HomeMy WebLinkAboutPermit Fence 1989-11-13
I INSPECTION LINE . CITY UF SPRINJ;FIE~D
726-3769 COMBlIlATlON APPLICATION/PERMIT
~4n ~-~ 'f'\-.. ) SOURCES~
Legal Description
{name}
INFORMATION LINE
726-37S3
Sq. Ftg. '~aln
~q, Ftg, Access,
Sq. Ftg, Other
~Add_Alter-f.ep,
ge Fence Demo Change/Use
valUf-1 H{fy::)' 00 Other--
BuiloinQ.fennit Info: Describe Workl Le., Build Single
Familv rtesidence IHth Attached GaraQe'
r14b-K5Jl. ,n
'---! 0J1~
D (lies, nO,l
.'
'9
~
~
JOb Address
ow~n'\hili fV),O~
Address
Phone
Construction lender
Address
DESIGN TEAI~
Phone
{address'
[exoiresl (ohone
"*.
,
0':'_ )
Primary
Structura 1
Electrical
Mechanical
CONTRACTO~ . ! name '.
Gener(l AJLO om
Plumbina 6'
~} -
'i 112CJL 0)-
(adp{) fu~l~;e'~exo;re')
/ '1-': \L.A..-
fphor}e. nq. l
"14h8'~
Electrical
~1echan; ca 1
p~UllBrrlG
E~ECTRICA~
MECHANICAL
NO, '
FEE 'rH^RGE NO
--EEL-.QJARGl Nn.
H~ 'r....A.RG.E.
SQ, F1.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~ce ~eater and vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sin~ 1e duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood ~nd duct
Wood stove/heater
1
Sewer
Temporary Construction
Change in existing
rp<;.i (LpJu'p
multifamily, comm. or
Inrluc;trial
Additional bath
~Ia ter servi ce
CO~~,/IND, FEEDERS
Install/alter/relocate
rlic;trih_ ~ppdprs
Of
amps.
TOTAL CHARGES
WHERE STATE UW REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANCE nF PFRIIIT
TOTAL CHARGES
that tile Electrical work be done by an.-Electrical Contractor. the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed appl i cat i on for permit, and do hereb.y certify tha tall i nfonnat i on hereon is true
and correct, and I further certify that any and all work oerfonned shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that UO OCCUPAIKY will be made
of any structure without the permission of the Ouilding Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
I~Af.lE(please print) iG AN'! ( .t. dl1,.e~ SIr,IIATURE ~,(;J
FOr. OFFICE USE Q;ILY
Zone Type/Canst. Units Sq, Ftg, f1ain
Fire Zone Bedrooms Occy Load Sq, Ftg. Access
Flood Plain Stories Occy Group Sq, Ftg, Other
4~~
OATE//-/i- 85;
x
x
x
Value
Value
Value
TOTAL V ALUA TI 011
BUILDING PERNIT
Charges anC:
Surcharges
Plan Ck, Comm/Ind
65%/Blda Per Fpp
------------ Plan Ck, R'es
JOX/Bldo Per Fee
Systems Development
Charqe (1.5~ "
PLUMBING PERMIT Fence
Charges and -------------
Surcha rges Demo
c.ou
ELECTRICAL PERI~IT Sidewalk
Charges and ------------
Surcharges A/e Paving
Total Comb, Permit
TOTAL
5cO
,
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100. lane County Map Reference
17 OJ 4J
2, example- Lot I, Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examp.le- waterheater{electrical/or solar
E. Squar~ footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq, foot garage
2. . examp.le- if new project, check new - if addition,
-.' _. checK add, ete.
F. Building permit information:
1.- ~example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code ,
H. DESIGN TEAM'ANO 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.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. 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 appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building ~ivision
1. To conserve space on the permit form the schedules
have been abbreviated
2, I f the item( s) to be ins tall ed are not covered on
the abbreviated schedules you should consult the
full schedules
C. 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 electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III, Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture.
IV. Fees and Charges
Plan 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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
, ,
\ \/ \
Permi t
Permit appl icant exempt from regi strati on with the Bui 1 der' s Board because,:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date