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HomeMy WebLinkAboutPermit Fence 1983-4-4 . . I-J INSPECTION L1IIE, 726-3769 Job Address 'E~ M;/N S /_ Legal Description Irtf)<."y,..~. ~?O / f~ I~ 0\ I~ 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 ,~~ ~. 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 I I I I I I I I I I I I I I I VA-l 1~.-1 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 I I ,V~- I ! 1Is:- I I I I 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. - I I 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: - . ... 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: - ( Received For. J'iB"#-~~6 ~ "'P:P. IS-. _co ~'1~~ ."'e> E:.? ::z 0 . eo .. +-lftt:Jl)),p . B~ ')I/H. ~~p "?S:- '5.tjt/~ /.:;:JO. .. FaV<zc lB. -- ( c ( ~ IS~.Clo ,A'7f4 41 :zS . /"8~. ro I" .'. ( Amount Received ..... BY , ~, , ~--,?~~~,~" .,. - AUTHORlZE>>SIGNATURE tt1f?' . \ BRI0G8 ~RINTI:R.JUTHOGRA~HI:'U.. I:UGI:NI:. ORI:GON r- . -..-,.-.. 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 . , . date 'I' '7- ~ '3 ,., ! ,I " I -f,' , i 'I'~:"::-' -,- 'f""" I -;-,-- I....,' .,' ~ I" ,-:--~ I I. i 1,J. - 1 ',,' -,- '. 7.;/..... . ""l.' . 1 .. t !....-; I. . 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