HomeMy WebLinkAboutPermit Demolition 1981-5-19 (2)
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INSPECTION LINE
72~769
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~c,iy OF SPRINGfiELD ~
"c~'ArfON 'APPlICAflON/pERMlf.
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INFORMATION LINE
72~75J
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Job Add.... 41 51 m eLUl ~S t
1]Cf2A,? 32-
41.QPf./YY1/L.-" .:].i.M- {LrlUr
Own." ~fv.tunan '--Ru htP(/l (' j J.,/7f r
Q 4 0 c 11 Q .-1 ~:i- Building Permit Info: D~tCribe Work (i.e., Build Single
....ddr~" ~~ t...t : lV! l \~, Phone fom:!L~':',i~,:"'cf! With Altached GaroClel ~
'<;PV'lJtl(1 ({<POr^( j De 1~lJ.,-Cf,7?'L t).f VVlfll' IAn ! ~ 1\11 aD! I
Con"MHon l.nd., -h v.p, I \ )n .h 0 \ ,\()USJ! " I I
(add....l -f<~LtJJiL':,~ no(~..ppod ~hta.11
WD0 crt; t D (l g
Legol Descri~tion 'Z..ld'D,
I ENERGY SOURCES:
He- ,
I Water Healer
Ranqe _
I va,tue of Work:
i Sq. FIg. ~~i~ .
I Sq. Ftg: ACCUI.
Sq. Fig. Olher
_New _Add _Alter _Rep.
_ ._fence_Demo_ChongoJ Use
_Olher
-'
o
~
0J
Addr."
Phone
DESIGN TEAM
(I\ame;
Primary
CONTRACTORS
(addrl!lss)
flies. no.)
~
/l...\f/1
--r/~
11
(phone 1\0.)
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1
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Structural
-""
Electricol
Mechanical
{nome}
(expires)
G~neral
Plumbino
,
Electrical
Mechatlicol
PLUMBING
ELECTRICAL
MECHANICAL
NO. I
FE!:
I CHARGE 1 NO.
fEE
CHARGE
NO.
FEE
I CHARGE I
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'.'
Residence of
furtlacel burner fa
'll,TU's
Ap?liatlce Yent
separala
Each sil\Clle fi:lllvr.
Ro!laca,ed building
(tlew fiJl.. additional}
S.F. ilo!lide"ce
(1 balh)
H~: ft.
New circuit,. olteratiotll
or eJl.tensiatl'
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I TOTAL CHARGES
I WHERE STATE LAW REQUIRES .hal the Electrical war. be done by the Elertricel Contractol', the electrical portion of this permit shall not b. yalid until Q
label fias been signed by on Electricol Contractor and attached to the electrical panel.
i
I Ouale", (1 balhl each
I Additio"al both
I Waler seryice
I S.w..
I Slor.m Sewer
I
flliWY r n p
I
SERVICES
Stationary eyop.
cooler
Votll fatl with
,ingle duct
Vent 'ystem aport from
heating or A.C.
Mechanical ~Jl.hau't
hood and duct
Temporary Cotlstructiotl
Amps.
Wood stoy~/heatar
fEEDERS
Heat Pump
Air hotldlor to
10.000 CFM
Amps.
10 [x:h
Air handler oyer
10,000 CFM
ISSUANCE '-OI\-PfRMIT
ID.bC 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 furth.r
certify that otly atld all work performed sholl b. done in accordanc. with the Ordinance. of the City of Springfield and th.e Law. of the Stat. of Oregon
pertain;tl9 to the worlc described herin, afld that NO OCCUPANCY will b. mod. of otly structur. without the perminion of the Building Diyisian. I further
CIIrtify that my registration with Ihe Builder's Board is in full force atld effect os requir.d by ORS 701.055, ,hat if eX,emp. the basis for exemption is noted
heratl, and thai only twbcol\tractofl ond employees who are in compliance with ~RS 701.0" wal be ...d an ~d~' . . .
Basil fOt' Bwilder's Board exemptian: ~:e::::.....zjf (01
NAME'lpl.a.. p,;nl}'k'/~J?#.4/1J @-rT'=-^'~/7"-L"-~IGNATU~4'47,7/?,-,? J. ~~ATE 6- q-o_
FOR OFFICE USE ONLY
lone Type/Conlt Ilflih Sq. Ftg. Main
Fir. Zone 'edrooml. ...."y Load t;.". Ftg. Accon
Flood Ploin C,lorie' '":ccy Growp Sq. frg. Olher
BUILDING P!:RMIT I QO plan Ck. Camm/ltld
Chorglls otld 6s~~1 Blda Per Fee
Swrchorge. Plotl Ck. Res
JO~o/8Jdq Per Fee
PLUMBING PERMIT In.on
Charge, atld Fel\ce
Surcharges 40
Demo
ElECTRICAL PERMIT
Charges and Sidewalk
Swrcnarge.
..Ie: P':Ivin...
MECHANICAL PERMIT
Chorgel and Cwrb Cut
Surchorges &_------
.
.
.
Value
Value
Value
. TOTAL VALUATION
Systeml Deyelopmetlt
Char",. ll.5%\
I TOlal Comb. Permit
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I TOTAL
1140
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COMBINATION aICATIO.ERMIT (CAP)
. I. Applica~ 10 furnish
A. Job Address
B. legal Descri plion
1. examole-tax lot 100. lane County Map Ref.
2. examole-lol 1. Block 3, 2nd Addition 10 Spri
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. examole-heot/electricol ceiling/or forced 0
2. examole-waler heoter:, electrical! or solar
E. Square footage or valuation, etc.
1. examole-1250 sq. foot house. 500 sq. faol
2. exam~ie.if new project. check new-if addi
add. etc.
F. Building permit information:
1. exam ole-construct single family house wi
garage
2. exomole.remodel existing garagE: into fe ,..,
3. eXam pie-convert single family residence "'"
restaurant (change of ~se)
G. Value of wo,k as defined in Seclian 303 (0
St,uclural Specialty Code (
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays. Bl
Stoff must be able to contact appropriate fsc
design information or job site corrections
II. Abbreviated Plumbing. Mp.chanical & Electri
A. Except where blenk spaces occur in the ( ~ri'
of the Mechanical and Electrical Schedul
need fill-in only the No. Boxes adjacent
item(s) to be installed
B. Full Plumbing. Mechanical. and Electric
are available at the Building Division
1. To conserve space on the permit fo, .
hove been abbreviated ( .
2. If the item(s) to be installed are no
oted schedules you should consult
C. BUllDfNG DIVISION STAFF WilL FilL &,
CHARGES ON THE SCHEDULES !---
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SPR'NGF '-.-..
CltrHo" 'ElO
Springfield
Oepon ' Oregan
"'ent of P hi
OFFICIAL RU Ie Works
ECE/PT
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_mOUnt ReceiVed
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III. Applicant to sign and date
Whenever possible. the initial application will be used os 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 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 ore due and payable when the permit
is issued.
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V. FOR OFFICE USE ONLY
Permit Cler~
PROJECT. CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
to' ,".
,
. Additional Project Information:
name
r
'1
PLANS REVIEWED BY,
.signature
dale
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