HomeMy WebLinkAboutPermit Demolition 1985-12-6
~ IrlSPECTION LINE
726-3769
Job Address
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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- -
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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
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_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
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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
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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
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1
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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
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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,
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V. FOR OFFICE USE ONLY
Permit Clerk
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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
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