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HomeMy WebLinkAboutPermit Fence 1982-7-1 (2) . ...,,~ ~ . ~ ItISPECT 1011 LlIIE, 1716-3769 Job Address r041 0 INFORt1ATION UNt. I! 716-3753 Sq. Ftq. f'lain ~q. Ftg. Access. Sq, Ft9, Other r~ew Add Alter Rep. $ence_Demo _Change/Use O~X\~~ -A\~_:tf)l Y(\l"-\S. ValuE of4r(j(y),CO _Other Add f\ A (- / j _..jJ... . BUllclna pJmit Info: Descnbe Work(l.e., Build Single rcss r--.r-t _ (J _~~_' to 17 '-- Phone Far.lily l1esidence llith Attached Garaqe) '- <:::r1~ 0 r0 M Q.... I th-O(9() - ~ Xl Q..Q_ constru~tioX~~er I ) \../ CITY Uf SPRINGFIELD COIlBIIIATlON APPLICATlON/PERMfT ~....,() , IloJ:J1 E:iERGY SOURCES: Heat ~.jater Heater Ranqe , nO 1'\ ml t ^ _, 'J o<J Q) 1<] .:..J -0 Legal Description Address 'Ul:.~l{irl 1l:.1\t-' lnameJ Phone (address) (1 ies. no.) (exo;res) (phone no,) Primary Structural Electrical !1echan; ca 1 CONTRACTO~,"\ , Iname) Genera I (\lL.t J fU..,J, {address} (1 ics. no. l (exoir~c;) (ohnnp no. \ Plumb;no Electrical ~'echani ca 1 PLUrlBlNG ELECTRICAL MECHANICAL NO, ' , FEE 'CHARGF NO I FFF ' rHll.Rr,F NO. J FF~ I rHARGF SQ, FT, furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each SERVICES Recessed wa 11 Sn~cp hp~tpr ~nrl vpnt Storm Sewer Of amps.! Appliance vent sPni'lriltp Stationary evao. cooler W , Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hond tlnd dud Wood stove/heater Sewer Temporary Construction Change in existing rp); (tenc:e multifamily, comm. or Inrlustr;<ll Additional bath ~Ia ter serv; ce COI~r,1. lIND, FEEOERS Install/alter/relocate di~trih. fpeder~ Of amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE L\\/ REQUIRES that tile Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical ISSUANCf OF PFR111T TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXN1INED the completed aprlication 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 UO OCCUPAfKY 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 7nl.055 will be used on this project. IIAI-IE(please print) t 10L J..J OIn.-7" HEvf S IGi~ATURE FO~ OfFICE USE DilLY Zone Tyoe/Canst. Units Sq. Ftg. t1ain Fire Zone Bedrooms Occy load Sq, Ft!J. Access Flood Plain Stories Occy Group Sq, Ft9, Other O~,TE 7-1-~J- I) x x Value Value Value x TOTAL VALUATION BUILDING PERI,I!T Charges an': Surcharges Plan Ck, Comm/Ind 65%/Rlda Pf'r Fpp P1an Ck. Res 30%/81 do Per Fee Fence Systems Development Charqe (1.5") PLU'1BING PER!~IT Charges and Surcha rges / g, OeJ Demo ELECTRIUL PERI:IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Sidewalk AIC Paving Total Comb. rermit TOTAL /0: 06 'I ij Curb Cut . COMBINATION APPLlCATlOII/PERi'lIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference -17 63 43 2. examDle- Lot 1. Block 3. 2nd Addition 1 springtield Estates ( C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forI 2. examole- waterheater/electrlcal/or s~ t. Square footage Or valuation, etc. ----- ( 1. examole- 1250 sq. foot house, 500 sq. fo 2. examp 1 e- lTnew proj ec t, check ----new - if ' check add, etc. F. Building permit information: 1. example - construct single family house" a ttached garage 2. example - remodel existing garage into fal 3. example - convert single family residence (~ restaurant (change of use) G. Value of work as defined in Section 303 (a) of Structural Specialty Code H, OESIGN TEAM ANO CONTRACTORS To avoid design or construction delays, Buildil Division Staff must be able to contact appropri persons regarding design information or job sit corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical Sche, A. Except where blank spaces occur in the descript. portion of the Mechanical and Electrical Schedul the applicant need fill~in only the No. Boxes ad '" to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedu are available at the Building Division 1. To conserve space on the permit form the sch!: (es have been abbreviated 2. If the item(s) to be installed are not covere the abbreviated schedules you should consult full schedules C, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANI CHARGES ON THE SCHEOULES D. As noted on the CAP. the label must be delivered t electrical contractor for signature by his electri. supervisor. The general contractor is ,not authori. to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be used a worksheet only. Where possible, Building Division St, will prepare a type written copy and return it to the applicant at the time the actual permit is issued for hi signa ture. 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. II. Ill. IV. V, FOR OFFICE USE ONLY (j . .......... .~ PERMIT VALIDATION ( C\TY OF SPR\NGF\ElD ClIy Hall sp.ingtleld, o.egon rtment 01 public Works ~e:~ICIAL RECN~: B 59364 ( \ :9~i~)'\Clj\m. (. lC] ~\ LottJ '~ ~Q~~ L1 \ ( oat ,~ \ ( _(I Received !:,or: - - (6J-9-JU . ( - ( ( - ( - i - ( '--.- Amoun\ Received ~' \" -,,/" \ - ~( GENII: ORCGON BRIOGS PRINTERS/LtTHOGRAPHEJlS, E~. . " . ......J-.. .< ( Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ,I . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: 1 PLANS REVIEWED BY: name signature :-~~"7.":- ~::-::,,",::~:!":';~~.~::~--.:,,~:,~,~::,:.~::,::,,--::~=_~,_..~'::'t.~.=-:-;:':.":"':::l:"';::::::=:::::"':-=.:::~"7':::_~;,~.,~~-==::.;""~~...~;'_.__~~.._~,-___'_'"~,'.'- 1 date