HomeMy WebLinkAboutPermit Demolition 1981-1-14
INSPECTION LINE
.726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
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ENERGY SOURCES: W'g. Main
He-" /' Sq. Ftg. Acceu.
Water Heater ~ Sq. Fig. Other
Ranqe /' _No....._Add_Alter_Rep.
~alue of way. _Fence_~Change/Use
/". _Other
oo!Uilding Permit Info: Describe Work (i.e., Build Single
Family ~,!~j1"!"'~"! With Attached Garage'
l~0 [[\.0
Address
Phone
DESIGN TEAM
(name)
(address)
(lies. no.)
. (expires)
(phone no.)
Primary
Structural
Electrical
Mechanical
Electrical
\)0
.(address)
.r1. () t~ ,)
\
(lies. no.)
(expires)
(phone no,)
CONTRACTO~S na~.
_Generol\ ~ (j ~
--z; j
PlumbinQ
Mechanical
PLUMBING
elECTRICAL
MECHANICAL
NO.
FEE
CHARGE, NO. I
I
FEE
I CHARGE
NO. I
FEE
, CHARGE I
I
I
Residence of
furnace/ burner to
~TU's
Appliance vent
separate
Stationary evop.
cooler
Vent fan with
sin!:!le duct
Vent syste;'" aport from
heating or A.C.
Mechanical exhaust
hood and duct
Each sinQle fixture
Rolocated building
(ne..... fix. additional)
S.F. Residence
(1 bath)
tq: ft.
New circuits, alterations
or extensions'
SERVICES
Duplex (1 hath) each
Temporary Construction
Additional bath
Amps.
Water iervice
Sewer
'Wood stove/heater
Storm 'Sewer
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handler over
10,000 CFM
Amps.
I
I
I
r
I TOTAL CHARGES
I
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES that Ihe Electrical work ba dona by Iha Electrical Contractor; .the electrical portion of this permit sholl not be valid until.o
label hos boon signed by an Electrical Contractor and attached to the alectricol pone!.
I HAVE CAREFUllY EXAMINED the completed applicotion for permit, and do hereby certify that 011 information hereon is true ond correct, and I further
certify that any and all wor~ performed shall be done in occardance with the Ordinances of the City of Springfield and the Laws of the State of Orogan
pertaining to the work described horin, and thot NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further
certlfy that my registration with the Builder's Boord is in full force and effect as required by ORS 701.055, that if exempt the bosis for exemption is noted
heron, and that only subcontroctors ond 'employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder'~ Boord exemptior'.
NAME (please print)~I?A;~L.""
/
/),~ SIGNATURE_~~-- /L2$~DATEld4gl
FOR OFFICE USE ONLY V
Zon~ Type/Canst. Units Sq. Ftg. Main
Fire Zone Bedrooms n-::cy Lood Sq. Ftg. Access
Flood Ploin c.toril"" ""ccy Group Sq. Ftg. Other
BUILDING PERMIT I ( ,00 Plan Ck. Comm/lnd
Charges and 65%/ Bldq Per Fee
Surcharges Plan Ck. Res
30%/ BId!:! Per Fee
PLUMBING PERMIT T;C;U
Charges and ~ )<() Fence
Surchargos
Demo
elECTRICAL PERMIT -->
Charges and Sidewalk
Surrharges A/ C Pavi~a
MECHANICAL PERMIT
Charges and Curb.Cut
Surcharges --------
x
\Ialue
)( Value
x Valuo
TOTAL VALUATION
Systems Development
Chorae (1..5%)
,.., "~ ."." }2)
./
Q~
TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant-ja furnish. .
A. Jab Address
B. Legal Description
1. example-tax !ot 100, Lane Cou:~ty Map Reference 17 03 43
2. example. Lot 1. Block}, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc. -
1. example.1250 sq. foot hous~, 500 sq. foot garage
2. exam~le-if new project, check new-if addition, check
add, etc.
F. Building permit information:
1. eyomple-construct single family house with an attoched
garage
2. example-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 AND CONTRACTORS
To avoid design or constructio'n. delays, Building Division
Stoff 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 adiacent 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 schedules
hove been abbreviated
2. If the item(s) to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used os 0
worksheet only. Where possible, Building Division Staff will
prepare 0 typewritten 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
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<'~gnatur""
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PERMIT VALIDATION
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Permit CierI-
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