HomeMy WebLinkAboutPermit Demolition 1987-12-10
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I INSPECTION LINE .'
726-3769 /'I .
Job Address Iil!tJ 'k~/Z; !-/n!~ t/1//
Legal Description (j T {/O
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EflERGY SOURCES:
Heat
\~ater Heater
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INFORl1ATION UNt:
726-3753
Sq. Ftg. r.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
Range
/Y
'lJOI~ ./ D.A,r/cU r Co Valu.e of Hork~
Owner PA CJ {/ i ,.)' IJJfe5 (7 J( 1-0/'1) (-eA .0
r- / i 1 J.1 ,<< oBuildinc Permit Info:
Address/:) 9" S. hDS Ii n ~ /~ ~ prJf-; 1'7"~oU Familv ~idence Hith
(1/-C1JJ~/fY., CA ~ 9 J) Ur
Construction Lender NOI1/-e.
Descr.be l~ork(Le.,
,ttached Ga race)
c
Build Single
00
-:J
()
~
Q'
r
(name)
Phone
(address)
ltJo
S/~IU:c/(
(lics. no.)
C/9P-])/t-1
(exoires)
(ohone no. l
Address
DESIGN TEAI~
1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
.c: fA to A/
(address)
C01J S M 1.1 r:./io N
(] ics. no.)
(exoires)
(ohone no. )
General
Plumbing
~! <X, ~ 0 0 ~
Electrical
'" -\'-1
~lechani ca 1
PLUt.1BING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF rHARGF NO.
FFL CHARGE
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
~
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Soace heatpr and vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
~Iater service
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
10 (a
ISSUANCE OF PFRrlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\l~ REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED 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 performed 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 NO OCCUPAr~CY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
"AI-lE(,l "" ,C< "t) :P'If te lei PA / /Vb ::r r<. , SIO"ATURE d/~ ~ r:.. DATE/:l- -/0 - ~ ?
FOr. OFFI CE USE or~L Y
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
Sq. Ftg. 11ain
Sq. Ftg. Access
Sq. Ftg. Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck.
65%/Blda
Plan Ck.
30%/Bldc
Fence
CommlInd
Per Fee
Res
Per Fee
Systems Development I
Charge (1.5%) -
PLur~BING PERMIT
Charges and
Surcha rges
D/]mo
,\
/8'.00
ELECTRICAL PERMIT Sidewalk
Charges and ------------
Surcharges A/C Paving
Total Comb. Permit
I1ECHANICAL PERMIT
Charges and
Surcharges
5"/0
" rtJ
TOTAL
/6,7"-'
I
Curb Cut
-.-,
e
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached 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 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 Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
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
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
tcJ
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
(
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date