HomeMy WebLinkAboutPermit Sidewalk 1988-5-31
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Job Address
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CITY Uf SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Ran!le
ValuE of I'/ork:
.
INFORlIATlON LINt
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
--Fence Demo Change/Use
Other- -
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jlNSPECTlON LINE
726-3769
Legal
Owner
Address
Phone 1~
Builclna Permit Info: Describe Work{i,eo, Build Single
Familv rl.esidence Hith A.ttached Garaael
/,5' ~ /,/L /J.l.r0A./d/C
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Construction lender
Address
Ut'lliN ltAI1
I Mile J
Phone
(address)
(lies. no.)
(exniresl
,r ohone no.. I
*
Primary
Structural
~:+I, I::; :;l,60
Electrical
Mechanical
CONTRACTORS
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Genera 1
Plumbino
Electrical
~'echanical
I'llJll3l1lG
ELECTRICAL
MECHANICAL
NO.1 ' FH 'rHA~r.f
-1.Each single fbtlJre
I Relocated bujl~in~
. (new fix. additional)
S. F. Residence
(1 bath]
Ouplex (1 bath) each
Additional bath
Nn
I ~n.
, rH'IRti.E. _ill!.,.:
'n:'~ I r~l1R!iE
SQ. FT.
furnace/burner to
BTU's
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
~narp hp~tpr ~nrl vpnt
Storm Sewer
Of
COMf1./IND. FEEDERS
Install/alter/relocate
d;c;tr;b. fppdpr~
amps.
Appliance vent
5~[)aratF!
Sta'tionary evap.
cooler
Vent fan wi th
c;inole duct
Vent system apart from
heat;na or A.C.
Mechanical exhaust
hoorl and duct
Wood stove/heater
~Iater senrice
Temporary Construction
Change in existing
rec; i Qe.ncp
multifamily, comm. or
Industrial
Sewer
Of
amps.
M~
I SSUANCf OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE 5TATI l'\1I REQUIRES that the Electrical work be done by an EI,ktrical Contractor, the electrical rortion of this pemit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
I HAV[ CAREfUllY EXAtlINED 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 aoo the laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPAr~CY will be made
of any structure ~ithout the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in lull 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 OP.S 7Ql.055 will be used on this project.
IIAHE(please print)
ME-LVI (\)
fJ tc.}-if') LS SIGUATURE
U4~ )(~
OATE
5'31 f!
Zone
Fire Zone
Flood Plain
FOr. OFF! CE USE DIlLY "-
Tyoe/Const. Units So. Ftg. t1ain
Bedrooms Occy Load Sq. Ftg. Access
Stories Occy Group Sq. Ftg. Other
x
x
ValuE"
Value
Value
x
TOTAL VALUATION
BUILDING PElmlT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65~ Bld~ Ppr Fpe
Plan n. R-es
30%lBldo Per Fee
Fence
Systems Development
CharQe (!.5~)
PLU!IBING PERMIT
Charges and
Surcharges
Dell\Q
Sidewalk
A/C Paving
IL {9,.,t
I
I
-'33-1/J I
ITotal Comb. Permit
I
I TOTAL
~), 10
I
ELECTRICAL PERr~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
~
7 "
.
.
~ ~. -\
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. 'Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II uj 43
2. exa~le- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqfor forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check new - if addition.
check. add. etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached gan~ge
2. examele - remodel existing garage into family room
3. examyle - 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 TEAI.I 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
fu 11 schedu 1 es '
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. ---
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.
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V. FOR OFFICE USE ONLY
Permit Cl erk
c~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registration with the Builder' sBoard because:
Additional Project Information:
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ORDELL CONSTRUCTION CO.
COMMERCIAL - INDUSTRIAL
MEL NICHOLS
PLANS REVIEWED BY:
TELEPHONE:
AREA CODE 503
485-4711..0FF1CE
7"7-3489 SHOP
746-2865 HOME
OAKMONT OFFICE BUILDING
SUITE 21"
2300 OAKMONT WAY
EUGENE, OREGON 970401
name
signature
date
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