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HomeMy WebLinkAboutPermit Sidewalk 1990-7-10 ~l INSPECTION LINE 726-3769 . \ u"' - _ ~ g\ 10 oa 'oO,"""" ~ ~ . ""t.'-Il. CITY UF SPRINGFIElD CmlBIIIATION APPLICATION/PERMIT E!IERGY SOURCES: Heat t'Jater Heater Job Address ...T. INFDR/IATION 726-3753 . Sq. Ftq. 1.lain ~q. Fla. Access. Sq. Ftg. Other lIel< Add Alter Pep. Ranqe . ~ -Fence Demo Change/Use ValuE of HOf\ 1(').....) -Other-- BullriinQ Permit info: Describe I~ork(;.,e.. Build Single Familv nesidende With Attached Garaoel legal Description T"... l _,-... M.e.\,.. n-..". ~ " 01. ....l... .. L '2."" .. 't..~,., Owner :""..... u~ ... 'T".._....... \.......l.'"!It..I:I.~ Address 4n I,_r::" R.--.,T"\,l. \'l!:., \ '1' Phone, ....,. 'W,,""1Q 9"7'-1'" ~ciuuXJ1~ Construction lender SPQ'''''L e... n l""o.t? It,,.-?........,...... ~_\.l.. LL.....L#o......n c.-_.... 1....-- , Ne"'l( \ .:, , \ I . -,..-~ I"fAH. PlUllBING FEE r.HARGF Nn Address Ut~ lliN I EAH Primary Structural Electrical Mechanical CONTRACTORS Genera 1 . Plumbina Electrical' ~1echanical NO. h.T (name) Phone (address) (exoiresl (lies. no.l ....{name) \ \ -~ (addrflsc; ) (lire:. no.1 r I>xoi rpc:; , r ohnnp no. 1 J'~, L.......""-.elo.....r lO-.oc..D ""~I 3 '1S- R /0-> "1 /3o/"r' . ElECTRICAl MECHANICAl ~~~ r~ARr.t NO_ ~~~ r~AI:lr.~ Residence of furnace/burner to BTU's Each single fixture SQ. FT. Relocated building (new fix. additional) S.F. Residence (1 bath) Ouplex (1 bath) each Additional bath Water service Sewer Storm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~nArl> hl>Atpr Anrl vpnt Temporary Construction Change in existing ,r~c;.idf.l:n~p' Imultifamily, comm. or tnduc;trial 10f I COMI"./I NO. FEEOERS I Install/alter/relocate rtic:;trih. fpprtprc:; 10f I I I Appliance- vent s~oaratp Stationary evap. cooler Vent fan wi th sinole duct I Vent system apart heatino or A.C. I Mechanical exhaust hood and dur.t I Hood stove/heater I I I ;~. amps. from amps. ISSUANCE OF PFRIUT TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES WHERE STATE L\\/ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit shall not be valiJ until the 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 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 1m OCCUPA!~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 ORS 701.055, that if exempt the basis for exemption is noted ereon, and that only subcontractors and employees who are in compliance with ORS 7QI.055 will be used on this project. IlAI-lE(please print) ,10);1/1/ //l"L/JIV.cJ SIr,;IATUR~_ FO~ O'FF I CE USY-ll'rlL Y ~ Ftg. liain Sq. Ft~. Access Sq. Ftg. Other Zone Fire Zone Flood Plain BUIlOIrlG PERflIT Charges an': Surcha rges PlU'~BING PERMIT Charges and Surcharges ElECTRICAl PERr:1T Cha rges and Surchi!-rges IiECHANICAl PERMIT Charges and . Sure ha rges om_I -/.o.~ Tvpe/Const. Bedrooms Stories Units x Value Value Value Occy load Occy Group x x TOTAL VAlUATION Plan Ck. Comm/Ind 65~/Bldo P~r Fpp ------------ Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development I Charoe (1.S~) O~mo ___nn____Jsidewalk '7D..~.w.,' J !Jf'\.::Y7 I A/C Paving Total Comb. rermit Curb Cut J 1()5 51 ~1 TOTAl - . - - , - "' COMBINATION APPLICATION/PERMIT (CAP)' PERMiT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. exa~le- Tax lot 100, Lane County Map Reference 17 03 43 2. examole- Lot 1. Block 3, 2nd Addition to sprlllgtield Estates .: C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinqlor forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check:ruew - if addition. cneck add, etc. F. Building permit information: 1. examole - construct single family house with an attached garage Z. example - remodel existing garage into family room 3. examJPle - 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 fonm 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. --- Ill. 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. I ~ (~~qo -t:t l1 (o:Q1 V. FOR OFFICE USE ONLY Permit Cl erk ~(nQ ) PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Bui!der's Board,because: , : .... Additional Pro~ect Information: PLANS REVIEWED BY: name signa ture date