HomeMy WebLinkAboutPermit Fence 1981-04-27Job
ENERGY SOURCES:
INFORIAAIION TINE
72&3f 53
INSP€CTION IINE
72U3769
CITY OF SPRINGFIETD
COMBTNAIION APPTICAIION I PERMII
Heot
-
Woter Heoter
--
Sq. ttg. Main
Sq. Ftg. Acccrs'
Sq. Frg. Other
Addrers Ra\ N. \Bqft St,Phone Fomilv Reridence With Aroched Goroqe)
Euilding Permit lnfo: Dercribe Work (i.e., Build Single
1*b-Lo1rg*\r-[tr't $tq-
I.o.lilX)."r",-,-{ Q'b or:\
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l-
RP\
I
IAddrer:Phonc
OESIGN TEAM (nome)(lics, no.) (expirar)(phone no.)
Primory
Alcchoni<ol
Electricol
Mechonicol
ETECTRICATPTUMBING MECHANICAL
FEENo.FEE CHARGE NO CHARGE NO.FEE I CHARGE
Eoch cinqle fixture
Residence of
--tq.
ft.
furnoce/'burner lo
-BTU'T
Relocoled building
(new fix. odditionol)
New circuifs, qlteroiions
or extensions
Applionce vent
Sepq ro te
S.F. Reridence
(l both)SERVICES
Stoiionory evop.
cooler
Temporory Conrlruclion
Vent fon with
sinqle ductDuolex (l both) eoch
Additionol both Ampr.
Vent syslem oporf from
heofing or A,C.
Wotar retvice
Mechonicol exhqust
hood ond ducr
Scwer Wood:love/heoier
Slorm Sawer FEEDERS Heot Pump
Ampr,
Air hondler to
t0,000 cFA{
Air hondler over
I0,000 cFA{
ISSUANCE Of PERMIT
TOTAI CHARGES IOTAL CHARGES
WHERE STAIE tAW REQUIRES rhol lhe Electricol work be done by the Eleclricol Contrsctor, the alectricol porlion of lhir pcrmit rholl not be volid unril o
lobel hos bccn :igncd by on Electrical Controctor ond ottochsd to the electricol ponel.
TOTAI. CHARGES
I HAVE CAREFULIY EXAMINED lhe completed opplicotion for permit, ond do hereby certify thot oll informotion hereon is rue ond correct, ond I furrher
certify thot ony ond oll work performed sholl be done in occordonce with the OrCinqnces of the City of Springfield ond the Lowr of the Stote of Oregon
pertoining lo lhe work dcrcribed herin, snd thor NO OCCUPANCY will be mode of ony siructure without the permission of rhe Building Division, t further
certlfy thor my .egittroiion with rhe Builder's Eoord is in full fare ond effect os required by ORS 701.055, thot if exempt tha bosis for cxemption is'noted
heron. ond lhot only subconlrociors ond employees who ore in complione wiih ORS 701.055 will be used on this proiect.
SIGNATURE DATE
Boris for Builda/c Boord cxcmption:
NArftE (pleose print)
FOR OFTICE UsE ONLY
Zonc
-Type/Const, -Units
--Sq.
x Yolue
x
--Voluex
-Yolue
IOTAI. VATUATION
Fire Zone-Bedrooms ccy Lood Sq. flg. Accesr
Flood Ploin torior-Occy Group-Sq. Flg, Other-
Ftg. Main
Syslemr Devalopmenl
Chorqe ( I .5?'o)
BUITDING PERMIT
Chorges ond
Surchcrger
Plon Ck. Comm/lnd
Per Fee
Plqn Ck. Ra:
Per Fee
/o. oo
Tolol Comb, Permit
PLUrrlBlNG PERMIT
Chorges ond
Surchorges
fence
Demo
ETECTRICAI. PERMII
Chorger ond
Surchorger
c
Sidewolk
MECHANICAT pER,\ tT
Chorger onl
S urchorg e r
Curb Cut
TOTAT I
-
New --Add--Alter-ReP.
ffip"mo-chonge/ Use
EO
Volue of Work:
(oddrer:)
(lics. no.)(ohano na I{oddress)(exoires)aoNTRACTORS (nome)
+v)E)
C,od
. COMBINATION APPLICATION,'Pr{ IT (CAP)
l. Appliconf. to furnish'A. Job Address
B. Legol DescriptionI. exomple-rox-lot,lOp,-Lo1e County Mop Reference I7 0-
- 3. @-Lot I. Block 3, Z"a aJJit,{on to Sprinsfietd EsrcC. Nome, etc. of owner ond construction lenderD. Energy Sources
l. exomple-heot,'electricol ceili
col
'or forced oir oos/:+.'or solor2exomote-woter eoter eci
PERI\,IIT VATIDATION
_ctTY OF SPRTNGFTELD
Ciry Holt
Springfield, Oregon
Deportment of public WorksOFFICIAT RECEIPT
No. B 50376
r
I
)
I,E. Squore fooroge or. "olrotioilr-l]-I
=+ef-.l2lg
rq. foor house, 500 sq. foot sorosel. exomole-rt new proiecl, check new-if ocjdition, check;A-f.
F. Building permit informotion:l. exomple-construct single fomily house with on ottochegoroge
2. exomple-remodel existing goroge into fomily room3. exom;l-e-converr single fir;ily residence into
relTEGEnt (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of theStructurol Soecio lry Code
H. DESIGN TEATA AND CONTRACTORS
To ovoid design or construciion Celoys, Building DivisionStoff must be oble to contoct oppropriote p...Jn, regor.didesign informction or iob site corrections, etc.
ll. ,A,bbrevioted Plumbing, Mechonicol & Electricol Schedules
A, Except where bionk spoces occur in the description portioof the Mechonicol ond Electricol Schedules, the oppiicont
need fill-in oniy the No. Boxes odiocent to the oppropriot
item(s) to be insrolle<j
B. Fuil Plumbing, Mechonicoi, ond Elecrricol Scheciules
ore ovoiloble or the Building Division
I. To conserve socce on the permit form the schedules
hove been obbrevioted
2. lf the irem(s) to be instolled ore not covered on the ob. oted scheduies you should consult the fuil schedules
C. SUILDING DIVISION STAFF WILL FILI OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible. the initiol opplicorion will be used os o
worksheet oniy. Where possible, Builciing Division Stoff will
prepqre o iypewritten copy oncj return it to the opplicont ot
the rime fhe octuol permit is issued for his signotuie.
lV- Fees cnd Chorges
Plon check fees ore due ond poyoble ot the time of the oppl,,
ond no plons will be processed until lhese fees ore poia. ,lttL
other fees ond chorges ore due ond poyoble when ihe permit
is issued-
V. FOR OFFICE USE ONLY
Address 6A \K\tr
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AUTHORIZEO SIGNATURE
SHELTON.IURI'U!L PRINTERS - EUGENE OR 97'O!
Permit Clerk
3a5tt.a
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PROJECT CONDTTIONS TO SE SATTSFIED BEFORE OCCUPANCY:
Additionol Pro[eo lnformorion:
nome signoture ote
PLANS REVIEWED BY:
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