HomeMy WebLinkAboutPermit Fence 1984-02-25L
CITY
COIlBI NATI ON APPL CATI
SP NGFR
I
726-Job Address
Val ue of oo
SOURCES
l'/ater Hea
Legal Description
I
Owne r
Address
l?
J
Sq. Ftg. Acc ess.
f'la n
Buiiciinq PernriilFamily Residence ,e., Build Single
tUv'tt\ o
Constructi L I
'-"-Addre s s Phone
Structura I
Pri ma
E I ectri ca I
Mechanical
Genera
P
PLUIIBI NG ELECTR I CAL MECHAN I CAL
t- t- t-CHARGF NN FFF CHARGF NO FFF CHARGF
Each single fixture furnace/burner to
BTLI ' S
Relocated building
(new fix. additional)New circuits alts
or extensions
Floor furnace
and vent
S. F. Res i dence
( l battr)SERV I CES Recessed wal I
SDace heater and vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
separate
[.later service ge in existing
dence
Chan
res i
Stationary evap
cool er
Sewer multifamily,
Industrial
cofiifn. or Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A-C.
c0r4r.{./IND. FEEDERS Mechanical exhaust
hood and duct
Instai I /al terlre1 ocate
distrib. feeders tJood stove/heater
0f ampi
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l,lHERE STATE L{N REQUIRES that the Electrical work be done byshall not be valiC until the label has been signed by an Electrii
an Electrical Contractor, the electrical portion of this pernit
cal Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA|IINED the completed application for nermit, 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 accoidance with the Ordinances of the Cityof Springfield and the Laws of the State of 0reqon pertaining to the work described herein, and that N0 OCCUPANCY will be madLof any structure without the permission of the Building Diviiion. I further certify that my registration vlith the Builder's
Board is in full force and effect as required by ORS 70i.055, that if exempt the baiis for Lxemption is noted hereon, and thatonly subcontractors and ernployees who are in compliance with 0l?S 701.055 will be used on this oroject.
t-dL-llAllE(please print S IGiiATURE
0itL
Ftti
Ftg
Ftg
l{ain Val ue
Group Sq Val ue
TOTAL VALUATION-
x
x
Fire Zone Bedrooms 0ccy Load
Uni tsisqConst.
lueAccess
0ther
Zone
Flood Plain Stories
Plan Ck. Cornm/Ind
65"/./Bldo Ppr Fec
Svstems Deve'
charqe (1.5%'
opmentBUILDING PERMIT
Charges and
Su rcharges Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Su rcha rges Dgmo
SidewalkELECTRICAL PERI1IT
Charges and
Surcharges A/C Paving Total Comb. Permit
Curb CutHECHANICAL PERMIT
Charges and
Surc ha rges I,tTOTAL
Ftg , 0ther
/-
L
I
Electrical
Residence of
sQ. FT.
x(x,
COMBINATION APPLICATiON/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal DescriPtion
1. example- Tax Lot 100, Lane County Map Reference
17-TT-713
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction Iender
D. Energy Sources
PERMIT VALIDATION
1. exampi e- heat,/2, example- water
Square footage or
el ical ceiI i or forced qi1 gq:
r e ec r solar
E va I uat OD,
I example- 1250 s
example- if new
check add, etc.
q. foot house, 500 sq. foot garage
project, check new - if addition,2
II.
F. Building permit information:1. examp]e - construct single family house with an
attached garage
2. example - remode'l existing garage into family room
3. example - convert single family residence into
iEltiuFant (change of-use)G. Value of work as defined in Section 303 (a) cf the
Structural Speciaity CodeH. DESIGN TEAI{ 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.
Abbreviated Plumbing, Mechanical, & Electnical SchedulesA. Except vrhere blank spaces occulin the description
portion of the Mechanical and Electrical Schedules,
the appl icant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full P'lumbing, Mechanical, and E)ectrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedu'les
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noteci on the CAP, the label must be delivered to theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be, used as
a worksheet oniy. l,lhere possible, Building Division Staffwili prepare a type written copy and return it to the
applicant at the time the actuai permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, 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.
FOR OFFICE USE ONLY
III.
IV.
V Permi t Cl
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit appf icant exempt from registration wfth the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s i gnature date
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