HomeMy WebLinkAboutPermit Sidewalk 1988-9-22
'I INSPECTION LINE
726-3769
Job Address
legal Description
3;211
-8
fJILa4..J
INfORl1ATION lINL
726-3753
Sq. Ftq. 1.la i n
~q. Ftg. Access. ~
Sq. Ftg. Other ~
New Add Alter Rep. ~
Range Fence_Demo_Change/Use ~
ValuE of Hork: _Other ~
Builoino PennH Info: Describe Work(i.e.. Build Single .L~
Familv nesidence With Attached Garaae) ~
1M)' 'if cfdaP f r
(ohane no. \
CITY Of SPRINGfIELD
COMBINATION APPLICATION/PERMIT
EilERGY SDURCES:
Heat
l~ater Heater
.
Owner
/1- /' Ir
{~ ?~
! S.;2. 5" I f71/lo~
Address
Construction
Address
OES I GN TEAI1
Primary
Structural
Electrical
Mechanical
CDNTRACTDRS
Genera 1
Plumbina
, Electrical
~'echan;cal
Phone
Lender~~
L. ()
tw~\
Phone }
(address)
(exoires)
(name)
nics. no.)
l.t/1Il, I \ :> ?
(name 1
1'X.uj/J;.Iv J
(address)
11 ir:<;.. no.)
(pxoirps)
(ohn"p t1n \
_ ",lD
/!\JV
PLUlIBI NG
ELECTRICAL
MECHANICAL
~I
Each single fixture
FEE
fHARGF
C" I r"1\RG.E JJll....1
NO
1m
'r"1\RG.E
Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
11 bath)
Duplex (1 bath)
Additional bath
~Ia ter serv; ce
Sewer
I Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~~p hentpr nnd vpnt
each
I
I
I
I
PlU \61 ;
I
I
!TempOrary Construction
IChange in existing
res5 dJ>nce
Imultifamily, camm. or
Tnrlu~trii'll
IOf amps.1
ICOffi1./IND. FEEDERS
I Install/alter/relocate
rlic:t.rih_ fpprfprc:
Wood stove/heater
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart from
hea t; nq or A. C.
Mechanical exhaust
hood .:tnd duct
Of
amps.
n I
ISSUANC, nc PFRruT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an,
shall not be valid until the label has been signed by an Electrical
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 NO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I f rther certif t~registration with the Builder's
Board is in full force and effect as required by ORS 701.055. that if e mpt t asi for emption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701. 55 will e us on thi project.
\ - ------
NANE(please print) J/JI1 I~- ,4c;/f',I..IIf'V SIGIIATUR ~)
FDP. OFFICE USE OIlaY : "-
Tvpe/Const. Units Sa. Ft Haio x
, I
Bedrooms Occy load Sq. Ft . Access x
,
Stories Occy Group Sq. Ft . Other x
TDTAL VALUATION
Zone
Fire Zone
Flood Plain
BUILDING PERMIT
Charges ant::
Surcharges
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
Dm '1-o?.;2. ~8'"
J/
Value
Value
Value
Plan Ck. Comm/Ind
65%/Blda Ppr Fpp
------------ Plan Ck. Res
---- 30%/BldQ Per Fee
Systems Development
Charoe tl.5~) ,
PLur~BING PERMIT ..... Fence
Charges and.../' - - - - - - - -- --_
Surcharges. OCIflO
ELECTRICAL PERr~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk 1"1. :4 if. 0'0 I
I A/C Paving I ITota, Comb. Permit
I Curb Cut I I J
I I I TOTAL 34.0'0
.
.
CDMBINATIDN APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 10D. Lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilin~/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examyle - remodel existing garage into family room
3. exam~le - 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 TEM1 AND CONTRACTDRS
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 ~ivision
1. To conserve space on the permit form the schedules
have been abbreviated
2. I f the item( 5) to be install ed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL DUT ALL FEES AND
CHARGES DN 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.
~.<ii /~~Oi
C,D
-if' tt'O
V. FOR DFFICE USE DNLY
Pennit Clerk
CD
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
.
'.
PLANS REVIEWED BY:
. name
signature
date