HomeMy WebLinkAboutPermit Demolition 1981-6-29
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I INSPECTION LINE
726-3769
I Job Address
Itegal Description
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CITY OF SPRINGfiElD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
170m:'" n21\00
ENERGY SOURCES: Sq. Fig. Main ;>0 I 0
Heat ~AS Sq. Fig. Accen.
Water Heater elect Sq. Ftg. Other
Ranqe _New_Add_Alter_Rep.
1 Value of Work: \_FenCe_DOmO_ChangefUI.
_Other
81. 088.00
Building Permit Info: Describe Work (i.e" Build Single
Phone 7,d';_ ,7,0 Family Residence With Attached Goraae\
Addren940 SOUTh .4 ~rrl St-
Springfield, Oregon 97477
Construction Lender PeonIes Bank
DEMO existing store structures and
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4157 Main Street
Own" Sherman Ruttencutter
Address
Phone
co.,,~trt1ct she:ll only fOT new Nel~onts.
Tire Warehouse
DESIGN TEAM
(name)
(address)
(lies. no.)
(expires)
(phone no.)
Structural
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7?(,-nsn
Primary Georve (;riffin
2&1\(, Mannr nriv~
Electrical
Mechanical
CONTRACTORS
(nome)
(address)
(lics. no.)
{excirell
{,)hone no'\
Twin Rivers
44 Or~~on StT~et. Creswell
2040 W. Broadwav
345''''
.,dd-l &32
G..neral
Metal Clad 8ldrs.
Plumbing
f.R,_1d1d
Electrical
J.I~Tn"y Dpnc:ol;n
SR t:; wP<:.t (t.mf' ~nT\; ':::J 1 R 1 ,~A
~1_110t:
I Mechanical
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PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE
CHARGE NO. I
FEE
CHARGE
NO.
FEE
CHARGE
Duplex (1 bath) each
1 Temporary Construction
1"1 nil
furnace 1 burner to
A.TU's
Appliance vent
seporate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
: ~ Each sin~le fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
25.0
Residence of
sq. ft.
New circuits, alterations
or extensions
SERVICES
Additional both
Amps.
Water service
Sewer
Wood stove.lheater
Storm Sewer
FEEDERS
Heat Pum"l
Air handler to
10,000 CFM
Air hondler oyer
10,000 CFM
Amps.
ISSUANCE Of PERMIT
TOTAL CHARGES
25.00
TOTAL CHARGES
10.00
TOTAL CHARGES
WHERE STATE lAW REQUIRES that the Eledrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the .Iectrical panel.
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further
certlfy that any and all work performed sholl b. done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will bit made of any structure without the permission of the Building Division: I further
certlfy that my registration with the Builder's Board is in full fQt"ce and effect as required by ORS 701.0.5', that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be uUld on this project.
Basis for Builder's Board exemption.
NAME (please print) M.., ~ e f
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t:/'o P/
SIGNATURE,9~......,..../ vt1 ~4
OATE t:t. -.;:7 P-I7 .
fOR OFfiCE USE ONLY
,
BUILDING PERMIT
Charges and
Surcharges
SHELL ONLY
I
ADDITIONAL
Units Sq. fig. Main 5R7'" x 13 &0 Value &1,0&&.00
n.cy Load c_. fig. Access x Value
""'~'"Y Group Sq. ftg. Other x Value
PERMITS ROD FOR INTERIOR TOTAL VALUATION 81.088.00
Zone C4
fire Zone
flood Plain
Type/Const.~
Bedrooms
c'ori~.
PLUMBING PERMIT
Charges and
Surcharges
251. 00
10.04
25.00
Plan n. Comm/lnd
6.5%/ Blda Per fee
Plan C\!:. Res
30%1 Bldq Per Fee
163.15
Systems Development
Chcrae n.5%'
1216.33
fence
ELECTRICAL PERMIT
Charges and
Surcharges
1. 00
10.00
Demo
Total Comb. Permit
Sidewalk
(,.30
^"
AIC Povinn
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
1683.22
III. Applicant to sign and date
Whenever possible, the initial application will be used as
worksheet only. Where passible, Building Division Staff.,. (
prepare a typewritten copy and return it to the applicant .
-. the time the actual permit is issued for his signature. ~ .
IV. Fees and Chorges
Plan check fees are due and payable at the time of the application,
'and no plans will be processed until these fees are poid. All
other fees and charges are due and payable when the permit
is issued.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference
2, example-Lot 1. Block 3, 2nd Addition to Springfield
C. Name, etc. of owner and construction lender
D. Energy Sources
'1. example-heat/electrical ceiling/or forced air gas
2. example.water heater/electrical/or solar
E. Square footage or valuation, etc. .
1. example-I 250 sq. foot house, 500 sq. foot gorage .
~ ,2. example-if new project, check new~if addition, ehec
add, etc.
. F. Building permit information:
1. example-construct single family house with an otta
garage
'2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value of work os defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS ' .
To avoid design or construction delays, Building Divisi
Staff must be able to contact appropriate persons rege
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical'Schedules
A. Except where blank spaces occur in the description po
~ of the Mechanical ond Electrical Schedules, the applicl I
need fill-in only the No. Boxes adjacent to the approp Ie
item(s) to be installed
B. Full Plumbing, Mechonical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedule:
have been abbreviated
2, If the item(s) to be installed are not covered on the
ated schedules you should consult the full schedule C
C.' BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At
CHARGES ON THE SCHEDULES
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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CITY OF SPRINGFIELD
City Hall
Springfield. Oregan
Department af Public Works
OFFICIAL RECEIPT
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Dote '-\.A.U\ Cl , N-' \ 1 cR \
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Received "For: \....A ). \'\L) n ')51 0 ~ \
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nnc OERMIT IS APPRO"ED FOR cnMcTollrnON OF nit' "I~!'-IHNG SWEll ("~'- v. An'ilTTTnNAI
~ . PERMITS AND' INSPECTIONS ARE REQUIRED FOR COMPLETION OF THE INTERIOR OF THE BUILDING
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'PRIOR TO OCCUPANCY.
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Additional Project Information:
PLANS REVIEWED BY:
nomeL"~I~t: t" ~.:-:~~
signaturl'"
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JUNE 29,19fn'