HomeMy WebLinkAboutPermit Fence 1987-06-01L CITY OF SPRINGFIELD
COI{BI IIATI ON APPLI CATION/ PERMIT 7
Job Address 2 ZO
r-esal Desffiption lZ O S 3s. .3 Z_
Hea
Range
EIIERGY SOURCES
l.Jater Heater
7a* /-+ zaoo Value of l.lork
?.
Sq. Ftg. Access._
-0t her-
Sq. Ftq
Sq. Fto. I'la n_
0ther
l,ler^r Add A
-Fence Derno
rGT:Cp.-
_Change/ Use
Owne r
)0JOs
-0- Builciinq Pernrit Info: Describe Work(
'Farnily Residence I'lith Attached Garaqri
e., Build SingleAddres s A.L
-*/ C-, q74ZZ
Constructi on Lender
Addres s Phone
i ics . no.exo i res Dhone noDES I GN TEAI.I name (address
Pri ma ry
4t lOCSt ructura I
E l ectri cal
l'|echani ca l
a ddres s 'I i cs. no.CONTRACTORS name
Genera I
Pl umbi t
I I
Ul..r'
/l'lechan ical
ELECTR I CAL MECHAN I CALPLUIlB I NG
ct.tapcFNNFFFTHARGFNOFFFFEECHARGE
Residence of
FTSQ
furnace/burner to
BTLI' sEach single fixture
Floor furnace
and vent
New ci rcui ts al ts.
or extensions
Relocated building
(new f.ix. additional)
SERV ICES Recessed wal I
Soace heater and vent
S. F. Residence(l bath)
Duplex (l bath) each
Apol iance vent
seDa rat-eTemporary ConstructionAdditional bath
Change in existing
res i dence
Stationary evap
cool erl,later servi ce
mu l ti fami ly, cornm
T ndrrst-ri a i
or Vent fan with
sinole ductSewer
Vent systern apart from
heatino or A.C.0f amps.Storm Sewer
c0tr'1./IND. FEEDERS
Mechani cal exhaust
hood and duct
trJood stove/heaterInstal I /al ter/rel ocatedistrib. feeders
0f S.
ISSUANCF OF PFRI,IIT
TOTAL CHARGESTOTA.L CHARGESTOTAL CHARGES
WHERE STATE LAtl REQUIRES that the Electrical work be done by an Electrical Contractor, the e
shall not be valii until the label has been signed by an Electrical Supervisor and returned to t
and correct, and I further certif-v that any
of Springfield and the Laws of the State of
of any structure without the permission of t
Board is in full force and effect as require
only subcontractors and ernployees who are in
and all work performed shall be done in accordance with the 0rdinances of the City
rtaining to the work described herein, and that NC 0CCUPAI'ICY will be made
Division. I further certify that m.y registration urith the Builder's
055, that if exempt the basis for exemption is noted hereon, and that
I GNATURE TEl,lAl'1E(please print)
ng
701
0regon oe
he BuiIdi
d by ORS
'i ance wi th 0l?S 7n1.05 ilI be used on this pro,ject
lectrical portion of this permit
he Building Division
t completed apnlication for oermit, an hereb.y certify that all information hereon is true
Fire Zone Bedrooms Occy Load
Flood Plain Stories Occ.y Grou
Val ueZone
ToTAL VALUATIoN__
x
x
x
sq.F tg
p Sq. Ftg. other
(nConst. Uni ts
Val ue
Value
Access
Ftq. l'la i
opmentPlan Ck. Comm/Ind
65%/B1do Ppr Fee
Svsterns Deve'
Charqe (1.5{'
Plan Ck. Res
30%/B1dq Per Fee
".
BUILDING PERT'1IT
Charges anC
Surc harges
-)@FencePLUi4BING PERMIT
Charges and
Surcha rges D6mo
Sidewalk
Total Comb. Permit
ELECTRICA,L PERIlIT
Charges and
S urc ha rges A/C Paving
Curb Cut c oo.
TOTAL
I,IECHANICAL PERMIT
Charges and
Surc ha rqes
a\
(nhonp no
COMBINATION APPLICATION/PERMIT ( CAP)
I. Applicant to furnish
A. Job AddressB. Legai Description
1, example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. example- heat/electrical ceilinq/or forced air oasz. example- waterheater/electrical/or solarE. SquaiE-Tootaqe or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - if addition,
EIEcI--add, etc.F. Building permit information:1. exampje - 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)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM 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, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the app)icant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Piumbing, Mechanical, and Electricai Schedules
are available at the Bu'ilding Division1. To conserve space on the permit form the schedu'les
have been abbreviated2. If the item(s) to be instailed are not covered onthe abbreviated schedules you should consuit thefull schedulesC. BUILDING DIVISiON STAFF t^liLl FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the labei must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical iabel.III. Applicant to sign and date
l,Jhenever possibie, the initial appl ication wil I be used asa worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is.issued for his
s i gna ture.
PERMIT VALIDATION
IV, Fees and Charges
Plan check fees are due andapplication, and no plans wi
fees are paid. All other fe
payable when the permit is i
p
1
e
s
ayable at the time of the
1 be processed until these
s and charges are due and
sued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Perm'it applicant exempt from registration with the Bujlder's Board because
Additional Project Information:
PLANS REVIEWED BY
name Si gna tu re date