HomeMy WebLinkAboutPermit Sidewalk 1984-10-26
\ INSPECTION LINE
726-3769
Job Address 1('')1 P
.
CITY Of SPRINGFIELD' INFORJIATION LINt I
COMB IllATION APPLICATION/PERMIT < 726-3753
~ I (\ <.:..:+- E!lERGY SOURCES: ______ Sq. Ftg. 1,Ia i n ./ I _
- I"'; Y ~ [) \. 'ti ) Heat ___ :q. Ftg. Access. ./' "]IJ
~"Iater er Sq. Ftg. Othe (',I
./ New Ad lter Pep. G
ge ------ Fen- _Demo_Change/Use I'?
ownerl1l\\. \!h~rJ'\ !,,e]'+.P oit\QJl r\ 2:::: Describe work~~.e.. Build Single I~
Address' LJ \\ ( __ L~ ~ \t .'-1' IV \ Phone Fam; 1 y Ilesidence Hi th Attached Garaoe) \. .....,
cons~~~~n~~ ,Ul-4~q{r) \~~~P ('
.
legal De5cription
Address
Ut~ tliN TEAr~
{name}
Phone
(address J
(lies. no.)
(exoiresl
(ohane no.")
Primary
A
~
~
Structural
Electrical
Mechanical
CONTRACTOIl&. (name)
General U q, ')1\.0 Y
(address)
(lies. no.)
(exoires) (ohone no.)
Plumbina
Electrical
~lechanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
I FEE I CHARGE' NO l I HI=' . fHARG.E. NO _ I
Residence of furnace/burner to
SQ. FTc BTU's
I HI=' Ir':lARG.E.
.'
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
amps
Appl iance 'vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rpS.i r1!,n~p
multifamily, comm. or
Industrial
\
~Iater service
COMfI./IND. FEEDERS
Install/alter/relocate
r1;~tr;h_ fpprlpr~
I
Of
amps.
ISSUANCE OF PFR!11T
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\li REQUIRES that the Electrical work be done by an'Electrical Contractor, the electrical portion of this permit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 performed 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 OCCUPAr~CY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employe~ who are in compliance with ORS 7Dl.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SI"IIATURE
FOR OFF I CE USE miL Y
Sq. Ftg. r1ain
Sq. Ft9. Access
Sq, Ftg. Other
k-!./ tf~.~<
DATE 1<J~26 /<iJ'T
IIAI,lE(please print) [)II-L( ~ f me - bLf)t;, Ci..,,.,, UI/l1~
-,
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
PI an Ck.
____________ 65%1Bldo
Plan Ck,
30%/Bldo
I Fence
------------1 D(IA1o
I'S1dewa lk
I AIC Paving
I Curb Cut
------------
I
C011l11/1 nd
Ppr Fpp
Res
Per Fee
Systems Development
CharQe (1.5%) ,
PLur~BING PERMIT
Charges and
Surcharges
I
I I
I-.Q.r{) I\UAJ
I ITotal Comb. Permit
LJl? 5S I
I I TOTAL
4L/~g/ L
, ,
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
.
COMBINATION APPLICATION/PEffi1IT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
II O'j 43
2. exa~le- Lot I. Block 3, 2nd Addition to
Spr,ngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilin~/or forced air Qas
2. example- waterheaterjelectrlcal/or solar
E. Square rootage or valuation, etc. -
I. 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. exa~le - remodel existing garage into family room
3. exall!Ple - conver:~ single family res.1dence 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
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
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. ---
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.
,
111.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
, %L-\
\/&0- ~
Jt\
O~ .
\y~ (oJ3~
Pennit
cler;=dINV
Pennit appl icant exempt from registration with the Builder' s Board because':
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date