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HomeMy WebLinkAboutPermit Demolition 1985-12-6 ~ IrlSPECTION LINE 726-3769 Job Address . .. ~\ tit CIlT'OF SPRIrlGFIELD ' - COMBIilATION APPLICATION/PERMIT EIIERGY SOURCES: Heat l~ater Heater Ranqe <t'S6l1Z I Owner '11/1 u'J-Ah,,) ~T ~.f;, /,1 fiA-f.-/ Address /75 /'~Ahjh I/JL>;h&e':Pf< cz, / C7 A/I P ,;' f h 4"1-Z- Construction lirnder INFORllATION LINt 726-3753 Sq, Ftg, 1,la;n ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Pep, --Fence Demo Change/Use Dther- - I XJ LJ-.\ ""--- ~ o q /ft'9 /II auv Legal Oescription ValUE of Hark: Address Ul:.~ ll.iN Il:.Ar~ (name) Phone (address) BU11GlnQ Permit Info: DeSCflbe Work(i,e., Build Single Fam;l~Residence Hith Attach~d Garaoel Jk~~~I1I4iJ;;y- ZlfcL //""77 ,--, (lies. no,) rexoiresl (ohone no,l Primary Mechanical CONTRACTORS (name 1 J General ()JJ/J1 M ./ Plumbina (addre~s , (lire;. no.' ~ (PX)~ (ohnnp nn.l Structural Electrical Electrical ~'echanical PLUflBlNG ELECTRICAL MECHANICAL 110_ HE r:HARr.E NO I n'~ r~Alu::r: NO I I r:r:r: I rI-lA~r.r: Each single fixture Residence of SQ. FT. furnace/burner to BTU's / Relocated building (new fix, additional) New circuits alts, or extensions Floor furnace and vent I I I l (I I _rjO"':lJ,-J7~ I I ,.1' ~ I t1>1 [;If) -=~ .Po/VF!-A ~-""JV TOTAL CHARGES Iv 6 () TOTAL CHARGES WHERE STATE L\\~ REQUIRES that the Electrical work be done by an' shall not be vali~ until the label has been signed by an Electrical S.F. Residence (1 bath) IDuplex (1 bath) IAdditional bath I ~Iater service I Sewer I Storm Sewer each J I I ITemporary Construction , IChange in existing I rp~ i d_pnrp Imu1tifamily, comm, or I Indll,triil.l IOf ICD~1,/IND. FEEDERS I Install/alter/relocate rli,tdh fpprlpr, IOf amp~1 I I I SERVICES Recessed wa 11 ~o~rp hp~tpr ~nrl vpnt amps,1 Appliance vent seoarate I Stationary evap. cooler I Vent fan with sinole duct I Vent system apart from I heatino or A.C. I Mechanical exhaust I hood il.nd duct. I Hood stove/heater I I I I I I I I 1 I I I 1 ISSUANCE OF PFRlnT ,I TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division HAl,IE(please print) I HAVE CAREFULLY EXAMINED the completed apr1ication 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 Orel.:lOn pertaining to the work described herein, and that UO OCCUPAr~CY will be made of any structure without the permission of the Building Division, I further certify that my registration with the Builder1s 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 ORS 701,055 will be used on this project. kiTe:. (jo~P SI'GHATUREq-..a-er;:/~ FO~ OFFICE USE Q;lLY _,r) 1/ I' So' Ft9_ liain x Sq, Ftg. Access x Sq, Ftg. Other x /JIl1f1T DATE~-S- - , I Zone Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group Value Value Value \ Fi re Zone Flood Plain \ TOTAL VALUATION BUILDING PER~1lT Charges and Surcharges '-----lE!..~_ Plan Ck. Comm/lnd 65%/Bldo p.pr Fpe Plan Ck, Res 30%/Blda Per Fee Fence Systems Development Charae t1.5~) , PLU11BING PERMIT Charges and Surcharges O~mo ___________J Sidewalk I A/C Paving ____________, Curb Cut I I I I ELECTRICAL PERI~lT Charges and Surcha rges MECHANICAL PERMIT Charges and Surcharges ITotal Comb, Permit I I TOTAL !~,'ifD , COMBINATION APPlICATION/PE~~IT (CAP) PERMIT VALIDATION II t. Applicant to furnish A, Job Address B, legal Description 1, example- Tax lot 100. Lane County Map Reference 11 03 43 2, examole- lot I. Block 3. 2nd Addition to Sprlngtield Estates C. Name, etc, of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrical/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. .Building permit information: 1. examole - construct single family house with an attached garage 2, example - remodel existing garage into family room 3. exa~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 TEM1 ANO 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 full schedules C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES O. 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 payabJe when the permit is issued, " / 'I' I I c: 1 'J-( &J . 1j~l 0 rl . /~<,,'t) ~rr V. FOR OFFICE USE ONLY Permit Clerk rv PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additlonal Project Information: PLANS REVIEWED BY: name signature date . . (-1\ .