HomeMy WebLinkAboutPermit Demolition 1990-4-4
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jlNSPECTION LINE
726-3769
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CITY UF SPRINGFIELD
CGr1GlIIATlON APPLICATION/PERMIT
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Address
UeSHiN lEAI1
(name)
Phone
( addres~
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BuilriinQ Permit Info: Describe Work(i.e., Build Single ~
Familv nes;dence Hith JI..ttached Garaae) '->
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(phone no.)
tNFORllATlON LINe .1
726-3753
Sq. Ftg. 1.lain
:q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
. -.
Job Address
Owner
Address
ri JplO/iVh
(li,..e:,
'1~~
(~X[); res)
; Primary
St,'uctura 1
Electrical
t1echanical
CONTRACTORS '" Inamel
:'it- fi. ffJJ1
(addrp,c:)
(lire:. no.
(PXOlrpc:\
(ohnnp fin
Genera 1
['m x17u.1Aor-, ,
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Plumbina
Electrical
~1echanical
PLUrlBING
ELECTRICAL
,
~~~ r~AQ~~ NO.
MECHANICAL
NO.
FFF rHI\Rr;f Nn
Each single fixture
Residence of
J:n rl-lll.lliiE..
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
~Iater service I
Sewer I
Storm Sewer I
filA?1/? _ Sept/c.1
'i- ,hLl I
, I I
I
I
I
INew circuits alts.
or extensions
ISERVICES
I
Floor furnace
and vent
Recessed wall
Sn~r~ hp~tpr ~nn ~pnt
If:), 00
ITemporary Construction
IChange in existing
rp~; rI~nq~
Imultifamily, corrm. or
Induc;,trii\l
IOf amps,
ICONI1.fINO. FEEOERS
I Install/alter/relocate
rI;~trih_ fpprlpr~
10f amps.
Apoliance vent
seoari\te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
ISSUANCE OF PFR!IIT
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 pemit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed aprlication 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 Ore~lOn pertaining to the work described herein, and that 1m OCCUPAHCY 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
OfJ/lrJ;d1jS anasb{'$"h;ro ar.. in ~~~~O~S 7n!.055 will be used on this project.
IWIE(please print) '-r'r'lLl liD. ~..s_~_ SIGilATURE 0 ~ ~ lvv,(U,\ '-..
Far. OFFICE USE ~
Sq. Ftg. rla;n
Sq. FtQ. Access
Sq. Ftg. Other
onE
4 ~-(:. 90
Zone
Fi re ZonE'
Type/Canst.
Bedrooms
Units
x
Value
Value
Value
Flood Plain
Stories
Occy Load
Occy Group
x
x
TOTAL VALUATION
BUILOING PERIIIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65%/Rldo Ppr ~pe
------------""Pian Ck. Res
30%/Bldo Per Fee
__JI?,LQP___ Fence
. '75' 06mo
I Sidewalk
-----------~I A/C Paving
r
I Curb Cut
------------1
Syste~s Development
Ch~
GOZD
IX.DO
,1D
PLUt1BING PERI1IT
Charges and
Surcha rges
ELECTR I CAL PERlm
Charges and
SurchC!, rges
Total Comb. Permit
',ECHANICAL PE.RMIT
Charges and
Surcharges
I TOTAL . 3L/&6 r
-
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. legal Oescription
1. example- Tax Lot 100, lane County Map Reference
11 oj 43
2. exam~le- lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Q3S
2. examole- waterneater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check:ruew - if addition,
cneck. 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 TEN4 ANa 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. BUllOING DIVISION STAFF WIll Fill OUT All FEES ANa
CHARGES ON THE SCHEOUlES
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
e
P~RMIT VALIDATION
* IltS0 ~
~
Clerk~
Permit
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
.. ~
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.
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Address~~;~_ ~~~
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Phone 0~:\Cr.o ' Apt
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DESCRIPTION OF WORK DONE: #1 e.rl. . '-< ..... .s I"",/., e
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Tho.on "t-
Septic & Rooter Service
P.O, Box 636, Springfield, OR 97477
Phone (503) 746-4224
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Bill 1b:
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Name
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I Address , Ct. :,</ L1 _!] ,I. + Z1)
L. ~, 0 (1;<,~..- ;...<<
I
E",-~ 91<-
I Phone 41,/-0-:"43
Job SII.: (\ ^ "'r \,
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ZiP'i'7'{ol.
'Name
U'("~"'" .1 r...
,
h/~
(?~5~
JOB .K ORDER
NO. OOL)UU
I Date 'i' -/2 -'7<>
PO. No. '"' -/2.. -<iD
Salesman 'j).;,:L
OOI.rlp"on of Job:
~,:ump Septic /S 00
j 0 ROOler: 0 Main 0 Sink
J 0 Laundry 0 Toilet
o Tub
o Inspection ./
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NDTES:~ .
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V
Date
Scheduled
Time
Scheduled
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CUSIOJl~llre
~1 No one home
TERMS - Nel 30 days unless olherwlslllndlcallld on InvoIce. A SERVICE CHARGE OF lVI'll PEn MONTH 118111 PER YEAR) WILL
BE CHARGED ON All AMOUNTS NOT PAID WITHIN TERMS"
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PAY FROM THIS INVOICE
I 'Separil:te Invoice will be generated only if box is checked.
TERMS:
I I CASH upon complelion
IXI' CHARGE
I hereby acknowledge the satislac~prelion of Ihe above described work:
./,1"", ~/ ~/ <
Work don, bWffl..c:c.."'::___~~ ._.______
STATON CONSTRUcnO~, INC.
29394-8 Airport Rd.
Eugene, Oregon 97402
Phone (503) 461-0543
tj>,-<.'~_ ~.
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Pumping
Labor
,.
,
!;
Total
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