HomeMy WebLinkAboutPermit Sidewalk 1986-11-4
Job Address III c:; . IV\. g Yn ~
Legal Omription 11- 03 - & - 7)/- f'U1{J1)
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~ CllY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Heater
Ran!'}e
Valu' of Hork:
.
INfORlIATlON LINt
726-3753
Sq. ftg. /.Iain
~q. Ftg. Access.
Sq. ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
-Other - -
~
I;:;,
~
1)0
llNSPECTIOII LINE
726-3769
Address
BuilGina Permit Info: Oeser.be Work(i.e., Build Single
Family nesidence With Attached GaraQe)
Address
UI;.~lliN fEAr-'
(name)
Phone
(addressl
fU.\ I'llA "lliilW_ViJL
Construction lender
Mechanical
CONTRACTORS
() (1) \\ Q IL---
(name)
(addr~c;.c;.)
fl ics. no. ) {exniresl (ohane no. 1
l>. -&
cd, . ,) +
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(lkc;,_ nn. \ (pvnirpc:.\ (nhnnp nn \
Primary
Structura 1
Electrical
Genera 1
Plumbina
Electrical
~1echan; ca 1
PLUIIB JrlG
ELECTRICAL
MECHANICAL
---.llih
fEE CHARGf Nn
rrr rH~ NO_
""L !JlARliE.
Each single fixture
Residence of
SQ. fT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~tpr ~nn vpnt
Sewer
ITempOrary Construction
IChange in existing
res i dence
Imul"ti-{amily, COrml. or
Indllc;.trial
IOf amps.1
I COMI.\. /I NO. fEEDERS
I Install/alter/relocate
,dic;.trih_ fppnprc;.
IOf amps.
I
I
I
Appliance vent
sJ~o!'lrate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood rind dUl"t
~!ater service
Storm Sewer
Wood stove/heater
ISSUANCF Of PfR!lIT
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali1 until the
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Zone
Fire Zone
I HAVE CAREFULLY EXArlINED 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 Derformed 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 UO OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project.
IIAI.IE(please 'prinili-i-,,: l')p k,,,,i.JL.,,,, SIGNA@~':~ ::....~__
fO~ OFf I CE USE DIlLY
Sq. 'ftg. 110in
Sq. FtlJ. Access
Sq. ftg. Other
DATE //; ~-,fc,
Tyoe/Cons t.
Bed rooms
Units
Occy Load
Occy Group
,
Value
Value
Value
x
flood Plain
Stories
,
TOTAL VALUATION
BUILOIllG PERNIT PI an Ck- Conm/l nd
Charges an,;:: 65%/Rldo Per Fpe
Surcharges ------------ Plan Ck. Res
30%/Bldo Per Fee
PLU'1BING PERMIT Fence
Charges an.d ------------
Surcha rges, OeRlO
ELECTRICAL PERtm .S1dewalk 1,r>D
Charges an~ ------------ ,
Surcharges; A/C Pavi ng
MECHANICAL PERMIT I Curb Cut
Charges and ------------
, Surcharges I
Syste~s Development
Charqe (L5~)
Total Comb. Permit
TOTAL
7, D ()
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. example- lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin9/or forced air qas
2. examole- waterneater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check-new - if addition,
check add , etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. 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
8; 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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WIll FIll OUT All FEES AND
CHARGES ON THE SCHEDULES
O. 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
Wnenever possible, the initial application will be used as
a worksheet only. Where possible. Building Division Staff
wi.ll 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
fe~s are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY:
)..
.
-PERMIT VALIDATION
J J-J JJIU
~~1340
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Permit Clerk
~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name'
signature
date