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HomeMy WebLinkAboutPermit Sidewalk 1984-3-5 I IrISPECTION LINE 726-3769 , Job Address I Q. -l1-- C/ h<.~ Legal Description \ tz.i:)t") . INFORl1ATION LlNt 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. --Fence Demo Change/Use Other - - . CITY Of SPRINGfiELD COMBIilATION APPLlCATION/PERMIT E!/ERGY SOURCES: Heat Hater Heater LtIv J Ur\ t.fl ~ Ran!1e ValuE of Hark: lt~ ~ Address (j<9.,~n n~ D. Ao.Zld Constructio,( Lqtder Owner BullciinQ Permit Info: Describe Work(Le., Phone 79/.,,*, )'family ~esidence Hith A.ttached Garaoel ',I Build Single C;;;:idu.;',fW 6i.JtA1,G\j <;( &,I~' 0 ~,;:f (lies. no.) (exnires~ ' {ohone A ~~ ~: Address Ut~IGN TEAl.! (name) Phone (address ) Primary Structura 1 Electrical Mechanical CONTRACTORS (namel (addrpss) l1in.. no.) (pxnirpc:) (ohonfl nn, Genera 1 Plumbino Electrical 1\ . IJL;. (Jy~( pJl. PLUI!BI NG I) . '\ .JL/d./J.l.' 37 () "Jd',f',J,-4w ~ 299'/<1;,0 9/z~:<; MECHANICAL Hechanical ELECTRICAL ..J!ih I Each single fixture Fff rHARGF 'ill.... rr> rHAI!G.E. NO, Res i dence of furnace/burner to SQ. FT. BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath 1 IDuPlex (1 bath) each IAdditional bath I Ha ter servi ce I Sewer I Storm Sewer I I I I I I SERVICES Recessed wall So~~P hp~t~~ ~nrl v~nt ITempOrary Construction IChange in existing rps.iqti::n(':~ I multifami ly, COfJJTI. or Induc;tr;",l I Of amps. ICO~1./IND. FEEDERS I Install/alter/relocate rHc;trih fppr1prc; IOf amp..1 I I I Appliance vent seoaratp Stationary evap. cooler I Vent fan with sinole duct I Vent system apart from I heatino or A.C. . I Mechanical exhaust I hnod and durt j Hood stove/heater I I~~L I I I I I rp 0, ~ ~ \) " ',' .1 " no, ~rr fl-l>1B.G!. I I I 1':1,..,." I - I TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be valiJ until the TOTAL CHARGES that the Electrical work' be done by an. label has been signed by an Electrical ISSUANCE OF PFR!HT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit 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 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 rm OCCUPAfKY 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 employees who are in comoliance with ORS 701.05f:'ill be~ ~~prOject. UAI!E(please print) (?o 6 S'e-L""J .. SIGUATURE J Q,Q ':::;>~-- DATE 5c-'-\~ 'X'j" FO~ OFFICE USE Q;lL Y 1- , Sq. Ftg. Hain x Value Sq. Ftg. Access x Value Sq, Ft9. Other x Value Zone Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group Fi re Zone Flood Plain TOTAL VALUATION BUILDING PWIlT Charges an~ Surcharges Plan Ck. Corrm/Ind ____________ ~/Bldo PPl" Fpp Plan Ck, Res 30%/Bldo Per Fee r Fence I D~mo I'Sidewalk I A/C Paving I Curb Cut I 7)30 Systems Development Cha rq. (1. 5~) PLU'1BING PERMIT Charges and Surcha rges ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges '7. tV) Total Comb. Permit I TOTAL I . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION III. I. Applicant to furnish A, Job Address B. legal Description I. example- Tax Lot 100, Lane County Map Reference 11 U3 43 2. example- Lot I. 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 qas 2. examPle- waterheater/electrlcal/or solar E. Square footage 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 pennit information: 1. examole - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examole - convert single family residence into restaurant (chan-ge 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 fonm 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 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 penmit is issued. : ~ (?-~ ~1o~ * tJ8A V. FOR OFFICE USE ONLY Pennit Clerk ~ I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because.: Additi ona 1 Project Infonnation: PLANS REVIEWED BY: name signature date