HomeMy WebLinkAboutPermit Demolition 1988-07-28CITY OF SPRTNGITELD-
COHBI NATI ON APPLI CATION/PERMIT 7?6-37
,Job Address lD
l-egal Description
Range
EIIERGY SOURCES:
Hea t
Owner Bon^xn, /-.re---r--a-a Value of l.lork:
Sq. Ftg. Access.--
Sq. Fto. other_
_llew_Add Af IeE[ep. -
_Fence_Demo Change/Use
-other-
. Fts
Phone Buildi
Fami I y
nq Pennit Info: Descrit
Res i dence l,li th Attache<
.e., Build Single
Ezm-a,a 5z*azF5rurz
Construction Lender ,4F 4aro.a*
Addre s s Phone
(-
$
0
N
vl
\]
name s ICS. nO.exD l res
Pri ma ry
)3 I
Structura I
Mechani cal
El ectri cal
CONTRACTORS name iics- no.)exD l res ohone no^
P l umbi
'I
-D
El ectri ca l
l'lechani cal
PLUIIBi NG ELECTR I CAL MECHAN I CAL
FEE CHARGE NN FFF C HARG F NO FFF CHAAGF
Each single fixture Residence of
FTSQ
furnace/burner to
BTU' S
Relocated buiiding
(new fix. additional)New circuits alts
or extensions
Floor furnace
and vent
S . F. P.es i dence(l uatn)SERV I C ES Recessed wal I
SDace heater and vent
Duplex (l bath) each
Additional bath Temporary Construct ion Apoi iance vent
seDarate
hlater servi ce Change in existing
rps i dpncc
Stati onar.v evap
cool er
Sewer Industrial
multifamily, comm. or Vent fan with
sinole duct
Storm Sewer 0f s Vent systern apart from
heatinq or A.C.
/.aZ*ta E+COMI'I./IND. FEEDERS
IMechanical exhaust
hood and duct
I nsta I I /a I ter/ rel ocate
di cfri h fcpderc l'lood stove/heater
0f amp s"
Yer
I
t Vh )ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I^IHERE ST,
shall not be
ATE L,\t,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitvalid until the label has been signed by an Electrical Supervisor and returned to the Building Division
IiNATURE ?-2I'lAl'!E ( pl ease pri nt)s
any
of Ci ty
made0regon
he Buiany
ard
L xAtlE N t he ca on dtan do cert t fha a forman t n hereon trusc0mpappDChereb.y efy
and co rrec t and rthfu e cert t ha t an d a work rmedfo ha donebe n eaccordanc ht 0rdthe ffyDernance s theofSrlfdeandhetawsLStateofthenpngtoWOthedrkesbedrtnhereirtaandthatw1NCngpeOCCUPAI,ICY beoftsruwlcturehottheutrmlssofntpediDisvronfuhertrcertthatrestrta0nthBungv/l the der sfym.y g
Bo s n fu force nda fectef sa tha t f t the bas S for 0 s hereo n a ndredORS701055exempnoted tha trequbyexempt
on s bconu tortrac and who av re n a l|lnce 0th 7ntI?S tJ'l055 USbe 0nedempoyeesc0mD th s e ctproj
Fire Zone Bedrooms Occy Load Sq
Ftg
Ftg
Ftg
So Value
Val ue
TOTAL VALUATION-
Zone x
xSq
x Val
Const. Uni ts
Group
l'la i n
Acces s.
0therFlood Plain Stories
Plan Ck. Conm/Ind
65%/81do Per Fee
terns Deverqe (1.52Svs
Cha
opmertBUILDING PERI'IIT
Charges and
Su rcharges Plan Ck. Res
30%/BIdq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges 5
G
D6mo / 1g-*
,9+derblk #26 -4aELECTRICP,L PERt,IIT
Charges and
Surcha rges A/C Paving Tota'l Cornb. Permi t
Curb CutI,IECHANICAL PERMIT
Charges and
Surcharge s 7f.65TOTAL
l,later Heater_
COI'IBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to
Springfie)d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. exampl e- heat/2. ExffiT-e- waterE. SquaFE-Tbotage or
e .I 'I forced air gas
r or solar
va l uat o[t
l. example- 1250 sq. foot house, 500 sq. foot garage2. 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 fam.ily room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI'I AND CONTRACTORS
To avoid design or construction delays, Bu.ilding
Division Staff must be abie to contact appropriate
persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacent
III.
to the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful'l schedulesC. BUILDING DIVISION STAFF l,lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his eiectricalsupervisor. The general contractolis not author.izedto sign the electrical label
Applicant to sign and date
Hhenever possibie, the initial application will be used asa worksheet on1y. Where possible, Bu.ilding 0ivision Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
si gnature.
Fees and Charges
Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV
A@errr t
Permit Clerk
/1777
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit app'licant exempt from registration w'ith the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name S'I gnatu re date