HomeMy WebLinkAboutPermit Curb Cut 1984-5-16
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726-3769
Job Address
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Owner
ConstrLction ~ender
Address
Ut:~lliN fEAr1
Primary
Structural
Electrical
Meehan; ca 1
~ CONTRACTORS
Genera 1
Plumbino
Electrical
~'echanical
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CITY OF SPRl.I~'.;II. 11:'/"
COMBINATION APPLICATION pERMrT
,~r. {41."" ~i) ~~~~GY SOURCES:
Hater Heater
Range
Value of Hork:
INFORl1ATlON liNt
726-3753
Sq, Ftg, 1,Iain
~q, Ftg, Access.
Sq, Ftg, Other
Ilew Add Alter Pep,
Fence _Oemo _Change/Use
_Other
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Phone
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BU11dino Permit Info: Descrlbe Work(i.e.,
Familv Residence With Attached GaraQe}
Build Single
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{name)
Phone
(address)
(ohona nO.1
flies. no.l
(exniresl
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(name)
(address)
(ohone no.
(lics. no,l
(exniresl
PLUIIBIIIG
ELECTRICAL
MECHANICAL
FEE CHARGE NO
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CH' r~~..JiQ......
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
\oIater servi ce
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~D~~~ hp~tpr ~nrl vpnt
ITempOrary Construction
IChange in existing
r~<;J d~J'I~~
Imultifamily. comm. or
Inr1uc;tri~l
10f amps,
ICOMfI,/IND, FEEDERS
I Install/alter/relocate
di<;trih. f~pdpr~
IOf amps.
I
I
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Appliance vent
~~Dil.r~tp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
ISSUANCE OF PFRIIIT
TOTAL tHARGES
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
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 EXAHINED 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 rm OCCUPAHCY 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 hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IlAI-lE(please print)
Zone
Fire Zone
Flood Plain
BUILOING PERfIIT
Charges and
Surcha rges
PLUt1B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERf~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Sur~harges
$Tt/IJLE'f T ;t{EKlt:rL
SIGilATU~~ r~Jl/
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#
Value
Value
Value
Dim .s-~ if'!
Tvpe/Const.
Bedrooms
Stories
FOP. OFFICE USE 0I1L Y
So, Ftg,
Sq, Ftg,
Sq, Ftg,
x
x
Units
Occy Load
Oeey Group
riain
Access
Other
x
TOTAL V ALUA TI ON
Plan Ck, Comm/lnd
65%/Bldo Ppr Fpp
------------ Plan Ck, Res
30%/Bldo Per Fee
Systems Development
Charae (!.5~) "
Fence
I
I
I
I
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I
1 ITota' Comb. rermit I
____________lcu.1' Cut 2~1 oyw <-<J/B~/~TOTA~/ Q/'\
11f"12;:>enn1r -r1/:ZI/t.-,F I IV,UJ
Demo
Sidewalk
AIC Paving
.
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I, Applicant to furnish
A, Job Address
B, Legal Oescription
1, example- Tax Lot 100, Lane County Map Reference
11 03 43
2, example- Lot I, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinqjor forced air oas
2. examgle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I, example- 1250 sq. foot house. 500 sq, foot garage
2. examp.le- if new project, check-new - if addition.
check add. etc,
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examEle - remodel existing garage into family room
3. examole - 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. OESIGN TEM4 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, ---
Applicant to sign and date
Whenever possible. the initial application will ba used as
a worksheet only. Where possible. Building ~ivision Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture.
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 penmit is issued.
,
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8071/{P
V, FOR OFFICE USE ONLY
Pe rmi t
Clerk W
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Permit applicant exempt from registration with the Builder's Board because':
Additional Project Information:
PLANS REVIEWED BY:
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signature
date
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