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Home My WebLink AboutPermit Demolition 1981-5-19 I NO. I I I I I 1 I I I I I I I I r I TOTAL CHARGES I WHERE SlATE LAW REOUIRES that the EI.ctrical work b. done by the E!."'rical Contractor, the .lectrical partioll of this permit shall not b. valid until a lab.1 has b_n signed by on Electrical Contractor and attached to the electrical panel. ..-' ~...;, INSPECTION LINE 72~769 _ITV OF SPRINGFiElD CO AHON APPLICATION/PERMIT . .:. INFORMATION LINE . .~ :.... 726-37 S3 Addreu Phone oESIGN TEAM (nome; I I I I 1 1 I 1 1 1 I Primary Structural Electrical ,'-"echanicol CONTRACTORS (name) (address) (lies. no.) (....pinuJ Gl!nefol Plumbinq Electrical Mechonical PLUMBING ElECTRICAL MECHANICAL fEE I CHARGE i I FEE I CHARGE CHARGE I ./ I NO. FEE NO. Residence of furnace/ burner to Il,TU's ~1:1: ft. Eoch 5inqle fiJIC'ur. Relocored bvilding (new fill.. additional) S.F. Residen~e (1 balh) New circuits, alterations or extensions Ap?liance vent separato Stationary evap. cooler Venl fan with sintlle duct Vent system aport from heating or A.C. Mechanical exhaust hood and duct I I SERVICES Dualex tl balhl @ach Temoorory Construction Additional both Amps. Water servic@ Sewer Waod stovel heater Stor,m Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Amps. :~r(] D I Air handler aver 10.000 CFM j(}lX,> I (DPLJ I ! ISSUANCE .OF,P~MIT TOTAL CHARGES TOTAL CHARGES I 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 ood all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work descriDed herin, and that NO OCCUPANCY will be made of any structure without the permiuion of the Building Division. I further certify that my registration with- the Builder's Board is in full forte and effect as required by ORS 701.055, that if .x.~mpt the basis for exemption is noted heron, and thot only subcontractan and employees who are in complianat with ORS 701.05.5 will be u~d on this pro'ect. I I Basis for Builder's Boord ellemption- -- '5-lq-g{ DATE NAME'(please print' <::J'lI=J:!'~.fA) ~'7'T hV ('Ll7IL"-~IGNATU~~-;7/2-77 FOR. OFFICE USE ONLY Zone Typel Const 'nits c:.... Ftg. Main Fir. Zone II-drooms 'Jccy Load .l;,q. FIg. Acceu Flood Plain <'torief Occy Group Sq. Frg. Other BUilDING PERMIT I 00 PIon Ck. Comm/l"d Charges and 65%/ Blda Per Fen Surcharges PIon Ck. Res 30%/ BldQ Per Fee PLUMBING PERMIT In.oo Charges a"d Fence Surcharges 40 Demo ELECTRICAL PERMIT Chorge' and Sidewalk Surcharges .'e: p,::,,,:..,:, MECHANICAL PERMIT Charges and Curb Cut Surcharge, -------- "alue Value Value x x x . TOTAL VALUATION Systems Development Charae (1.5%' I Total Comb. Permit TOTAL 1140 . . . :....... ......:...- ,.- -'.' .' COMBINATION APPLaION/PE.T (CAP) . I. Applica~ 10 furnish . A. Job Address B. legal Description . 1. exomple-tax lot 100, Lane County Map Reference 17' 03 43 2. example.Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D.. Energy Sources 1. exomole-heot/electricol ceilinq/or forced air gas 2. exomole-waler h~otei'/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. fool house, 500 sq. foot garage . 2. example-if new project, check new.if addition, check add, etc. \ F. Building permit information; 1. exam ole-construct single family house with an attached: garage 2. exomole-remodel existing garagE. into family room 3. exampie-convert single family residence into restaurant (change of use) G. Value 01 work as delined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able '0 contact appropria'e persons regarding design informa'ion or job si'e correc'ions, etc. II. Abbreviated Plumbing, Mechr;mical & Electrical Sched~les A. Except where blenk 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(,) to be inslalled B. Full Plumbing, Mechanical, and Electrical Schedules . are available at the Building Division . 1. To conserve space on the permit form the schedules hove been abbreviated 2. If the item(s} to be installed are not covered on the abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISfON STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES .- 111_ 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 typewritten copy and return it to the applicant at the time the actual permit is issued for his signatur!.. IV. Fees and Chorges Plan check fees are due and poyable 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: ~ . Additianal Project Informatian: PLANS REVtEWED BY: namf" ",ignaturr'>- I- Permit CierI- . PERMIT VALIDATION -, ., ~ .Jat.... --'", '.' .I I I f , f';I: "