HomeMy WebLinkAboutPermit Fence 1981-04-21CIIY OT SPRINGfIETD
COMEINATION APPTICAIION/PERMII
INSPECTION TrNE
7?(F3769 INEORilATION tINE
7264753
Job
ENERGY SOURCES:
Heot
Wol,ar Heoter
Sq. Ftg. ,lrloin
5q. Ftg. Access.
I Description 5q. Ftg. Olher sO
Ron
-Add-Alter -Rep,Volue of Work:-Fen r9r/ Use
,o"
Addrers Phone
Building Permir lnfq Describe Work (i.e.,Single
Fo Reri
Conrtr n -)
Addre s I Phone
DESIGN TEAA{(nomei (oddress)lics. no.)(expirer)(phone no.
S tru ctu ro I
Electricol
Electriqol
PtUMEING ETECTRICAT MECHANICAL
No.FEE CHARGE NO,FEE cH,NO FEE
_Eoch single fixturc I
Residence of furnoce/ burner lo
--==_.-BTU'SRelocoted building
(new fix. odditionol)
New circuits, olterotions
or extensions
Applionce vent
sepo ro te
S.F. Rasidence
(l borh)SERVICES
Siolionory evop.
coo ler
Duolex (l both) eoch Temporory Conslruction
Vent fqn with
single duct
Additionol both Ampr.
Yent sylrem oport from
heoting or A,C.
Woler rervice Mechonicol exhousl
hood ond duct
Sewer Wood slove/heoler
Storm Sewer FEEDERS Heot Pump
Ampr.
Air hondler to
10,000 cFM
Air hondler over
I0,000 cFM
ISSUANCE OF PERlrtlI
I HAVE cAREFULtY EXAMINED the completed opplicotion for permit, ond do heraby certify thot oll informoiion hereon is true ond correct, ond I furlher<ertify thot ony ond oll work performed shoil bo done in ocordqnce with the ordinonces of the City of Springfield ond the Lo*, of the stota of oregonPertoining to the work de:cribcd herin, cnd rhot No occUPANCY will be moda of ony siructure witlout lhe permission of rhe Building Division. I furtherclrllfy thot my ,cgitiolion with lhe Euilder'r Eoord ir in full fore ond effect os required by oRS 701.055, thot if exempt the bosis for exemption is- notcdheron, ond lhot oniy subcontroclors ond employeer who ore in complione wiih ORS 7Ot.O55 will bc used on rhis proiect.
TOIAI. CHARGES TOTAI, CHARGES
,lnnso.n/2- N/.--- ^SIGNATURE DATEA r--.-^^
w HERE 5T rAwIE thotREQUIRES ElectricqlthG bework o'onc thc Electrical Conlrc rhebyctot,cleclricol ofportion rhis rhollpermit not Ydlidbe oudtilhoslqbelbonqnConlrdctorEloctricolri9 nad by ottochedond rhato electricol pcncl.
TOIAT CHARGES
Sosir for Buildcr's Boord exemption:
NA.ir{E (pleore print)J\anna- /
FOR OFTICE USE ONI.Y
Firc Zone-Bedroomr occy Lood 5q, Flg. Acces:
Flood Ploin
-Srorie.
Occy Group-Sq. Ftg. Orher--
x Volue
x Yolue
x
-Yolue
It Ftg. Moin
TOTAT VATUAIION
Zone
-Type/Conrt.
Plon Ck. Comm/lnd
65016/Bldg Per Fee
Sysiems Developmenl
Chorqe (1.5%)
BUII.DING PERMIT
Chorger ond
Surchorge:Plon Ck. Rer
3O%/Bldg Per Fee
Fence
crePTUMBING PERMIT
Chorqes ond
S urchorges
Demo fotol Comb. Permit
Sidewolk
EIECIRIC,AI. PERMIT
Chorget ond
Surchorges
A/C Povinq
MECHANICAI, PERAAIT
Chorge: ond
Surchorger TOTAI.<rc)
ilecho nico I
Curb Cut /o,
PERMIT VALIDATION
oo
Permit Clerk
l ck-
/
4-el-B\
bb34\
COMBINATION APPLICATION,/PEI (CAP)
Applicont to furnish
A. Job Address
B. Legol Description
I. exomple-lox lot 100, Lone County Mop Reference 17 03 43
2. ex"mFlE-Lot t. Block 3, 2nd Addition to Springfield Estotes
Nome, etc. of owner ond construction lender
or forced oir gos
,/o.:g1gt
E. Squore footoge or voluotion, etc.
l. exomple-l 250 sq. foot house, 5C0 sq. foot goroge
2. e-xE?nil6-iT new proiect. checki-ew-if oddition, check
odd, etc.
F. Building permit informotion:
I. exomPle-construct single fomily house wilh on ottoched
goroge
2. exomple-remodel existing goroge into fomily room
3. ;fimEf-e-ccnvert single fomily residence into
EitoiFEnt (chonge of use)
G. Volue o{ work os defined in Section 303 (o) of the
Structurol Specio lry Code
H. DESIGN TEAIVI AND CONTRACTORS
To ovoid design or construciion deloys, Building Division
Stoff must be oble to contoct oppropriote Persons regording
desiEn informction or iob site correclions, elc.
It. Abbrevioted Plumbing, Mechonicol & Eleciricol Schedules
A. Except where blonk spoces occur in the description portion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in oniy the No. Boxes odiocent to the oopropriote
item(s) io be insrolled
B. Full Plumbing, A\echonicol, ond Electricol Scheciules
ore ovoiloble ot the Building Division
l. To conserve spoce on the permil form the schedules :
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the obbrevi-
. oted scheduies you shouid consult rhe full schedules
C. SUILDING DIVISION STAFF WILL FILL OUT ALL FEES,AND
CHARGES ON THE SCHEDULES
lll. Agplicont to sign ond dote
Whenever possible, the initiol opplicotion will be used os o
worksheet oniy. Where possible, Builciing Division Sroff will
prepore o typewritlen copy ond return it to ihe oPPliconl ot
the rime the octuol permit is issued for his signoture.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicotion,
ond no plons wili be processed until these fees ore poid. All
other fees ond chorges ore due onci poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
c.
D.Energy Sources
l. exomple-heot,'electricol ceilingz',
2. exo mFG-*o te r TEJEIEIE-,''i co I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
TANS REVIEWED BY:
1e t signoture dote