The URL can be used to link to this page

Home My WebLink AboutPermit Sidewalk 1990-8-17 11 NSPECT ION LI NE. 726-3769 Job Address \C\ l)9. \\ \CJ..tn _"117.0 ~ Legal DescriPtfon\n()~?'lo4-A. rY\Qr-l:) CITY Uf SPRINGfIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Nater Heater Range Valu, ~W~ BuiltiinQ Penmit Info: Oeser be Workl1~e., Familv Resfdence Wfth Attached Garanel h\(h.L\'Y\ Q r ~\l O(\iJ - 4-5 ( l . INfDRl1ATlON LI"t 726-3753 Sq. Ftg. 11afn ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Pep. --Fence Demo Change/Use Other- - Owner (lDUH\ '" Pmo~!, $'.R l:'n Address4~o~~\~~n ~~~ne cons~n Le~d~r' .,~) , . I . '. Build Sfng1e ~ --- ~ Address DESIGN TEAM (name) Phone (address' (lies. no_ \ (exoirEls) (OhOM no. i Primary Mechanical CONTRACTORS (name' (address' nics. no. \ ~i. + (exnires\ i (ohane no.) Structural Electrfcal General Pl umbi no Electrical ~lechanical PLUIIBING ELECTRICAL MECHANICAL NO.1 Each single fixture FEE . C'JABf.F Nn ':f.L.CliAlll'F NO, Residence of furnace/burner to SQ. FT. BTU's FFF 'f"ARliE. Relocated buflding (new ffx. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (J bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall SLate heater and vpnt Storm Sewer Of amps. Appliance vent ~roar:atP Stationary evap. cooler iient fan wi th sin91e duct Vent system apart from heatinq or A.c.. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing re'iiQfrcp multifamily, comm. or 'ndustrial Water service COMM./IND. FEEDERS Installlalterlrelocate ~i~trih_ feedprs 10f amps. TOTAL CHARGES WHERE STATE LAN REQUIRES shall not be valiJ until the TOTAL CHARGES I SSUANCF OF PFRlllT I TOTAL CHARGES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit label has been sign~d by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed applicatfon for permft, and do hereby certify that all information hereon 1s true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i n i ng to the work descri bed here; n, and that NO OCCUPAUCY wi 11 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 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 701.055 will be used on this project. IW1E(please print)!1I'Le'.> J: t,,,,~o;, -1'1~11"f1;( S'IGIIATUREh'J!: 9~ v FOP. OfF ICE USE IlIlL Y Sq. Ftg. Ilain Sq. Ftg. Access Sq. Ftg. Other DATE Rr/1/"I'C' j Fire Zone x Value Value Value Zo~e Type/Cons t. Bedrooms Storfes Units Occy Load Occy Groun , Flood Plain , TOTAL VALUATION PLur1BING PERMIT Charges and Surcharges , Plan Ck. Conm/lnd 65%/B1~o ppr ~p~ Plan Ck. Res 30%/Bldo Per Fee Fen;;e syste,ms. Development Charoe (1. 5% '. BUILDING PWlIT Charges and Surcharges ELECTRICAL PERtllT Cha rges and Surcharges D,mo 'Slde;.a 1 k \lO.rl~ AIC Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL , \ l () ,1 S , . . j. , I COMBINATION APPLICATION/PERMIT (CAP) ~ERMIT VALIDATION 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map'Reference 17 oj qJ 2. example- Lot I. Block J, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heatlelectrical ceilin9/0r forced air Qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. \.example- 1250 SQ. foot house, 500 sQ. foot garage 2. example- 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. example - remodel existing garage into family room 3. exa~le - convert single family residence into restaurant (change of use) G. Value of work as defined in Section JDJ (al 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 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. --- 111. 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 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 permit is issued. V. FOR OFFICE USE ONLY \lee. P:- I g /75 pe~i0 Cl:~~ A~ v . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date ,-