HomeMy WebLinkAboutPermit Fence 1987-2-27
I IIISPECTIOII 1I1IE
726-3769 .
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CITY Uf SPRIIIGFIElO
C0I1BIlIATION APPlICATION/PERMIT
'A " EIIERGY SOURCES:
Heat
Hater Heater
Ranqe
Valu€ of Hark:
.
lNFORllATION lie,"
726-3753
Sq. Ftq. r.iain
~q. ~t9. Access.
Sq. Ftg. Other
flew Add Alter P.eo.
--Fence Demo Change/Use
-Other -- --
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Job Address
.305
Sructh
( ?"')
legal De5crlption
Address
.L,j. \
-:2,()5
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_C: IJ", -t-/J A- Phone 'iLl I
fJO;$
13uiltiiOQ Pennit Info: Describe Hork(i..e.. Build Single
Familv I'lesidence-Uith J'I.ttached l1araae)
~fl.fl./
~ S-f..;~;'l
Owner
Construction Lender
Address
Ut~ lliH TE.Ar.'
(name)
Phone
(address 1
(1 ics. no.)
(exo; res)
(ohone no.)
Primary
Structural
t
--
1'\,00(")/
(/tv , -1
v,l.la'"/
( J/.
V'
1,flU
Electrical
11echanical
CONTRACTORS (name) /J
Genera 1 /J7 tlA.P' /i ~/
P1umbina .........-.;:... ()
"
{address)
~/ff\/'
(lies. no.)
(pmi res)
(ohonp no.)
(/Y1
Electrical
'.lechanical
PLUIIBIrIG
ELECTRICAL
MECHAN I CAL
Each single fixture
FFE CHARGE ~J() I
IReSidence of
SQ, FT,
I New circu~ts alts.
or extenslons
I SERVICES
J:'n' rHAR(;~ NO. I J:'i:~ rI-tAQ(;J:'
furnace/burner to I
BTU's
Floor furnace I
and vent
110,
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Recessed wa 11
~n~cp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
I Appl iance vent
<;eoaratf'
Stationarv evao.
cooler ~ .
Vent fan with
sinole duct
I Vent system apart
heatino or A.C.
Mechanical exhaust
hood and duc.t
from
Additional bath
Hater service
Temporary Construction
Change in existing
rec;..i4enc.p'
multifamily, comm. or
Induc;.trial
Sewer
C0I11'[, /I NO, FEEDERS
Install/alter/relocate
dic;.trih fpp(lf:.r<;.
Wood stove/heater
Of
amps.
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ISSUANCF OF PFR'lIT
TOTAL CHARGES I TOTAL CHARGES
f1HEnE STATE L\H REQUIRES that tile Electrical work be done by an Electrical
shall not be valij until the label has been signed by an Electrical Supervisor
I TOTAL CHARGES
Contractor, the electrical portion of this pe~it
and returned to the BUilding Division
I HAVE CAREFULLY EXMlI NED the comp 1 eted appl i ca t i on for germit. and do hereb.v cert ify tha tall i nformat i on 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 Soringfield and the laws of the State of OreC]on pertaining to the work described herein, and that rlC OCCUPAUCY 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
on ly subcontrac tors and emp 1 oyees who are in camp 1 i ance with ORS 701. 055 \'Ii 11 be used on thi s project.
IlAIIE(please print) S0fI0 P/lI1lULbll\lG:, FO~ or~:~~A~~ 171~'0 >
w Ftg, Ilain t/
SQ. Ftg. Access x
Sq, Ftg, Other x
OATE~_ z 7--ff'7
Zone
Fire Zone
Tvpe/Const.
Bedrooms
Stories
Units
Value
Value
Value
Flood Plain
Occy Load
Occ'y Group
TOTAL VALUATION
BUILOIIIG PERI,IIT
Charges an':
Surcharges
I Plan Ck. COlTllllInd
65%/B1do P€'r Fee
------------P"f'an Ck. R-es
30%/Bl do Per Fe.
Fence
.Syster.1s Development I
Charoe (J,5~)
PLU'1BlIIG PERMIT
Charges and
Surcharges
O~mo
\~
I
I
-.S. 00
ElECTRIUL PERI~IT
Cha rges and
Surcharges
Sidewalk
AIC Pavi ng
iotal (omb. Permit
TOTAL
I
s: ~Ol
I1ECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
'17 oj 4J
2. examele- lot 1. Block 3, 2nd Addition to
~prlngfield Estates .
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or so)ar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- Tfinew project. check-new - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as deflned in Section 303 (a) of the
Structural Specialty Code
H, DES I GN TEAI.I ANO 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
Z. 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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArJCY:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
1
date
,