HomeMy WebLinkAboutPermit Fence 1988-05-18I
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COMBINATION APPLICATION/PERMIT 726-375
Job Address 3 tO V"r r'\\I{EIIERGY SOURCES
Hea t
llater Heater
Ran
n
Sq. Ftg. Access._
Sq. Ftg. other_
_l,lew_Ad d_A1 te r_Pe p .
_Fence_Demo Change/Use
0ther
s
CO
D
+
&)p
l-egal Description (, tr*-kt .t i,V s
I oo
Owner o
Value of tlork:
Soo''
-v'|, n_-rAddressl3ts s A-nnon{J}-(,7}f-Bui
Fanr
n n scr
Ga ra
re., Build Sinqle
Fo- t.e- - gu c-lonq
Construction Lender So-o* s
Address I 0 +\ + ULo -lq-{r,r.
6j.r--70 ri )-
Phone
DESIGN TEAI.I name address s n exD t res ohone no.
Pnimary
Structura l
El ectri cal
Mechan i ca I
CONTRACTO RS name a ddrps s lics. no.exDt res (ohone no^ )
Genera I
Pl umbi nq
El ectrical
l'lechan i ca I
PLUTIBI NG ELECTR I CAL MECHAN I CAL
NO FEE CHARGE NO FFF CHA RGF NO FFF .HAAGF
Each single fixture furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New ci rcui ts al ts
or extensi ons
Floor furnace
and vent
S. F. P,es i dence(l hath)SERV I C ES Recessed wal I
SDace heater and vent
Duplex (| bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa ra t-e
[,later servi ce Change
res i de
in existing
naF
Stationary evap
coo l er
Sewer multifamily, conn. or
Tndrrctrial
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
c0Mr'1./rND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
distrib. feeders llood stove/heater
0f amp s.
rE}J CE 5e
ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES 65- ee
WHERE STATE L{li REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Div'ision
i HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NC OCCUPANCY will be madeof any structure without the perm'ission of the Buiiding Division. I further certify that m.y registration urith 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 ernployees who are in compliance with 0l1S 701.055 will be used on this nroject.
l,,lAt'lE ( pl ease pri nt )'("I-IGNA C DATE
Zone Cons t.Uni ts Sq. Ftg. l4ai al
Fire Zone Bedrooms
Flood Plain Stories
Load Ftg Access x Val ue
0cc.y Group Sq. Ftg. 0ther Val
TOTAL VALUATION
BUILDING PERNIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/81tio Per Fce
Svs
Cha
terns Derqe tl.VC
57
opment
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Su rc ha rges
Fence I 5,oo
D6mo
ELECTRICAL PERIlIT
Charges and
Surcha rges
Sl dewa l k
A/C Paving
Curb Cut
Tota'l Comb. Permit
I4ECHANICAL PERHIT
Charges and
Surc harges TOTAL
6se
Residence of
SQ. FT.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County l
17 03 432. example- Lot 1. Block 3, 2nd Addit
Springfield EstatesC. Name, etc. of owner and construction l,D. Energy Sources
l. example- heat/electrical ceiling/o?. example- waterheater/elbttilcalTorE. Square footage or valuationl-eTtl-
PERMIT VALIDATION
Map Reference
ion to
ender
r forced air gas
sol ar
F
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.
Building permit information :1. exampie - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)
Value of work as defined in Section 303 (a) of the
Structura'l Specialty Code
DESIGN TEAII AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, &A. Except where blank spaces occurportion of the Mechanical and E
the applicant need fill-in only
Electrical Schedulesin the description
'I ectrical Schedules,
the No. Boxes adjacent
B.
to the appropriate item(s)Full Plumbing, Mechanical,
to be installed
and Electrical Schedules
III
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the 'item(s) to be installed are not covered on
the abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor .is not authorizedto sign the electrical label
Appiicant to sign and date
Hhenever poss'ible, the initial application will be. used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
PIan check fees are due and payable at the t.ime of theapplication, and no plans wi1) be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV.
v rmit Clerk
Pr * //5,3
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name S1 g nature date