HomeMy WebLinkAboutPermit Fence 1982-06-13I NS PECT I
725-37 69 COMBI NATION APPLICATION/PERMIT 726-37 53
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6l-egal Description
Job Address l/7t)
Ranqe.
I'later Heater
EIIERGY SOURCES
Hea t
Value of l,lork:25>--''
Ftg . l'la in_
Sq. Ftg. Access.--
Sq. Ftc. 0ther_
_l.lew--_rAdd-A 1 te r_Re p .
Fence Demo_Change/Use
Owner
Address vn "{f{"14za J- d tZ-Builcii
Fami ly nq Permit Info: Describe Work('Residence l,lith Attached Garaqd
e., Build Single
04- qq(?fua,a-
con(tr(ction Lender
Go
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N
"0
Addres s Phone
DLsIGN TEAI!na{qe address lics. no.exD l res ohone no.
Pri ma ry
r)nr'al)Structura I
EI ectri ca]
Mechani catr
CONTRACTORS addres s 'I i cs, no.exn l res (ohone no- )
Qo,.ralGe -4/g3 A/4/rH/L a
E l ectri cal
ELECTR I CAL MECHAN I CAL
FFF THAPAFNOFEECHARGENOFFFCHARGFN0.
Each sing'!e fixture Residence of
SQ. FT
furnace/burner to
BTU' S
Relocated hui?dimg
(new fix- a&itimal )
New ci rcui ts al ts.
or extensions
Floor furnace
and vent
S.F. Residence
( I har.h1)SERV I CES
Recessed wal I
Snacp hpatcr and vpnf
Duplex (1 battr) each
Addi ti onal hatih Temporary Constructi on Apol i ance vent
seDarate
l,later service ge in existing
dence
Chan
res i
Stati onar,v evap
cool er
mu1 ti fami 1 y,
Tndustrial
cornm. or Vent fan with
sinole ductSewer
Storm Serer 0f Vent systern apart from
heatinq or A.C.
coMtt./IND. FEEDERS
l,4echani cal exhaust
hood and duct
Instal I /al ter/re1 ocate
distrih- fpedprs l'Jood stove/heater
amp s.0f
KI I
u t
I ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES
WHERE STATE LALI REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perm'it
shall not be valiC until the labe1 has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFU{-LY EXA}IINED the completed apnlication for oermit, and do hereb.y certify that all info
r,rAr'rE(please en;'nt'l -9'Te ue: E .Tns/a ud srcnar rc [.)t3/82
0req
the B g
0
proj
h
and correct, .and I further certify that anyof Springfield and the Laws of the State of
and all work performed shall be done in accordance with the
on Dertaining to the work described herein, and that ll0of any structure without the permission of uildin Division. I further certify that my registrati
Board is in full force and effect as required by ORS 7 1.055, that if exempt the
with OPS 701.055 wilI be
basis for exemption is
only subcontractors and employees who are in comcliance used on this ect.
h?r',
rrmation hereon is true
r 0rdinances of the City
| 0CCUPANCY will be made
on vrith the Builder's
noted hereon, and that
Ftg
Ftg
FtgFlood Plain
l'la i n Val ue
tsedrooms
Stories
Val ue
Valu
TOTAL VALUATION
F
x
x
X
Units
Load Sq
Const.
Group
Fire Zone
Zone
Acces s
0the r
Plan Ck. Conrn/Ind
65%/81rlo Per Fee
Svsterns Deve
Charqe (1.51 opmentBUILDING PERI'IIT
Charges and
Surcharges Plan Ck. Res
30%/81dq Per Fee
Fence fl*PLUI4BING PERMIT
Charges and
Surcha rges Demo
Sidewal kELECTRICAL PERI|IT
Charges and
Surcha rges Total Comb. PermitA/C Paving
Curb Cut 6a>;
I,IECHANICAL PERMIT
Charges and
Surc harge s
TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition toSfFiffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
4:#)
VALI DATION
1. example- heat2. example- wateE. Square footage or
/el ectrical ce i 'I or forced air gas
e or solar
vai uation,
II
l. 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 garage2. example - remodel existing garage into family room3, example - convert single family residence into
EGTiuFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Buiiding
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, 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 installedB. Full Plumbing, Mechanical, and E)ectrical Schedulesare available at the Bui)ding Division1, To conserve space on the perm'it 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 WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theeiectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electricai label.Applicant to sign and date
trlhenever possible, the initial appl.ication wil l be used asa.worksheet oniy. Where possib'le, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual perm.it.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 thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III.
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Perm'it applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name sig na tu re date