HomeMy WebLinkAboutPermit Demolition 1984-11-27
I INSPECTION LINE
726-3769
')0 Job Addresss?s?h' HAJ'ldw j( D. <l/J/lD
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CITY U~ SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
t~ater Heater
Range .'
J ValuE of Hark:
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INFOR/1ATlON UN"
726-37S3
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
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k.
Legal Description
l' Owner A A/A/'" p'1l Y [) R f:-lD
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/' Address 'i{(?,( H/fIf/ftA/ j{J D , S;1PLO
~hone7.'~/ .,.. I BUllainQ Permit Info: Descr.be Work(i.e., Build Single
1\" ~"7.ZJb Famil; ~esidence With Attached Gar~Qel
k'0~''--&:'--'~ - (l11A~
Address
U"5IGN T"AH
(name)
Phone
(address)
~I
~
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Construction lender
(1 ics. no.)
{exnires}
(ohane no.)
,
,
Primary
Structura 1
Electrical.
Mechanical
CONTRACTORS (namel
General 8 f&.J<. ~aJ
Plumbino
(address)
if? () . /!,,J, tA I
fJ)"Q.oO
&..,.,
(j
(lin. no.) (pxoires)
Cfc.f J/(,r'ot10 2./22. IK"
(ohnnp nn. ,
Electrical
Mechanical
PlUIIBI NG
ELECTRICAL
.' ,
.....'..
n"l=' .~ ......1:iARG.E. _~ln
MECHANICAL
NO.
FFF r.HARr,F N()..o..-
Each single fixture
Residence of
~~~ rullif.
SQ. FT.
furnace/burner to
BTU's
~
INew circuits alts.
or extensions
ISERVICES
I
ITemporary cons~ruction
[Change in existing
rps j qe.nt"'P
Imultifamily, comm. or
Industrial
10f amps.l
I COMI.I. IIND. FEEDERS
I Install/alter/relocate
dic;trih. fppdprc;
Of amps.1
Floor furnace
and vent
Relocated building
(new fix. additional)
S.F. Residence
(1 bathl
Ouplex (1 bath) each.
Additional bath
Recessed wall
So~rp hp~tpr ~nrl vpnt
II
,
[
[
Appliance vent
Si='oarat.p
Stationary evap.
~ooler
Vent fan with
sinale duct
Vent system apart from
hi='ilting ,:"r A,"L
Mechanical exhaust
hood and dud
I ~'Jood stove/heater
[
I
[
"
~Iater serv; ce
Sewer
Storm Sewer
.1I~
I SSUANCE OF PFRIIIT
TOTAL CHARGES ,~ TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'l~ REQUIRES that the";~ectrical work be done by an. Electrical Contractor, the electrical portion of this pernit
shall not be vali:J until the label hasfeen sig'ned by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the compl~~.d application for permit. and do hereby certify that all information hereon is true
and correct, and I further certify thatfany and all work oerformed shall be done in accordance with the Or,dinances of the City
of Springfield and the Laws of the State of Orel)on pertaining to the work described herein, and that 110 OCCUPAIKY will be made
of any. structure without the'permission,tpf the Building Division. I furthe~ 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 OP.S 701.055 will be used on this project.
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'IWIE(please print) ,4A.?t.!I!
Zone
Fire Zone
F1 ood PI a i n
Type/Const.
Bedrooms
Stories
Uni ts
Occy load
Occy Group
&11^TURa~_AKJ...~r .)7
FO~ OFFICE USE DIlLY I' I I /
"
Sq. Ftg. Ilain x
Sq. Ft~. Access x
Sq. Ftg. Other x
Value
Value
Value
AtfYD. &,t:/J
\""",-., TOTAL; VALUATION
BUilDING PERfllT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Rldo Ppr Fpp
------------ Plan Ck. R-es
3D%/Blda Per Fee
Fence
Systems Development
Charqe tJ.5~) f .
e
PlUl1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERrm
Charges and
SUE~harges
11ECHAN I CAl PERMIT
Charges and
Surcharges
"
I
[
[
'''',..1 Curb Cut' 1
I~~I
Sidewalk
D~mo
A/C Paving
Total Comb. rermit
I -; O. (J1)
) 8'. cro I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT'VALIDATION
'{2#-- b 79/~ .
€~ II! &.-r/W
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I. Applicant to furnish
A'. Job Address
B. legal Description ! j'
1. example- Tax lot 100, lane County Map Reference
11 oj 43
2. example- lot I. Block 3, 2nd Addition to
~prlngtieId Estates
C. Name, etc. 'of owner and construction lender
D. Energy Sources
1. exam21e- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
.check add, etc.
F. ~Bui1ding pennit information:
,1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
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 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 Hem(s) to be installed 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 electrjca.l. 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
. 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
, '
Permit appl.lc?nt exempt from registration with' the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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