HomeMy WebLinkAboutPermit Fence 1988-10-10
1
I INSPECTION LINE CITY OF SPRINGFIELD INFDRlIATIDN UNL .1
726-3769 _ CmlBIIIATION A~LI,CJ;lON/PERMIT 726-3753
Job Address 19..l77~ Z~ ;;:,,~~~~~~GY SOURCES ~~ ~i~ ~~~~ss
Legal Dmnptlon17CJ,2 3/ ;;);;;J 002d1I,aterHeater Sq Ftq Other
New Add Alter oep
/) -Fence Demo change/Use
Owner A4.MtJ~ fJ.-t.L:4YJw-i'LANJ r ~:~:: of Ilork dOOO Other--
Add Phone BUllGlnq Pernllt Info Descnbe Work(, e , BUlld 5,ngle
ress'-- - Farnlv ('{esldence 14,th Jlttached Garaae)
~A1LQ-/
.
Constructlon lender
~:
~
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Address
DLSIGN TEAr1
(name)
Phone
(address I
(11C5 110'
(eXDlres)
~I
(ohane no )
Pnmary
Structural
Electncal
. A \
/V- .
Mecham ca 1
CONTRACTORS
(name)
f/t/l/?/}_
(LJ/LX--7Vl'l
(address)
(llCS
nn )
(eXlllres)
(ohnnp no \
Genera 1
;~t~
Pl umbl no
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C2.M
Electrlcal
C//L/r
- .
~1echanl ca 1
PLUllBING
ELECTRICAL
MECHANICAL
NO
FEE rHAR(.;F Nn
~H. fl-l.lH1GI= NO
I n:j: fl-lllQ(.:i="
Each slngle flxture
ReSldence of
SO FT
furnace/burner to
BTU's
Relocated bUlldlng
(new f1X add1tlonal)
New c1rcu1ts alts
or exterlS10ns
Floor furnace
and vent
S F Pes1dence
(l bath)
Duplex (1 bath) each
Addltlonal bath
SERVICES
Recessed wall
SOilrp hPiltpl" ;:Iflri \/Pflt
Storm Sewer
Of
amps
Apol1ance vent
seoarate
Stat10nary evao
cooler
Vent fan W1 th
s1nale duct
Vent syste~ apart from
heat1na or A C
Mechan1cal exhaust
hoad and dur:t
liood stove/heater
Sewer
Temporary Construct1on
Change 1n eX1st1ng
resldpnrp
mult1fam1ly, com~ or
IndlJstnnl
~Iater serV1 ce
C0I111 IIND FEEDERS
Install/alter/relocate
dl~tr1h fppdprs
Of
amps
t~
ISSIJANCF OF PFR'lIT
TOTAL CHARGES
Electr1cal Contractor, the electr1cal portlon of th1S perm1t
Suoerv1sor and returned to the BU1l?1ng 01v1S1on
TOTAL CHARGES TOTAL CHARGES
WHERE STATE 1.'1, REQUIRES that the Electncal work be done by an
shall not be val1j unt1l the labe1 has been s1gned by an Electr1cal
I HAVE CAREFUllY EXMlINEO t1e completed apol1cat1on for oerm1t, and do hereby cert1fy that all 1nformat1on hereon 15 true
and correct, and I further cert1fy that any and all work oerformed shall be done 1n accordance w1th the Ord1nances of the C1ty
of Spnngf1eld and the laws of the State of Ore~on oerta1mng to the work descnbed here1n, and that fm OCCUPAfKY w1ll be made
of any structure w1thout the perm1ss1on of the GUlld1ng 01v1s1on I further cert1fy that my req1stratlon wlth the BU1lder's
Board 1S 1n full force and effect as requ1red by ORS 701 055, that lf exempt the basls for exemptl 1S noted hereon. and that
only subcontractors and eMployees who are 1n comol1ance w1th OPS 7nl 055 \1111 be used on thlS proJec
NAHE(please pnnt) \2-0 fVA L D
t.-\ FlI2J;:' is" SIGNATURF ~ _ !'/ ~(
FOr OFFICE USE OIIL y
DATE (0 'I'D-~
Zone
Fue Zone
Flood Pla1n
Tyee/Const
Bedrooms
Stones
Um ts
Occy load
Occy Group
So Fto na1n
Sq Ft~ Access
Sq Ftg Other
x
x
x
Val ue
Value
Value
