HomeMy WebLinkAboutPermit Fence 1982-7-1 (2)
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~ 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 )
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CITY Uf SPRINGFIELD
COIlBIIIATlON APPLICATlON/PERMfT
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IloJ:J1
E:iERGY SOURCES:
Heat
~.jater Heater
Ranqe
, nO 1'\ ml t ^
_, 'J
o<J
Q)
1<]
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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
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PERMIT VALIDATION
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C\TY OF SPR\NGF\ElD
ClIy Hall
sp.ingtleld, o.egon
rtment 01 public Works
~e:~ICIAL RECN~: B 59364 (
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Received !:,or:
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Amoun\ Received
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GENII: ORCGON
BRIOGS PRINTERS/LtTHOGRAPHEJlS, E~. . " .
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,I
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
1
PLANS REVIEWED BY:
name
signature
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