HomeMy WebLinkAboutPermit Curb Cut 1984-7-13
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I IrISPECTIDN L1IIE
726-3769
Job Address / d-. I S- 1'1 A I M
Legal Dmription \ 'I ()~ 7'1~ ~ \
Owner ) D h N /\1 I f.. f1 / L L 1= IL--
Address / (L/. / 1-0 ft. / /\/
Construction lender
Address
Ul:.~lliU ItAr1
(name)
Primary
Structura 1
Electrical
Meehan; ca 1
CONTRACTORS
Genera I R 0 I)
(name)
C;-r-O u 14...-,0 I'M
Plumbina
Electrical
f..lechanical
PLUIIBHIG
.....llih
, FEE 'CHARGE NO
Each single fixture
, Relocated building
(new fix. additional)
S.F. Residence
(J bathl
IDuplex (1 bath) each
IAdditional bath
.Iwater service
ISewer
I Storm Sewer
\ ISYl'X,", ~\\)
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CITY OF SPRHlliflELD INFORlIATION liNt I'
COIIBIrlATION APPLICATION/PERMIT 726-3753 ~
E!lERGY SOURCES: Sq. Ftg. 1,Iain ,,,-
Hea t S:q. Ftg. Access. ~
C'l,",..-.." !-Iater Heater Sq. Ftg, Other ~
7\0. lL) flew Add Alter ~ep.
Ranqe -Fence Demo Change/Use -c:::..
valup;r&6 ~ _, Other- - c.o
Ph ""',~OfC,Builc;ino Pennit Info: Describe Work(;.e., Build Single 1-.....0
one/ Trcbl Familv nesidence With Attached Garaqe)
~~ ~'4..L4rI. I
...l (!,,~. 1{A-/+,WilIc. -rPl/J~.
Phone
(address)
(exoires)
"
(ohone no.)
(l ics. no.)
_Yr(1)~
*
(addrpSJ; )
~~
(lies. no.)
~"1)B-
(pxn;re<:;)
(nhonp nfl. )
(!J$!.
,Tc+i- ~ f?S'}.
(9~.~ qt..-J
ELECTRICAL
MECHANICAL
ccc f'lARGE. NO.
'FCC 'f'lARGE.
,/
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
Recessed wall
Sn~rp np~tpr ~nrl vpnt
ITempOrary Construction
IChange in existing
res i dence .
I mUlti-family. COIl1Tl. or
Industrial
IOf amps.1
ICOMfI./IND, FEEDERS
'Install/alter/relocate,
d;<:;trib. feeders
IOf amps.
I
I
I
Appliance vent
<;eoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
I Mechanical exhaust ,
hood and duct
Ilload stove/heater ,
, I
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, ,
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I ISSUANCf OF PFRlllT
I TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Division
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an-Electrical
shall not be valiJ until the label has been signed by an Electrical Supervisor
I HAVE CAREFULLY EXAMINED the completed apr1ication 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 NO OCCUPArKY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7Q1.055 will be used on this project.
IlAl,IE(please print)~"- sQ~Q _ SI('11ATU~tt'\ c::; clv.t~~
FO~ OFF I CE USE OIIL Y
Sq, Ftg. rlain
Sq. Ftg. Access
Sq. Ftg, Other
20ne r r .
TYDe/Const,
Bedrooms
Stories
Fire Zone
Flood Plain
BUILDING PERI.J1T
Charges an~
Surcharges
--~~~~----
\.0.'2..
---"-~,-~~----
(,,0
PLU'~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlm
Cha rges and
Surcharges
11ECHAN I CAL PERM IT
Charges and
Surcharges
DATE 7-:13-lJS':-
Units
Occy Load
Occy Group
x
Value
Value
Value
x
x
TOTAL VALUATION
Plan Ck. Comm/Ind
6~~/81do Ppr Fpp
Plan Ck. Res
30%/BldD Per Fee
Fence
~\ ' '2.0
Systems Development
Charqe (1.5~) ,
I
I
I "l. Ct:l
I
I \ '-\, ~8
I
CoO
I Demo
I Sldewalk\\\~~~,
I AIC Paving
I Curb Cut
I
Irotal Comb. Permit
1-
I'DTAL
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COMBINATION APPLICATION/PE~1IT (CAP)
PERMIT VALIDATION
.-/
(It/; 0 3 ~ i/ J
I. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100. ~lane County Map Referen~e
II OJ 4J
2. examole- Lot I. Block J, 2nd Addition to
:>pnngtleld Estates. . . '.. ,",
Name, etc. of' owner and construction lender'
Energy Sources' . ',' ,
'-1.. ".exainole-' heat/electrical ceilin"q/or forced 'air OdS
2: examole- waterheater/electrlcal/or SOlar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq, foot garage
2. example- if new pr.oject.~check-new - if addition,
check add, etc. \
F. .Building permit information:
1. examole - construct single family house with an
a ttach€:d garllge
2. examole - 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 J03 (a) of the '
Structural Specialty Code ,U,. ,..., "
H. DESIGN TEAfl AND CONTRACTORS
6. ,,' 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 schedul es
C. BOILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOOLES ,
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.
C.
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Permit Clerk ~ ~~
V. FOR OFFICE OSE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
i
~ermit appl i cant 'exempt 'Trom reg,i s~ration with ,the-Builder' 5 .~oard becaus:e:
_.....
Additional Project Information:
PLANS REVIEWED BY:
namD ~)~'" )~ AM\.1\'-
Signatu~M...I"'\.~ \f'A \(
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