HomeMy WebLinkAboutPermit Fence 1979-10-8
I INSPECTION LINE
726-3769
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CITY UF SPRI NGF I ELD ..
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
'.Valu, of Work:
T',C\bl:>.~
Bul1riina Permit Info:
Familv Residence With
INFORlIATiOH LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
. ~Fence_Oemo_Change/Use
_Other
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Job Address ("fn"-l G-vu.V\Ht_i'lo..Lt...
Legal Description
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Owner 10M ~ Lc>o........o.. S~e.\<r'\cH:."'-
Address Cl,.n V'i\f'... a....s. ~,c:.'c 721,~h<l!""2 q
Descr.be Work(i,e., Build Single
Attached Garaae)
Construction Lender . ""'0"'- ~
, 1=~Y\c.r.. G,' n....ou.V\ri ~ Ie
.3' 0...'-'0 \A ~d. \,.,. ""'" +-
Address
DE~jGN TEAH
(!lame I
~,,\~
Phone
t address 1
.....:
.flies.no.)
(exoires)
(ohane no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name I
(addrpc;s)
nie's. no.)
(PXr:li rpsl
(ohonp no
Genera 1
s~\c
Plumbina
Electrical
. . ~ .
~lechanical
PLUt.1S I NG
. ELECTRICAL
'rl"
. MECHANICAL
NO.
FFF rHARr,F Nn
Each single fixture
Residence of
SQ. FT.
furnace/burner to
STU's
IRelocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
IAdditional bath
Iwater" service
I Sewer
.1 Storm Sewer
I
I
I
I
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
I
I
I Recessed wall
~~~rp hp~t~r ~"rl wpnt
I
l
I
I
I
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10f
COMM./IND. FEEDERS
Install/alter/relocate
rl;~trih fpArlpr~
amps.
Appliance vent
~~oa ra t~
Stationary evap.
c:ooler
Vent fan with'
!;.inalE~ duct
Vent system apart from
heatina or A.C.
I Mechanical exhaust
hand ~nd dud.
Temporary Construction
IChange in existirg
rp') i dYJlre
Imultifamily, camm. or
, Induc;trial
Wood stove/heater
Of
amps.
.,.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali~ until the
I
I
I TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an. Electrical
ISSUANCF OF PFRillT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
'I
I HAVE CAREFULLY EXAMINED the completed application for ~ermit. 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 Sari n9f; e 1 d and the Laws of the S ta te of Oregon pe rta i n i n9 to the work descri bed here in, and tha t rm OCCUPAHCY wil 1 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 cornoliance with ORS 701.055 will be used on this project.
Zone
Fire Zone
Flood PhTn
Tvoe/Cons t.
Bedrooms
Stories
"''''l.' ,,,.\-\"''''" '_~SIr,1IATUr-- ~ ~ .....Q\.V ~'O.....
FOr. OFFICE USE O"LY
So. Ftg. 11aln
Sq. Ftg. Access
Sq. Ftg. Other
.,
rW.IE(please print) Tn Ll LA
OATE lo":'R- 7q
Units
Occy Load
Occy Group
x
Value"
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfllT
Charges anC:
Surcharges
~ ~ -::::-) . Plan Ck. conmlIndl
~~0~__-____ 65%/Bldo Psr Fpe
. Plan Ck. Res . -
------------, :;:"',"tJ IIO~)
.Sidewal k
------------
I A/C Pavi ng
Curb Cut
Systems Development
Cha roe {l. 5~)
PLUI~SING PERMIT
Charges and
Surcharges
~ _ .J..- .
.':.fJt;-;:'.;- .
.~--' .
- .
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANrCAL PERMIT
Charges and
Surcharges
: .Cot
....;... .
.:.......
.r
Total Comb. Permit
'..:. .. ...,:....:::,
'~.- --.......'Wl;.._,-"._.--.'"",.,
-.. . ,.. : ,
. I,OT"L . .'. . ...,... .
. .
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COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
.-' .:.B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
17 03 4J
2. examole- Lot 1. Block 3, 2nd Addition to.
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ce;l;nq/or forced air Qas
2. examole- waterneater/electr1caJ!or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examJDle - 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. OESIGN TEAM 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
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
. . C. BUILDING DI'IISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. . 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 OCCUPANCY:
'.
I
PERMIT VALIDATION
. . .
:ITY OF SPRINGFIELD
City Hall
Springfield. Oregan
Department of Public Works
OFFICIAL RECEIPT
,.
No. B 517t.
., ~K'-t-J. PJ 19 'lC\
I From \("')('(\ ~'(\ l;) \ I\t\('I
ress \C)\()U ~~0_~tO ".~
ived For:
~tr~
..:fJu.6\1-5
I(),CO
aunt
Received \,( ) 00
l't~
,.-.
Ml\fL>
~H~~r;o SIGNATURt!: l
.....lTO...'u.....u~~ ....'..'....5 . ..1.10....... 0" .7.01 ...".,
"-
. ~..o ~ 0 _ _ _ .0 _. .. _ 0 ~ _ . . .._ . _ .
Pennit Cl erk
".,,~ I
Pennit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
.. name
---'signature
-......
'date'
".
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