HomeMy WebLinkAboutPermit Fence 1982-7-1
.
~ .~ l'
CITY OF SPRINGFIELD
COI1BIIIATlOfl APPLICATION/PERMIT
.
I INSPECTION LINE.
726-3769
Job Addr~ t04/ 0 ~'){), IloJ:rl
Legal Dmription \In 3 3Lo 32..:(::(OCfn\
o~'x\~LD~ ~\_Ltr')~ Y(\l"\s,.
Address M ((J s-"JN./ to --!:t\ ' ~ -Phone
constr~~~rd J - ~ ,lb-O(9()
INFORI1ATlON L1N'
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq, Ftg, Other
r~ew Add Alter Rep.
Ranqe ~nce_Demo_change/Use
Valu, of4r(j(y) ,00 , _Other
Buildina Pe+'mit Info-: Describe \~ork(Le., Build Single
FamilY Residence With Attached Garaae'
ts(\(\ lL. '- ~O 1\ ml r 1J
EIIERGY SOURCES:
Heat
Hater Heater
~
Q)
~
I~
-0
Address
DESIGN HAl,'
{name}
Phone
{addressl
(1 iC5. no.'
(exo;res)
(ohane" no.
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTO~ (namel
Genera 1 (UJ..1 ') IliA
{addr~ss ,
(1;1"'.5. no.' ~ (exlJirpc;)
(I')hnne no.
Plumbina
~
Electrical
~1echan; ca 1
PLUI1BItIG
ELECTRICAL
MECHANICAL
NO,
FEF r.HARr,F Nn
FFF fHARhF NO.
FFF fHARG[
SQ, FT,
furnace/burner to
BTlI' 5
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Snac~ hpatpr ann vpnt
Storm Sewer
Of
amps.
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnnd and duct
Sewer
Temporary Construction
Change in existing
rp~jdf'nr::p
multifamily, comm. or
lndustrial
Additional bath
~Iater servi ce
COMI'!. II NO, FEEDERS
Install/alter/relocate
rli<;trih, fppdpr<;
Wood stove/heater
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\I~ REQUIRES that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I SSUANC, OF PFR!IIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN11NED 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 Derformed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the Sta te of Oregon perta i n i ng to the work descri bed herei n, and tha t rw 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 ORS 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.
I~AI'IE(please print)~k IA
U nUL:, /7{E\,f
SIGIlATURE_~~ n~
FO~ OFFICE USE DilLY I)
DATE
7-1-~J-
x
Value
Value
Value
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. f1ain
Sq. Ftg. Access
Sq, Ftg, Other
x
x
TOTAL VALUATIOIi
BUILDING PERI,IIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ 65%/Rldo J:pr Fpp
Plan Ck. Res
30%/Bl do Per Fee
____________1 Fence
Demo
Systems Development
Charqe (1. 5%)
PLUI1BIIlG PERMIT
Charges and
Surcha rges
/ [5, O()
ELECTRICP,L PERI~IT
Cha rges and
Surcharges
Sidewalk
A/C Paving
Total Comb. rermit
TOTAL
/0'.06
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
.
,>
COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A. Job Address
B. Legal Description \
1. example- Tax lot 100, Lane County Map Reference
1/ uj 43
2. example- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates. .
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air qas
2. example- waterheater/electrlCaJ/or solar
E. Square footage or valuation, etc. -
1. examele- 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. examEle - 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 ab1e 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 an
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 ~ivision 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
I'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
",\
Permit Cl erk
~
Permit applicant exempt from r~gistration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
'.-.;......-.... _...h,.~..._...,....::::t:J;'1;;.'.::::-~':::::...._.._..........,.=:;::,t:..-;::~.-o:~""~~":_...\...........",_...,;..:.;"-0-."'.............:.:....
,:;,-._'-.::-:...............
date
........................-
,J