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Home My WebLink AboutPermit Fence 1985-9-27 -- 'I INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT HlERGY SOURCES: Heat \~ater Heater I NFORllATION U N~ 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. Range --Fence Demo Change/Use Val~~f Hork::;) )CJ.O, Other-- -- BUilGi~rmit Info: Describe Work(i.e., Build Single Phone fo<(C(-'I1t./Familv nesidence Hith Attached Garaael ~ Job Address c.o~~ Legal Description 17 ~lQOGQq l::t 6:3 27 I o~ 0'6 <10 I Owner c:. '~I\ ~ '\0. &cf) Address Llo dS ~ (?~ p~ q,Zoz, ~(~ fYJ N) 0-.. \:) ,V; l)o Construction Lender Address DESIGN TEAM (rla~) Phone (address) (lics. no.) pg<. MJ~ (exoiresl (ohone no. \ Primary I" <j{1 Structural Electrical Mechanical CONTRACTORS (narnel General U ~ Q ~~ Pl umbi no V ~CL C(' lO-LA).; (addressl 91,1" vvJU ~ (l ics. no.) (exoires) (ohone no. ) ~~7 -/sS3 Electrical ~lechani ca 1 PUJllSmG ELECTRICAL MECHANICAL NO. Each single fixture FEE CHARGE NO I FFF rHARr,F NO. Res idence of furnace/burner to SQ. FT. BTU's FFF rHARr,F Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residel1lce (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Soace heater and vent ~Ia ter seni ce Temporary Construction Change in existing residence multifamily, comm. or Industrial Of amps. ICOMM./IND. FEEDERS I Insta ll/a 1 ter/re'l ocate distrib. feeders IOf amp~1 I I I I Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Storm Sewer ISSUANCE OF PFRr1IT TOTAL CHARGES . TOTAL CHARGES TOTAL CHARGES WHERE STA1r:E L'\l~ REQUIRES that the Electrical work be done by an-Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA~lINED 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 Springfie]d and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAHCY will be made of any structu,"e without the permission of the Building Division. I further certify that my registration ~Jith the Builder's Board is in f~l>> force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontracto~s and employees who are in compliance with ORS 701.055 will be used on this project. Zone Fire Zone Flood Plain Type/Collst. Bedrooms Stari es Units Occy Load Occy Group SIGN^TURF~<~.jf~ ~ ~~~ FOR OFFICE USE ONLY Sq. Ftg. 11ain x Sq. Ftg. Access x Sq. Ftg. Other x DJ\.TE 9'...~7.-~b rW.1E(please print)/J/.7/7j7/J// --t: ~clA- Value Value Value TOTAL VALUATION BUILDING P[R.~IT Charges and Surcharges Plan Ck. Comm/lnd ____________ 65%/Bldo Per Fee Plan Ck. Res 30%/Bldo Per Fee 1<6 ' DO 'Systems Development I Charge (1.5%) , PLU/1B ING PERMIT Charges and Surcharges Fence ------------ I D6R10 I'Sidewa 1 k - --- - - --- ---I A/C Paving I Curb Cut I I I ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Total Comb. Permit I TOTAL \~~V5'- I . . 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 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfleld Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. example- waterheater/electrical/or 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. example - 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 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. BUILDING 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. ~ I ~ ~y ~ /~i J G~ ~ V. FOR OFFICE USE ONLY Permit Clerk L PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ~ name signature date