TOTAL VALUATION
BUILDING PER~IIT
Charges and
Surcharges
Plan Ck Comm/Ind
65%/Bldo Ppr Ff'e
Pl an Ck Res
30%/Bldq Per Fee
I
I
\~I
.Syste~s Development
Charqe (1 5~)
PLU'1BING PERMIT
Charges and ""
Surcha rges
Fence
Cj,OO
D@ii!ffio
ELECTRICPL PERI~IT
Charges and
Surcharges
Sidewalk
AIC Pavlng
Total Comb Permlt
MECHANICAL PERMIT
Charges and
Surcharges
~___________: Curb Cut
I
I TOTAL
s
C'c)
,
COMBINATION APPLICATIONIPERMIT (CAP)
PERMIT VALIDATION
Appllcant to furnlsh
A Job Address
B Legal DescrlPtlon
1 example- Tax Lot 100, Lane County Map Reference
II 03 43
2 example- Lot 1 Block 3, 2nd Addltlon to
Sprlngt1eld Estates
C Name, etc of owner and constructlon lender
o Energy Sources
1 examole- heat/electrlcal celllnqjor forced alr qas
2 examyle- waterheater/electrlcal/or solar
E Square footage or valuatlon. etc
1 example- 1250 sq foot house, 500 SQ foot garage
2 example-,f new proJect. check new - If add,tlon.
check add, etc
F BUlldlng perm,t lnformatlon
1 example - construct slngle famlly house wlth an
attached garage
2 example - remodel eXlstlng garage lnto famlly room
3 example - convert slngle famlly resldence lnto
restaurant (change of use)
G Value of work as def1ned 1n Sect10n 303 (a) of the
Structural Spec1alty Code
H DESIGN TEAM AND CONTRACTORS
To avo1d des1gn or construct1on delays, BU1ld1ng
01v1s1on Staff must be able to contact appropr1ate
persons regard1ng deslgn 1nformat10n or Job slte
correctlons, etc
II Abbrev1ated Plumb1ng. Mechan1cal. & Electr1cal Schedules
A Except where blank spaces occur 1n the descr1pt1on
port1on of the Mechan1cal and Electr1cal Schedules.
the appllcant need f111-1n only the No Boxes adjacent
to the approprlate ltem(s) to be lnstalled
B Full Plumb1ng, Mechan1cal. and Electrlcal Schedules
are ava1lable at the BU11d1ng Olvls10n
1 To conserve space on the permlt form the schedules
have been abbrev1ated
2 If the ltem(s) to be 1nstalled are not covered on
the abbrev1ated schedules you should consult the
full schedules
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be del1vered to the
electr1cal contractor for slgnature by h1S electrlcal
superVlS0r The general contractor 1S not author1zed
to slgn the electr1cal label
III Appl1cant to slgn and date
Whenever posslble. the ln1t1al appl1cat1on w1ll be used as
a worksheet only Where poss1ble. BU1ld1ng Olv1s1on Staff
w1ll prepare a type wr1tten copy and return 1t to the
appl1cant at the t1me the actual perm1t 1S lssued for h1S
slgnature
IV Fees and Charges
Plan check fees are due and payable at the t1me of the
appl1cat1on, and no plans wl11 be processed unt1l these
fees are pa1d All other fees and charges are due and
payable when the permlt lS lssued
I~ 5 1&
I ()~/[) r-t(
V FOR OFFICE USE ONLY
Permlt Clerk
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Perml t appl 1 cant exempt from reglstratlon wlth the BUll der "5 Board because
Addltlonal ProJect Informatlon
PLANS REVIEWED BY
name
slgnature
date