HomeMy WebLinkAboutPermit Sidewalk 1984-6-13
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Job Address
116Q
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L. ~SIYO
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CITY U, SPRINGFIELD
COMBIiIATION APPLICAHON/PERMIT
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EilERGY SOURCES:
Heat
\'later Heater
Range
ValuE of flork:
INFORlIATIDN LINt
726-3753
Sq, Ftg, 1,Iain
~q. ~t9. Access.
Sq, Ftg, Other
New Add Alter Rep,
Fence_Demo _ Changel Use
Other
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(J;:)
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1 INSPECTION LINE.
726-3769
Legal De<cription T.
Owne r .
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?lJ ,.Builcilna Pennit Info: Describe Work(i-.e.. Build Single
Phone~7;:~IlI. Family Residence \-lith A.ttached GaraQe)
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'S... '&u..... ....u
10' )( '/'
Address )Cj:,!;; ~
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Construction Lend~
Address
DES I GN TEAI1
(name)
Phone
{address 1
(l ics. no.)
(exo;res}
I
no:\
{ohane
Primary
*
Structural
Electrical
!1echan; ca 1
CONTRACTORS
(name)
(addre~s)
(1 ;cs. no. \
(pxoirps)
(ohnnp no. )
Genera 1
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Plumbina
Electrical
~lechani ca 1
PLUIIBING
ELECTRICAL
MECHANICAL.
110, '
, FEE 'rHARGF Nn
I ~J:'J:' 'rI--lAIU:J:' ~m
I 1=1=1=' 1 nUHU~J:' ~
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
INew circu~ts alts.
or extenSlons
ISERVICES
I
Floor furnace
and vent
IS.F. Residence
(] bath)
IDuPlex (1 bath) each
IAdditional bath
I ~!ater service
I Sewer
I Storm Sewer
Recessed wall
Sn~rp hp~tpr ~nd vpnt
ITemporary Construction
IChange in existing
rpS; dJ'nrp
Imultifamily, comm. or
lnduc;tri~l
Of
amps,
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hood ~nd dud
10f
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TOTAL CHARGES I TOTAL CHARGES
WHERE STATE LW REQUIRES that tile Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
COffi1,/IND, FEEDERS
Install/alter/relocate
rl;~trih f~~rl~r~
Wood stove/heater
amps.1
ISSUANCE OF PFRI1IT
TOTAL CHARGES
'Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXA~1INED 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 rw OCCUPAIKY will 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 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 7Q1.055 will be used on this project.
NAI.IE(please print) tJf,jpv J
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Zone
Fire Zone
Flood Plain
Tvpe/Cons t.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGIIATURE ~ ,:J 'Y?
FOr. OFFICE USE ONLY 0-
Sq. Ftg. ,-\ain
Sq. Ftg. Access
Sq, Ftg. Other
DP.TE
6//3 Pi'
J(,.~I
x
Value
Value
Value
x
x
TOTAL VALUATlQrI
BUILDING PERflIT
Charges and
Surcharges
Plan Ck, Comm/Ind
65%/Bldo Pff~ ~Qe
------------ Plan Ck. Res
30%IBldQ Per Fee
I Fence
Isyste.ms Development
CharQe (!.5~)
PLU!~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERf~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk <{O.llt r
------------!A/C Pavin9
I Curb Cut
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7.00 I
ITotal Comb. Permit
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I TOTAL 7. a ()
I
Demo
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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
11 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. examole- heat/electrical ceilinQ{or forced air OdS
2. example- water'heater/electrlca (lor solar
E. Square footage or valuation, etc. -
1, 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. example - 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 ANO 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, BUILOING 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 Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's.Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name
signature
date
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