HomeMy WebLinkAboutPermit Curb Cut 1988-7-13
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I INSPECTION LINE
726-3769
Job Address
legal De5cription
Owner.
Address
/&1'3
Construction lender
Address
Ul,IGN TEAl'!
Primary
Structural
Electrical
Mechanical
CONTRACTORS
.
.
INFORllATION L1Nl II
726-3753
Sq, Ftq, r,lain
~q. Ftg. Access.
Sq, Ftq. Other
Ilew Add A Her ~ep,
-Fence Demo Change/Use
-Other - -
~
\)
~
\)
CITY UF SPRINGFIELD
COMB IllATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Range
)~73
!f}(j3
P1A.& ~
3(03/
OSOCy{)
Valu€ of Hork:
BuilciinQ Pennit Info: Describe Work(Le., Build Single
Familv nesidence With Attached Garaoel
~ f7~ t:,r
r
(name)
Phone
(address)
(nhone nDc
flies. no.)
{exoiresl
C'1/')O
t:'))..-V\ --'
'*
(T)hMP nn
Genera 1
In"",,1
/{jf'~tJ r>H
(p'l(I');"'P';'
Relocated building
(new fix. additional)
S,F, Residence
11 bath \
I Duplex (l batlll
1 Additional batb
I ~Iater service
I Sewer
I Storm Sewer
I
I
I
I
Plumbina
Electrical
~lechani ca 1
NO,I
Each single fixture
(i'lrl,dress'
flir:s no \
/)Av\
PlIJ'illIIlli
. . l
t"t:~ rU.dQr.~
ELECTRICAL
MECHANICAL
I FEr I r.HAR~F Nn I n~ . r\..lllQr.~ ~m
Residence of
furnace/burner to
BTU's
SQ, FT,
INew c;rcu~ts alts.
or extenSl0ns
I SERVICES
.-,
Floor furnace
and vent
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
each
I
I
-b
tit I
I
I
I
I
ITempOrary Construction
Change in existing I
rp<:;;dpnrp
mult{family, COI11l1. or I'
Inrlu<;.trial
IOf amps,l
ICO~1,/INO, FEEOERS
IInstall/alter/relocate I
rli~trih fpprlprc;.
IOf amp~1
Wood stove/heater
1 App 1 ; ance vent
s~oari'ltp
I Stationary evap.
r(l('ller
1 Vent fan with ---
sinale rluct
I Vent system apart from
hf'i'ltinq or A.C.
I Mechanical exhaust
hood nnd rltlrt
ISSUANCE OF PFRllIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\W REQUIRES that the Electrical work be done by an."Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREfUllY EXArlINED 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 NO OCCUPAr~CY will be made
of any structure ~thout the permission of the Building Division. I further certify that my registration with the Builder's
Board is in f~lJ 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 701.055 will be used on this project.
rWIE(please print)
Zone
Fire Zone
Flood Plain
BUILOING PERNIT
Charges and
Surcharges
PLU!1BING PERMIT
Charges and
Surcharges
ELECTR I CAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
IJt1I1(2V j)E"fJICTH
OATE 1-13 ~8 g-
SIGNATURE ~ ,/0 ~ ~
FOn OFFICE USE DIlLY (/
Sq, Ftg, 11ain x
Sq. Ftg. Access x
Sq, Ftg, Other x
Value
Value
Value
I
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
TOTAL VALUATION
Plan Ck, Comm/lnd
65%/Bldo P~r Fpp
------------ Plan Ck, Res
30%/Bldo Per Fee
r Fence
------------
I D~R10
I Sidewalk
------------1 A/C Paving
____________1 Curb Cut
1
Systems Development
Cha roe (I. 5~)
I
I
I
\1--
I
ITotal Comb. Permit
(0,9'0 I
J TOTAL
(0 " r 0
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
'11 oj 43
2, exam~le- Lot 1, Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilin~/or forced air Qas
2. examole- 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. examele - construct single family house with an
attached garage
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 303 (a) of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction deiays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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. ---
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
II ?Iff
1..;(?? ~ r C(
Permit Clerk
c?
.
1
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date