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Home My WebLink AboutPermit Fence 1988-02-04I NSPEttd-3 CITY OF SPRINGFIELD COMBI NATI ON APPLICATIONIPERMIT 7?6-37 Job Address EIIERGY SOURCES: Hea t l,Jater Heater Ranqe Sq. Fto.n_ Sq. Ftg. Access.-- Sq. Fto . 0ther o0 oo O,f) -\ \ o /500l-ega1 Descri ption o 7J Value of \,lork: Owner Addres s tk{;S Builrlinq Pernrit Info: Desciibe t^iort-fFanily llesidence l,lith Attached Garaqd .e., Build Single I ,/)-/Construction Lender Addre s s Phone name address lics. no.exoi res ohone no- Pri ma ry Structura I Electrical 40J- €\oc) Hechani ca I name addres s I ics. no.exnires)(nhone no EI ectri ca 1 l.'lecha ni ca I PLUt4BI NG ELECTRI CAL MECHAN I CAL FEE CHARGE NO FFF CHARGF NO FFF at{a pcF Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. Residence(1 bath)SERV I CES Recessed wai I Snaae hPatpr and vpnt Duplex (I bath) each Additional bath Temporary Construct i on Apol iance vent seDa rate l,later servi ce Change in existing rpci dcnrp Stati onar,v evap cool er Sewer multifamily, comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f amps.Vent system apart from heatino or A.C. COMI'1./IND. FEEDERS Mechanical exhaust hood and dur:t Instal I /al ter/rel ocate di stri h fppdprc l'Jood stove/heater \ I 0f s. / ISSUANCF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAl,l REQUIRES that the Electrical workshall not be valiC until the label has been signed by be done by an Electrical Contractor, the electrical portion of this permit an Electricai Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 0reqon oertaining to the work described herein, and that NC OCCUPANCY will be madeof any structure without the permission of the Bu'ilding Division. I further certify that m,y registration r.rith 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 comcliance with 0l1S 70i.055 wi'll be used on this Droject. I'lAl'lE( p1 ease pri nt)lcEuruqru CopEtAND S IGN 2-r-rr r' Zone_______Type/ Co n s t Uni t s Sq.Ftg. l,lain x Value_ Fire Zone Bedrooms Occy Load Sq Ftg. Access Val ue Flood Plain Stori Group Sq. Ftg . 0ther I TOTAL VALUATION es BUILDING PERIiIIT Charges and Surcharges Plan Ck. Comm/Ind 65%/B1dq Per Fee stems opment Plan Ck. Res 30%/81dq Per Fee A PLUI4BiNG PERMIT Charges and Surcha rges Fence lq) s. oo D6mo ELECTRICAL PERt,IIT Charges and Surcha rges Sidewalk A/C Pavi ng Total Comb. Permit I,IECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL $co Phone 7 ILAI'1 ACTORS ue_ c0r"1BINATI0N AppLICATI0N/PERMIT (CAp)PERMIT VALIDATION I Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to Springfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources 1. exampl e-2. exampl e-E. Square foota hea t/e ical forced aiL gas wa r or soTar ge or valuat OIl'1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct singie 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 jn Section 303 (a) of the Structural 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 site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be instailedB. Full PIumbing, Mechanical, and Electrical Schedules are avai lable 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 onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electricaisupervisor. The general contractor is.not authorizedto sign the electrical label Applicant to sign and date Whenever possibie, the initial application wjll 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 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 unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued. D? I 5 Vtr II ?'q- ffi, III IV V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name S1 g nature date CU