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Home My WebLink AboutPermit Fence 1988-05-17I 7 L CITY OF SPRINGFIELD COHBI NATI ON APPL ICATION/PERMIT 726 Job Address 5 7t/EIIERGY SOURCES: Hea t l,later Heater Ranqe. Sq Ftq Ftg Ftc Acces s 0therSq _llew_Ad d_Al fer_PEp . - _Fence_Demo Change/Use 0ther n0 3l-egal Description 03ao o Owner d Addres s 5 Tk Phone Val ue of l,lork I Builciin q Pernrit Info: Describe Woi[I Residence l,lith Attached GaraqdFarni 1y ,e., Build Single lF/,4 Construction Lender Addre s s Phone DES I GN TEAI.,I name addre s s lics. no.exD l res r0ne no. Pri ma ry Structura I Electrical Mechan i ca I t-tzt-- Pl umb'i nq EI ectri ca I Itlechani eql PLUI{B I NG ELECTR I CAL MECHAN I CAL FFF CHARGE N0-FFF CHARGF Nn FFF CHARGF Each single fixture Residence of SQ, FT furnace/burner to BTU' S Relocated buildinq (new fix. additional ) New ci rcui ts al ts.or extensions Fl oor furnace and vent S . F. Res i dence(1 bath)SERV I CES Recessed wal I Soace heater and vFnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa rat-e [^later servi ce Change in existing res i dence Stationar.v sv6p. cool er Sewer multifamily,comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f Vent systenn apart from heatinq or A.C. COMI.1./IND. FEEDERS Mechanica l exhaust hood and duct Instal i /al ter/re1 ocate d i stri b. feeders l'Jood stove/heater 0f ISSUANCF OF PFRI,IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAN shalI not be valid REQUIRES that the Electrical work be done by an Elecuntil the label has been signed by an E)ectrical Supe trical Contractor, the electrical portion of this permitrvisor and returned to the Building Division L E XAI{I NTD t he comp app L at 'I o n fo r perm 1 t a nd certi fy tha t I I 1 n fo rma t on he reon 'I s t rueand correct, andof Springfield anof any structure Board is in full only subcontracto I fu rther c erti fy of the perm i ffect tha t any and a1 1 of oregonof the Buil wo rk pe rformed sha I I be do ne 'I n accorda nc wl t h the 0rd 'I nance s of the ci ty d the Laws Sta fo Derta I n I n s to the wo r k de sc r 'I bed here'i n a nd tha t NC OCCUPAI'ICY wl I I be madewlfhoutthes'I on d 'I ng D 'I 'I I on I fu rther certi fy tha t m.y re g 1 stra t 'I on u/l th the Bu 'I I der sforceandasrequ'I red by ORS 701 055 th at '|f e xempt t he bas 1 s for exempt ,l 0n 1 s no ted he reon and tha trsand1whoTIIwlth0Rs71'Iemp0yeesarenc0mDance0055'I I be us ed on th I s P roj ect llAtlE(please r.r.,) BJ h 1,^Jrd t-r yL IGNATU DATE .T*T 7-8tr Zone Const. Uni ts_ So Ftg Ftg Ftg . l,lai x Val ue-__-- Fire Zone Bedrooms Occy Load S q.Acces s x 1 Up Flood Plain Stori Group Sq 0ther x Value TOTAL VALUATION-- es BUILDING PERNIT Charges and Surcharges Plan Ck. Comm/Ind 65%/81dq Per Fee Systerns Deve Charqe (1.52 opment Plan Ck. Res 30%/B1ds Per Fee PLUI,IBING PERMIT Charges and Surcha rges Fence q S.oo DBmo ELECTRICAL PERIlIT Charges and Surcharges Sidewal k A/C Paving Tota'l Comb. Permi t 14ECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL soi -- (n COMBINATION APPLICATION/PERMIT (CAP) I . Appl i cant to furni shA. Job AddressB. Legal DescriPtion1. 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 lenderD. Energy Sources PERMIT VALIDATION 1. example- heat/electricai ceiling/ 2. example- waterheater/electrical/o E. Square footage or valuation, etc. or forced air gasr sofar 1 example- 1250 sq example- if new check add, etc. foot house, 500 sq foot garage 2.project, check new - if addition, II F. Building permit information: 1. example - construct single family house with an attached garage 2, example - remodel existing garage into family room 3. example - convert single family residence into Estaurant (change of use) G. Value of work as defined in 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 iob site comecti ons , etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the Ful I Pl appropriate item(s) to be installed umbing, Mechanical, and Electrical Schedules Itare available at the Building Division 1. 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 the ful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his eiectrical supervisor. The general contractor is not authorized to sign the electrical label. Applicant to sign and date Hhenever possible, the initial application will be used as a worksheet only. lrJhere possible, Building Division Staff will prepare a type written copy and return it to the appiicant at the time the actual permit is issued for his s i gna tu re. Fees and Charges PIan check fees are due and payable at the time of the application, 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. 5-l 1 rf III. IV V. FOR OFFICE USE ONLY Permit Clerk 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 gnature date q