HomeMy WebLinkAboutPermit Demolition 1981-6-29 (2)
INSPECTION LINE
72~769
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CITY OF SPRINGFIELD
COMBINA TlON:APPLlCA TlON! PERMIT
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INFORMATION LINE
726-3753
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I ENERGY SOURCES:
Heat (;AS
1 Water Heater elect
Ran!:le
Value of Wark:
Sq. Ftg. Main ~o I 0
Sq. Ftg. Accen.
Sq.. Ftg. Other
_New_Add_Alter_Rep.
_Fence_Demo_Change! Use
_Other
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Job Add,... 4157 Main Street
Legal Description 17n?~2~2 02f.nn
OW"., Sherman Ruttencutter
81,088.00
Building Permit Info: Describe Work \i.e., Build Single
Familv Residence With Attached Garaae)
Address940 SmITh 4~T'r1 .c::."t Phone 7A"_ ,'),t)
Springfield, Oregon 97477
Construction Lender PeonIes Bank
DEMO existing store structures and
Address Phone
COT'strnct shell onl v for new Nel son t s
Tire Warehouse
DESIGN TEAM
(name)
(address)
(lics. no.)
(expires)
(phone no.)
CONTRACTORS
(address)
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(Iics. no.) Y (expires)
7?/\- 225('
Primary
Georue.Griffin
2866 Manor Orive
Structural
Electrical
Mechanical
(name)
(phone no.~
Plumbina
Twin Rivers
44 Orepon Street. Cre~we]l
204n W. Broadwav
:\4521'
:\44-1 ill
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Gener(ll
Metal Clad Bldrs.
Electrical
Ht)nT'Y Ponct)li'J"l
hQ~ Woc. ('pntt)nn; ~1 Rl,~r1
~A1_11Q~
Mechanical
PLUMBING
elECTRICAL
MECHANICAL
NO. ~
FEE I CHARGE
NO. I
FEE
I CHARGE NO.
FEE
CHARGE.
Duplex (1 bath) each
Temporary Construction
"n nil
furnace/burner to
~TU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heatinSl or A.C.
Mechanical exhaust
hood and duct
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
25.0
Residence of
s9. ft.
New circuits, alterations
or extensions
SERVICES
Additional bath
Amps.
Water service
Sewer
Wood stove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handler over
10.000 CFM
Amps.
ISSUANCE OF PERMIT
r TOTAL CHARGES
I
25.00
TOTAL CHARGES
10.00
TOTAL CHARGES
WHERE STATE LAW REQUIRES that th. Electrical work be don. by th. Eledrieal Contractor, the .Iectrical portion of this permit shall not ba valid until a
label has been Ngned by an Electrical Contractor and attached to th. .Iectrieal panel.
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 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 herin, and that NO OCCUPANCY will b. made of any structVre without the permission of Ihe Building Division. I further
certify that my registration with the Builder's Board is in full force ond effect a s required by ORS 701.055, 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 used on this project.
Basis for Builder's Board exemption:
NAME (please print)..J!,.,Af'tE.r
/7
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p-/ SIGNATURE;2r.. .-:'
FOR OFFICE USE ONLY
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OATE .c. -,,? 9-17 .
,
Zon~ r.4
Fire Zone
Flood Plain
Type/Const.--YN
~drooms
C;.torie~
Units
occy Load
n ""y Group
Sq. Ftg. Main
0::..... Ftg. Access
Sq. Ftg. Other
5R7/\ x 1 " R,O_Value Rln88.00
x Value
x Value
TOTAL VALUATION 81.088.00
SHELL ONLY
ADDITIONAL PERMITS ROD FOR IN' ERIOR
BUILDING PERMIT
Charges and
Surcharges
251. 00
10.04
25.00
Plan Ck. Comm! Ind
65%/Sld!:l Per Fee
Plan Ck. Res
30%/Bldq Per Fee
163,15
Systems Development
Charae f1.5%\
1216.33
PLUMBING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERMIT
Charges and
Surcharges
1. 00
._...1!L.00___
Demo
Total Comb. Permit
Sidewalk
/\.:\11
.n
AI C Pavino
MECHANICAL PERMIT
Chorges and
Surcharges
Curb Cut
TOTAL
1683.22
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.P~RMlt VALIDATION
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Legal Description
1. example-tax lot 1 Dei. Lane County Map Reference 17 03 43
2. example-Lot 1. Block 3, 2nd Addition to Springfield. Estates
Name, etc. of owner and construction lende", t ~.
Energy Sources
1. examcle.heat/electrical ceiling/or forced air go"s
2. example-water'h"eater!eledrieal/or 501ar. _.
E. Square footage or valuation,. etc. -. r. ., ." . ._
1. example-1250'sq. foot ho'use, 500 sq: foOt'gaiage'.
2. examole.if new project, check new-if addition: 'cheek
add. etc.
F. .Building permit information:
1.o'"example.consfruc;t single family house with an attached",
go rage
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 TEAM AND CONTRACTORS: .': --.. ,--.'
. To-qvoid design or construction delays, Building Division ....
'Staff must be able to contact appropriate persons regarding.
. c;fe_sign information or job site corrections, etc. .', .~. ~
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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 ~ivision
1. To conserve space on the permit form the schedules
hove been abbreviated
2. I~ the item(s) to be installed are not covered on the abbrevi-
ated schedules you' should consult the full schedules
C. BUILDING DIVISION STAFF WILL 'FIlL OUT ALL FEES AND"
CHARGES ON THE SCHEDULES
I,.'
III. Applicant to sign ond date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, Building Division Staff will
prepare 0 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.
V. FOR OFFICE USE' ONLY
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Permit Cler~
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PROJECT CONDITIONS TO BE' SATISFIED. BEFORE OCCUPANCY,
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THIA PFRMIT TC: APPROVFn FOR CO~STllliCTio~"oF T'lf RlITt "TJiG SHEll mol" v _ ADDITIONAL
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PERMITS ANDIINSPECTIONS ARE REQUI~D:FOR COMPLETION OF THE INTERIOR OF THE BUILDING
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PRIOR TO OCCUPANCY.
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Addi~if?n~1 Project Information:
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PLANS REVIEWED BY:
I,
nam""
c;ignatur""
"'atf"
JUNE ao:1'6;r".;';'
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