HomeMy WebLinkAboutPermit Fence 1985-2-20
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I UlSPECTlON LINE
726-3769
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CITY ue SPRINGfIELD
COMBlilATlON APPLICATION/PERMIT
EiIERGY SOURCES:
Heat
t1ater Heater
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fNFORJ1ATION liNt
726-3753
Sq. Ftq. I.lain
~q. Ftg. Access.
sq, Ftg. Other
New Add Alter Rep.
Fence_Demo _Change/Use
Other
.
)5"/7 ".6, '/j.'
Legal Description \'103?>l{):5dtn\02_
_n 011),1
Owner fr'/1 jJ ItJ t% U!J.-IfA4.A.//X)
'ddms 9cr Y .J<. /-I,sro ~ Phone '14' '1
constru~ tf/" 0 R- 9.297 ~ ()tRd,q
Job Address
Address
DESIGN TEAr1
(name)
Phone
(address l
1'-
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Bui1C:1M Permit Info: Descnbe \~orkll.e.~ BUlld Single l \':)
Familv l1esidence Ilith Attached (;araoe) I \
~~.A(l ~I fJ#UI-; ~,'Vi
;iAKU'f'- AJ/UAf) ~ ~J:f ~.
(t lei {~ no~'!t (J ~~Dhone-no.1
Ranqe
ValUE
of l'lark:
Primary
Structural
Electrical
Hechanica 1
CONTRACTORS
(name)
(addrpss)
(1 ice;, no. \
(pxoirpc;, \
(nhnnp M. )
Genera 1
(luJ~
Plumbina
I Electrical
~'echanical
PLUIIB I NG
ELECTRICAL
MECHANICAL
110.
FFF rHARGF Nn
FFF fHARhF NO.
F'FF rHARr,F
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Res i dence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Ouplex (1 bath) each
SERVICES
Recessed wa 11
Sn~rp hp~tpr ~nrl ~pnt
Storm Sewer
Of
amps.l
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole rluct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and durt
Additional bath
Sewer
Temporary Construction
Change in existing
rps i (tpncp
multifamily. comm. or
lnduc;trial
~Jater servi ce
COMi'\, /lNO. FEEDERS
Install/alter/relocate
distrib. fpprlprc;
Wood stove/heater
Of
amps.
TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electr;ca1 work be done by an.
shall not be valij until the label has been signed by an Electrical
I SSUANCf OF PFRtHT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed ap['llication 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 OreCJon oertaining 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 701.055 will be used on this project.
SIGIIATURE ~ / ('"
- - --
FO~ OFFICE USE DIlLY' ~
Sq. Ftg. t1ain
Sq. Ft~. Access
Sq. Ftg. Other
NAME(p1ease print) 11'~;t
:::::iOh"N..J'....v
DATEc5l-.:zc:> ~--
(
Zone
Fi re Zone
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERflIT
Charges and
Surcharges
, )0' tH) ,
------Q...:_---
Plan Ck.
6s%/Bldo
Plan Ck,
30%/Bldo
Fence
ComlInd
Ppr Fpp
Res
Per Fee
ISystems Development I
Charqe (1. 5r,)
PLUt1BING PERMIT
Charges and
Surcharges
Demo
ELECTRIC;,L PERI~IT
Charges and
Surcharges
Sidewalk
------------
I AIC Paving
Curb Cut
I
ITotal Comb. rermit
IIECHANICAl PERMIT
Charges and
Surcharges
TOTAL
l8~ ,
.
,
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
II uj 43
2. examele- lot 1. 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. examole- waterneater/electrlcdl/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exam~le- if new project, check-new - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached gar~ge
2. examele - 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 TEAM AND CONTRACTORS
To avoid design or construction delays. 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
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 nat 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:
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~
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PERMIT VALIDATION
,:<, (pl/a~ 7
tfrJ O&)~(jpr
Permit Clerk
M
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date