HomeMy WebLinkAboutPermit Demolition 1987-3-11
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INSPECTION LINE
i 726-3769
Job Address
Legal De$cription
Construction lender
Address
Ut~j~N I tAr~
Primary
Structural
Electrical
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INFORl1ATlON UNt
726-3753
Sq. Ftg, 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
l~ater Heater
Range
Yalu( of Hork:
I,?' C; 14
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oq
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(name)
Phone
(address)
BuildinQ Permit Info: Describe Work(i.e., Build Single
Familv Residence With Attached Garaoel
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a ~ftt-l A.tcf ~dcu
(fics. no.) (exoires) (ohane no..~
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Mechanical
CONTRACTORS f? Inamell/? ~
General rbm!',O I ~
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Plumbino
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~1echani ca 1
NO.
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(1 ies. no.)
(pxoirpc:.)
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PLUllB I NG
ELECTRICAL
MECHANICAL
~c~_ _'=~~ -YO I I He I ruARG.E ~
furnace/burner to
BTU's
"<>
r41l.!!GL I
Residence of
SQ, FT,
INew circuits alts.
or extensions
ISERVICES
Recessed wall
Sn~rp hp~tp~ ~nrl wpnt
Each single fixture
Relocated building
(new fix, additional)
I',S.F. Residence
(1 hathl
Duplex (1 bath) each
Additional bath
Wa ter ser\:i ce
Sewer
Storm Sewer
I
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I
Floor furnace
and vent
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lTemporary Construction
IChange in existing
rps; rlJ"nrFl
ImUltifamilY. COnIn. or
Tndustrial
IOf amps,1
ICO~~,/IND, FEEDERS
I Install/alter/relocate
rlh.tr; n fpprlpro;;
IOf amp,,1
I
Appliance vent
spoarate
Stationary evap.
c:nnlpr
Vent fan with
sinale duct
Vent system apart from
heatino or A.C.
I'MeChanical exhaust
hood and dud
I vload stove/heater
I
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ISSUANCE OF P[RIHT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 oerformed 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 NO OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project.
NAI,IE(please print)'t:c1- m""O-::r-iA/ SIGrlATUR:W-7:r,,!- "-
FOr. OFFICE USE- OI~L Y
Sq. Ftg. riain
Sq. Ftg. Access
Sq, Ftg. Other
Zone
Fi re Zone
Flood Plain
BUILDING PERMIT
Charges and
Surcharges
PLUl1B ING PERMIT
Charges and
Surcha rges
ELECTRICAL PERr~1T
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
DATE 3/( h 7
/ /
Type/Const,
Bed rooms
Units
Occy load
Occy Group
x
Value
Value
Value
x
Stories
x
TOTAL VALUATION
Plan Ck. Comm/lnd
____________~/Bldo p.pr ~PP
Plan Ck, Res
30%/Bldo Per Fee
Fence
Systems Development
Charoe t1.5~) "
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I Curb Cut I
I~~I
D~mo
I'Sidewa 1 k
I A/C Pavi ng
Irotal Comb. Permit
~\:
l <('. 00
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I TOTAL
I f, (jf)
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Appl icant to furnish
A, Job Address
B, legal Oescription
1. example. Tax Lot 100, Lane County Map Reference
II UJ 43
2. exam~le- lot I. Block 3, 2nd Addition to
springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. ex amp 1 e- hea tle 1 ectri ca 1 ceil i nq/or forced air Qa5
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -----
L exam~le- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family raom
3. examole - 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 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 Electrical 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, BUllOING DIVISION STAFF WIll FILL OUT All FEES ANO
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.
~& 712 I
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V, FOR OFFICE USE ONLY
Permi t Cl erk ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
j
name
signature
date