HomeMy WebLinkAboutPermit Demolition 1983-5-6
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I INSPECTION LINE.
726-3769
- Job Address fUll).~' *-t - ~ .J
legal Description \ fl )~ ~ _ ~ rr-1
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Construction ~ender
CITY OF SPRINGFIELD INFOR/1ATlON UNo
COMBIIIATIDN APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. 1.la i n
Heat ~q. Ftg. Access.
Nater Heater Sq. Ftg, Other
Range New Add Alter pep.
Fen~O_Change/Use
Valu, Of~'~k' Other
C7~q I Bu,la,no pen1~fo: Describe Work(l.e.. Build Single
. Phony.,-",_o3Q. Family Residence IHth Attached Garaoel
Address
UtSlbll ItAI1
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
. Genera 1
. Plumbina
Electrical
~'echanical
(name)
Phone
(address)
, n Q ~ 1 n()Y\.. OVl C1Q H_:(J::J
.. ()\.. " 0 ("(\ >
t (lies. no.) (exoires) (OhOM
no. )
t
--~
.~(
t~
(name)
A-fll~/)~~
(address)
nics.. no.)
(pxoires.1
(nhnne no
,.." AhAjJ) _
PlUllBlNG
ElECTRI CAl
MECHANICAL
NO.1
Each single fixture
FEE I CHARGE Nn I FFF I r"1\RG.E ....llil......'
Residence of furnace/burner to
SQ. FT. BTU's
l J:'~J:' I r~!RG..E.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bathl
Duplex (1 bath) each
Additional bath
I ~Jater service
I Sewer
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
ITempOrary Construction
I'Chdnge in existing
rps i qr;ncf'
Imultifamily. conn. or
Tndustrial
IOf amps
ICO~1./IND. FEEDERS
I Install/alter/relocate
distrih. fppdprs
IOf amp~1
Appliance vent
!'f'oaratp
S.tiltiona.,y evap,
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd ~nd dud.
Wood stove/heater
ISSUANCF OF PFRr1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L"~ REQUIRES that tl,e Electrical work be done by an.:Electrical Contractor. the electrical portion of this pen:tH
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
1 HAVE CAREFULLY EXAMINED the completed application 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 Oregon pertaining to the work described herein. and that rw 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 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 7Ql.055 will be used on this project.
.. . L PAc; e SIGIIATUREJt!.-t:t~X. ~.-t DATE..?- (; - 3'3
rWIE(please printlJ-o TIle
FOR OFFICE USE IllY tI
Zone Tyoe/Const. Uni ts Sq. Ftg. r1ain x Value
Fi re Zone Bedrooms Occy load Sq. Ft9. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
PlUt1BING PERMIT
Charges and
Surcha rges
Plan Ck. Comm/Ind
65%/Rldo Ppr Fpp
------------ Plan Ck. Res
30%/Bldo Per Fee
_J~____ Fence
40 D~mo
Systems Development
CharQe (1.5~) .
BUIlOING PERflIT
Charges and
Surcharges
J?).CXJ
ELECTRICAL PERlm
Cha rges and
Surcharges
/1ECHANICAL PERMIT
Charges and
Surcharges
'Sidewa 1 k
A/C Paving
Total Comb. Permit
I TOTAL
40--'
cJ8. ,
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax lot 100. lane County Map Reference
11 U3 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examyle~ heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electr;cal/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
chee k add. etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examjle - 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 TEN~ 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'Electrica1 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 WrLL 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 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:
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PERMIT VALIDATION
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(oO?5?;q
10/63
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Permit
clerfilwo.-J
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,_~..'._~..-~' ..'_..._.....__~...c_. "_, .._..''<_.....c
date
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