HomeMy WebLinkAboutPermit Fence 1983-4-4
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I-J INSPECTION L1IIE,
726-3769
Job Address 'E~ M;/N S /_
Legal Description Irtf)<."y,..~. ~?O /
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CITY UF SPRINGFIELD
CDlIBIiIATION APPLlCATIDN/PERMIT
EIIERGY SOURCES:
Heat
\-la ter Hea ter
INFDRlIATION L1Nl
726-3753
Sq, Ftq, (,lain
~q. Ftg. Access.
Sq, Ftq, Other
Ilew Add Alter Pep,
--Fence Demo Change/Use
Other- -
Range
Va1u, of Hork:
Owner VWAhN A~~€k
Address jPoRr~HZ:;>
BuilGlnQ Pernlit Info: Describe Work(i.e., Build Single
Familv Residence With Attached Garaael
c::::;"N3TRc.J....,. S 'c:.:;."VAjV~';>~.b
~#CE .,' Sc=..... ,.t..1;::>_Mo>>,,*,~
j;;..,lIf' Mc:s~.r ~r<tI'"'/!7.#""",' I
flies. no.) (exoires) (ohone no.)
-..A
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Phone
Construction Lender
Address
Ul~IGN TEAll
Phone
(address)
(namel
Primary
Structura 1
Electrical
,
Mechanical
CONTRACTDRS
(name)
5e-<r:
(address)
f1ir-Cj,. nn. \
(pxn;rp<;.)
(nhnnp M. 1
Genera 1
Plumbino
, Electrical
~lechan;cal
<"-L.I..cJJAIlG.J ""
PlUlIBIrIG
ELECTRICAL
MECHANICAL
ND,I
Each Single fixture
FEE r.HARr,F Nn
~~~ rl-ll1R.G..E..
Residence of
furnace/burner to
BTU's
SQ. FT,
"New circu!ts alts.
or extenslons
I SERVICES
I
Relocated building
(new fix, additional)
Floor furnace
and vent
S.F. Residence
(1 bathl
Duplex (1 bath) each
IAdditional bath
1~later service
/ ISewer&N"'~C..T"'.:o.'
I Storm Sewer I
/ M&>B/~E ~&:I
~~A~P I
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VA-l
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I ISSUANCr OF PFR!IIT
~. --I TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
Recessed wall
~n~~p hp~tpr ~nrl vpnt
ITemporary Construction
IChange in existing.
rp~ i dJI.n~~
Imultifamily. COIl1T1. or
Tnnuo:.trhl
IOf
I COIift. lIND, FEEDERS
IInstall/alter/relocate I
rl;~trih ~pprlpr~
IOf amp~1
I 1M.::>lS'...,cr N'.....;W.;!
I I 1M H. -5..or"... '" c:-I
I I I I
I~-t TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
Appliance vent
seoaratp
I Stationary evap.
cooler
I Vent fan with
s.inole duct
I Vent system apart from I
,heatinq or A.~.
I Mechanical exhaust
hnnd and rIlJ~t
I Hood stove/heater
I
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,V~-
I !
1Is:-
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amps.1
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances. of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAUCY will be made
of any structure without the permission of the Building 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.
NAI,IE(please print)~ Jl.n_~ SIGIIATORE~ ~
r - ~ FOR OFFICE USE Oi~l Y V
Type/Canst. Units Sq. Ftg. f1ain x
Bedrooms Occy load Sq. Ftg. Access x
Stories Occy Group Sq, Ftg, Dther~~ ~)c>
DATE {/4 /,,,
Zone.M'~~L1~
Fire ZonE'
Flood Plaip
Value
Value
Value
TDTAL VALUATION
Plan Ck, Comm/lnd
65%/Rlda Ppr Fp~
------------ Plan Ck. R-es
30%/BldQ Per Fee
_____.I~-I Fence
. ,"0 I Demo
ad.oo I Sidewalk
--------~.80-1 A/C Paving
I Curb Cut I
------------IM
. ./J. '5'"~ 'P I
BUILDING PERfIlT
Charges an~
Surcharges
syste. os Deve10pmen:L AI A
CharQe (1.5%) ~7'~ .
~ ~N: T_^,
I~. ~o I r40E It::::O. -
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PluP~BING PERMIT
Charges and
SurCharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
ITotal Comb, Permi t 8.,. yo
i T~TAL "
/'$.,. 0/6 .
~
MECHANICAL PERMIT
Cha rges and
Surcharges
'3S: -
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...
CDMBINATION APPLICATION/PE~~IT (CAP)
I. Applicant to-furnish
A, Job Address
. B.. legal Description
1. examole- Tax Lot 100, Lane County Map Reference
11 03 43
2, example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources I
1. examo 1 e~ hea tie 1 ectri ca 1 ceil i n%~~r forced air Q. '.
Z. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 12S0 sq, foot house, SOO sq, foot garag'
2. example~ if new project, check new - if addition (
checl< add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family rot
3. exam~le - 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 TEAI'I ANO CONTRACTORS
To avoid design or construction delays, Building
~ivision 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 adjacen
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedule
have been abbreviated
2, If the item{s) to be installed are not covered on (
the abbreviated schedules you should consult the
full schedules
C. BUILOING OIVISIDN STAFF WILL FILL DUT ALL FEES ANO
CHARGES ON THE SCHEOULES . f.
D, As noted on the CAP, the label must be delivered to tl
electrical contractor for signature by his electrical.. I
supervisor. The general contractor is.not authorized
to sign the electrical label. ---
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
signature. .
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.
111.
V, FDR OFFICE USE DNLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
~y OF SPRINGFIELD
(
CllyHall
Springfield, Oregon
Department 01 Public Worka
OFFICIAL RECEIPT
No. B 60669
(
Dale~/C- 4.
,
( Rec'd Fro~~;'
Address
19A>3
Pv "'B.-ru~
r:36 ye.. 4< HP '"5r:
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Received For. J'iB"#-~~6 ~
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.,. - AUTHORlZE>>SIGNATURE tt1f?' . \
BRI0G8 ~RINTI:R.JUTHOGRA~HI:'U.. I:UGI:NI:. ORI:GON
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Permi t Cl erk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~il1N'.!F hE'~E?li' signature
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date 'I' '7- ~ '3
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