HomeMy WebLinkAboutPermit Fence 1988-10-12
-44IP
~ CITY UF SPRINGFIELD
. COMBIIIATION APPLICATIONfPERMIT
, r--- EIIERGY ~OUIM..
7v'~~t..c.J Heat"""'-
rter Hea ter
/ Range .
lee> _D__~ ValuE of Hor1:{,5oo .1
Phone Buildina Permii Info: Oescribe Hork(i.e-{ Build Single
Familv ~esidencs-W+th-~ttached Garaop~ .
---
(~~ o/IIVfV
.
I INSPECTION LINE
726-3769
Job Address
-'
Sq.
INFORlIATION liNe
726-3753
Ftg. '.Iain
Ftg. Access.
Other
d Alter Rep.
mO_Changefuse
oQ
~
()
...0
Ul
.J)
Legal Description
Owner ~\t\;~ ~ ~ 'l)..
Address -4q{.,. rtJtJ...vt~
'--
Construction lender
Address
DESIGN TEAH
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
, Electrical
I
~1echanical
(name)
Phone
(address)
(l ics. no.)
(exoires)
(ohone no.)
~()") I ~'3 00
fnamel
{t)Y~1>h ~C!..'=--
(address) (lirs. no.)
/Zf54" A.J. .~5K
(p)(l)irp,,)
(ohnl'lp nn..)
'74" g:z,~ d.
, ,-
1'in.Y1
PLUllB I NG
ELECTRICAL
MECHANICAL
NO.1
lEach single fixture
IRe10cated building
(new fix. additional)
Is.F. Residence
(] bath \
IDuPlex (1 bath) each
IAdditional bath
I ~Iater service
I Sewer
I Storm Sewer
FEE
CHARr,E
NO
""L J:IJAB.IiE. NO.
SQ. FT.
furnace/burner to
BTU's
""L.cJJAIlG.E.
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp np~tpr ~nrl vpnt
Of
amps.1
Appliance vent
saoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from ,.
heatino or A.C.
Mechanical exhaust
hnod and durt.
Temporary Construction
Change in existing
rp'li1P.Jtl"'p
multifamily. comm. or
Tnnuc:t.ri.'ll
COMI.I.f1ND. FEEDERS
l'Install/alter/relocate
rlic:trih fpprlprc:
IOf ampsl
I
I
I
Wood stove/heater
~!\
( <.LV
'--1
I SSUANCE OF PFRrllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\l~ REQUIRES that the Electrical work be done by an,'E1ectrical Contractor, the electrical portion of this permit
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 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 Ore9on pertaining to the work described herein. and that NO OCCUPAr~CY 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 ORS 701.055 will be used on this project.
1lAf.IE(p1ease print)_~ A/ A II H/)4>I2-/s SIGIIATURE ~~.I<9{~ ; . '0 DATE/tl -/2. -$I
FD~ OFFICE USE O,ILY
Zone Type/Const. Units Sq. Ftg. f1ain x Value
Fi re Zone Bedrooms Occy Load Sq. Ft~. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Commflnd
65%/Bldo Ppr Fpp
------------ Plan Ck. R'es
30%/Blda Per Fe.
Systems, Development
Charae (1.5~) .
PLUI1BING PERMIT .~ Fence \P'I
Charges and,....... ------------
Surcharges Demo
ELECTRICAL PERIIIT 'Sldewa 1 k
Cha rges and ------------
Surcharges AfC Pavi ng
MECHANICAL PERMIT I Curb Cut
Charges and ------------
Surcharges I
-5",00
ITota' Comb. permit
I
I TOTAL
!#~
ao
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.
.
.
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
17 0:3 4)
2. example- Lot 1. Block 3, 2nd Addition.to'
sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilin~!or forced air Qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation. etc. -
1. exam~le- 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
attached garage
2. examt>le - remodel existing garage into family ,room
3. example - 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. OESIGN TEAM AND 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
2. 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
-re~ '
)J~ l~tt
Permit Clerk ~.~, ~
(D -h.-&;
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
_ name
signature
date