HomeMy WebLinkAboutPermit Fence 1986-4-23
....--.-~...._-..~ '-"--,~-" -'.'
..
I INSPECTION LINE
726-3769
Job Address
;Z04~
n
;;:J/'hl/U1/
CITY UF SPR1NGFIELO
COHBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat '
l4ater Heater
.
INFORllATlON LINe
726-3753
Sq. Ftg. 1'1ain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add A Iter Rep.
-Fence Demo Change/Use
,Other- -
\)Q
~
\::)
~
<><:\
~
legal Oe~cription
.
,
Ranqe
ValuE of Work:
Owner-CrJjj.r{ Ifj~ull I nrVc. (l ~
Address I Ipl) ISO)( /0 tfJ//rf
/Jte
Phone 1)<1 J;
33;1/
Address
DESIGN TEAI1
fnamel
Phone
(address)
Builolna Permit Info: Describe Work(i.e., Build Single
Family np.sidence With Attached Garaael
-:1JA14'~ /~ vdiv >>$
h-i/?"--- L-iJu~;-tf~~ /~/dA
/~/J/) rf-pd'- S/ a?
(lfcs. no. l lexniresl
(ohone no.
r-.C'tif1d.
-./, I
Construct n lender
Primary
Structural
Electrical
Mechanical
CONTRACTORS (namel
General If ~/hL- ~.;oJ
rf
(address 1
(1ir~_ nn.1
(pl(nir"p~ 1
(ohnnp nn 1
./
Lj // /.-,;;, O{J
/:J- 3/-f<?'
Plumbina
Electrical
f.lechanical
PLUflB I NG
FFF IJdjARCF I Nn
ELECTRICAL
r"~
HECHANICAL
.....till."
FFF
FFF
r"AIl1iE..
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
IRelocated building
(new fix. additional)
'S.F. Residence
Cl bath)
Duplex (1 bath) each
IAdditlonal bath
Iwater service
Sewer
New circuits alts.
or extensions
Floor furnace
and yent
SERVICES
Recessed wall
~~~~tpr ~nrl v~nt
Storm Sewer
Of
amps,
Appl iance vent
~POilratp
Stationary evap.
cnoler
Vent fan with
",inole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
honrl i1.nd durt
Wood stove/heater
Temporary Construction
Change in existing
l"ps j ~pn~p
multifamily, comm. or
I ndll~ tri il 1
CO~1./IND. FEEDERS
Install/alter/relocate
rl;~tr;h_ fp~rlpl"~
Of
amps.
ISSUANCf OF PFR'IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I/ REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pemit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all infonmatfon hereon is true
and correct, and I further certify that any and all work performed 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 110 OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 ORS 701.055~ used on this project.
NAHE(please print~ / jJ~ SIGrlATURE V--d--,,,/ dM DATE 4.2g~
- - FOP. OFFICE USFAllILY
<,
Sq. Ftg. 'lain
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Stories
x
TOTAL VALUATION
BUILDING PER/lIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Bld~ P~r ~p~
Plan Ck. Res
30%/Bldo Per Fee
Fence
syste,ms Development
Charqe t1.5~) ,
PLU!~BING PERHIT
Charges and
Surcharges
Domo
I'Sldewa I k
I A/C Paving
I Curb Cut
I '-1?tu-L
I
I
I
ITota' Comb. Permit
ELECTRICAL PERfllT
Charges and
SurCharges
11ECHANICAL PERHIT
Charges and
Surcharges
0.00
I
I TOTAL
5.08
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. exam~le. heat/electrical ceilin~/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Squar:e, footage or valuation, etc. -
I. -example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check new.- if addition,
check add, etc.
F. Building pennit information: ;
1. example - construct single family house with an
a ttached 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 defined in Section 303 (a) of the
Structural Specialty Code -
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Buildlng
Division Staff must be able to contact appropriate
persons regarding design information or jab 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 ~chedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
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
signa ture.
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.
~q I-
II .G '} /~'P
V ~/J-'7 '
;.
'~
,/~M-o(c-
V. FOR OFFICE USE ONLY
Permi t Cl erk ~_
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
name
signature
date