,,, '75//71"11
(ohonp on, l
(1J)?7 7 >it! 9
o/(08-g Cf3'-17
Electrical
~1echan;cal
PLUllBI NG
ELECTRICAL
MECHANICAL
NO.
FEE I (HARGF NO
FFL J:IiARGE. NO
'IE- J:IiARGE.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
orextens;ons
Floor furnace
and vent
S.F. Residence
(l bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~tp~ ~nrl upnt
Sewer
Temporary Construction
Change in existing
rp~ i dJIlJlrp
Imultifamily, camm. or
Industrial
10f amps.
ICO~1./IND. FEEOERS
Install/alter/relocate
di<;trih. fppdprc:.
Appliance vent
~pot\rrltp
stat; onary evap.
r.nnlpr
Vent - fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood i'l:nd durt.
Water service
Storm Sewer
Wood stove/heater
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\IJ REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
ISSUANCE OF PFRlHT
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
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 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" fm OCCUPAf~CY 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 ons 701.055, that if exempt the basis r exemption is noted hereon. and that
only subco~tractors and employees who are in compliance with OPOS 701.055 will be used his project.
D~.TE q:-V-70
HAI.IE(please print)~R", 7~ 8,e.6er1 SIGNATURE
FO~ OFFICE USE orlL Y
Zone Type/Canst. Units So. Ftg. f1ai{
Fire Zone Bedrooms Occy Load Sq. Ft9. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERI.IIT
Charges and
Surcharges
Plan Ck. Comm/lnd
_______"_____ 65%/~lr(1 P1>" ~"I'>
Plan Ck. Res
30~/BldQ Per Fee
Fence
Systems Development
Charqe (1.5~)
PLur1BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERI~ITSldewil1k
Charges and ----------__
Surcharges A/C Paving
4.3..31)
Total Comb. Permit
/lECHANICAL PERMIT
Charges and
Surcharges
~
Curb Cut
TOTAL
L/3- frD
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. ~xample- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
.1. examDle- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electricalJor 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 pennit information:
I. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. example - 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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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 Oivision 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
pc{ Cash -J - Lj-lo
lLec. #- JEw /
Penni t C1 erk ~vvvJ2.....
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date