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