HomeMy WebLinkAboutPermit Sidewalk 1984-7-13
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\laSPECTIOII LlIIE
726-3769
Job Address / d.- I S r1 A I M
Legal Omription \"1 ()~ :\~\ ~ \
Owner) r-, J... I\J f\1 I [. 111 L L /:=. re-
Address / (LI- I 1'0 AI 1\/
Construction lender
Address
Ut:.::lllir~ ltM1
lnamel
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTORS
General R 0 h
(name)
c;--r-Ou,r-4I6oA
Plumbina
Electrical
f..1echanical
PLUIIBING
NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence'
(1 bathl
Duplex (1 bath) each
Additional bath
Water service
Sewer
S to rm Sewer
\ S- -.(', '? 't-\ \::'?V>.\ 0
FEE 'CHARGE Nn
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CITY UF SPRIIIGFlELD
CDrIBlaATlON APPLICATION/PERMIT
EilERr,y SOURCES:
Heat
!'/ater Heater
WFORHATION U"t. II
726-3753
Sq. Ftg. "lain
~q. F'tg. Access.
Sq. Ftg. Other
Uew Add Alter Pep.
--Fence Demo Change/Use
Other- -
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9. ?r'{j
RaMe
valup;(66 _'": '
Phone /V7j(y , ~~~~ l;~n~e~~~~~e IQf~~ P.~~~~h~~e r,~~~~~ 1,.e.. Bui ld Single
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Phone
(address)
(exoiresl
(ahOM no:\
.' (lies. no. t
-'-I ( (-11~
(addres.s )
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(lies_ no.l
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(exoirps) (ohonp no l
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(9~.5 q t..-J
ELECTRICAL
MECHANICAL
"L'...GI!ARG..E. Nn,
~H nl~
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits a1ts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
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Temporary Construction
Change in existing
rp~ i rtpnrp .
multifamily. comm. or
lnduo;trial
Appliance vent
seo"rate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust I
hoorl and duct
Wood stove/heater I
Of
amps.
COMM./IND. FEEOERS
1'lnsta11/a1ter/relocate
.rlic:trin. fppnprc:
IOf amps.
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ISSUANCE OF PFRlIIT
TOTAL CHARGES
Contractor, the electrical portion 'of this pernit
and returned to the BUilding Division
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\\/ REQUIRES that the Electrical work be done by an 'Electrical
shall not be vali1 until the label has been signed by an Electrical Supervisor
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 UO OCCUPAIlCY 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 OP.S 7Q1.055 will be used on this project.
IlAIlE(please print)~_ W.Q _ SIr.;IATURElAtl-'\ ~JM~R
FO~ OFFICE USE OfILV
Sq. Ftg,
Sg. Ftg.
Sq, Ftg.
Zone CC-
Fire Zone
Flood Plain
TYDe/Const.
Bedrooms
Stories
BUILDING PERmT
Charges an~
Surcharges
__~l~~~_
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---,,--~,_,:~----
PLU'~BING PERMIT
Charges and
Surcharges
(,10
ELECTRICAL PERI~IT
Cha rges and
SUl'cha rges
/lECHArIlCAL PERMIT
Charges and
Surcharges
DATE 7-43-B~-;'
Units
Occy Load
Occy Group
'l3in
Access
Other
x
Value
Value
Value
x
x
TOTAL V ALUA TI 011
I Plan Ck. CO,","lInd
65t/Bldo Per ~ep
Plan Ck. Res
30%/Blda Per Fee
Fence
-=<\ LO
...),
Systems Development
Charae (1.5~) ,
I Demo
I Sidewal.;,\\\\~:,?
I AIC Paving
I Curb Cut
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ITotal Comb. rermit
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I TOTAL
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(,0
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date '7-\~-Y~l\
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J. ,I,
signature(
\1 :\\)'''''--~ I r=lc.
name './~;\.. \.",..J \\ i\ "'":.\.t\
PLANS REVIEWED BY:
Additional Project Information:
Permit applicant exempt from registration with the .Builder's Board because:
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
Permit Clerk
V. FOR OFFICE USE ONLY
Q)
/1
t. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100. lane County Map Reference
II 03 43
2. examole- Lot I. Block 3, 2nd Addition to
~prlnglield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources '.
,.. 1~ examole- heat/electrical\ceilinq/or forced "air qas
Z. examole- waterheater/efectrlcai/or soiar
E. Square footage or valuation. etc. ------
1. examole- 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. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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 TEM~ AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design infonmation or jOb site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electr;cal 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 penmit 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 SCHEOULES
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 penmit 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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PERMIT VALIDATION
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COMBINATION APPLlCATlOlI/PEP:1JT (CAP)
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