HomeMy WebLinkAboutPermit Plumbing 1985-5-10
..
.
I !llSPECTlON LIIlE
726-3769
Job Address
I c" Sc:;
~.
/1'// .~-fAuJ
CITY Uf SPRINGfiELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Ranqe
INfORlIATlON L1Nl
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
r~ew Add Alter ReD.
-Fence Demo Change/Use
Other - -
~
Legal Description
A J
~::::ss ~.~:s:~~
~""? j.fl J) .
Constructlon lender
ValuE of Hark:
Address
Ul:.~ll:jrl I!:.AH
(1 ics. no.)
(exoiresl
00
M
o
l/1
[00
I
no.l
lnamel
Phone
fMtrlress \
BuilriinQ Permit Info: Describe Work(i,e.. Build Single
Family rl.esidence Hith lI.ttached (;araae)
~ ..I ~_ .ka.J> 1-1~
~...A I) ~ LP'--'A :1-"./""-,,, &.JH --'" 1..J
II
Phone 7<17- 57/4
(ohane
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(exoirp<;)
(ohnne nn. )
Genera 1
PlumbinQ ~/~ll ~,~ i?1u-~
Electrical
~1echan; ca 1
PLUIIBING
NO. FEE CHARhF Nn
Each single fixture
-,.
Relocated building
(new fix. additional)
S.F. Residence
11 bathl
Duplex (1 bath) each
Additional bath
~Jater service
Sewer
Storm Sewer
} B.uJ.Ji."./.tJ LU'';L ... 10.00
if
1cf (9
1(.,35100
3 }oJ'i:"
ELECTRICAL
MECHANICAL
I="H rI-lARr,1=" NO_
~I="~ I rI-lARr,1="
Residence of
SQ. FT.
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~rp hp~tpr ~nrl vpnt
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
hea t i no or A _ C.
Mechanical exhaust
hnnd <lnd riurt
Temporary Construction
Change in existing
rp<;,idrpC':p,
multifamily, comm. or
Tnduc;tri<ll
COMM./INO. FEEDERS
Install/alter/relocate
rii<;trih fpprlprc;
Wood stove/heater
Of
amps.
ISSUANC, OF PFR!lIT
TOTAL CHARGES 10.00, TOTAL CHARGES
WHERE STATE L.'I~ REQUIRES that tile Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
, TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 OrelJon pertaining to the work described herein, and that tlQ OCCUPAr~CY 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 OP.S 701.055 will be used on this project.
NAI.IE(p1ease print) 'Rd~ y 4."", ~
I FQ~
SIG;IATURCRI'1.Ql" (l
OrFIr:f IISF Oill v v"
,.. .... -
I.~ATE 0- -It) _;:;,1
I
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ft9. Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PER~lIT
Charges and
Surcharges
I Plan Ck. Conrn/lnd
65%/Bldn PPl" I="ee
-~---------- Plan Ck. Res
30%/B1do Per Fee
___Jf.!..:.!?_i?._ Fence
, VO Demo
lSysteras Development .
Charqe (1.5~)
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERliIT
Cha rges and
Surcha rges
Sidewalk
A/C Pavi ng
Total Comb. Permit
I1ECHANI CAL PERM IT
Charges and
Surcharges
Curb Cut
I
I TOTAL
J $/O:#(}-
.
..
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
II 03 43
2. exam~le- Lot 1. Slock 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check new - if addition.
check add. etc.
.F. Building permit information:
1. example - construct single family house with an
a ttached garage
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. OESIGN 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 insta1led are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
O. 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
e.
..
.
PERMIT VALIDATION
'b ~
'i (,\
J ~ ~lo
~~
.~
I
Permit Cl erk
\.~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
..
-
CITY OF SPRINGFIELD
APPLICATION AND AGREENENT FOR SEHER HOOKUP
Application is hereby m"de by the undersigned property OHner for permission
to connect the folloHing described property to a city sanitary seHer line, OI-ffied
and maint"ined by the City of Springfield, and I agree to pay such a hookup charge
of $4.50 per front foot of the property f6r the first 150 feet in depth to be
served hy such city sewer line in lieu of an assessment against the described
property. An additional $0.03 per square foot Hill be charged for any additional
property beyond the first 150 feet.
Property Description:
Address:
l855.South 'A' Street
Assessor's Map No. 1703 36 3l, Tax Lot No. 7700.
Beginning at the.Southwest corner of the Railroad Addition to Springfield; thence North
89057'3~' West 90 feet; thence North 00 2'3~' East l73.68 feet to the southerly
right-of-way line of South 'A' Street; thence along the Southerly right-of-way line
North 43024' 30" East 49.48 feet; thence continue along said right-of-way line on a
spiral curve, the long chord of which bears North 44030'10" East 81.41 feet; thence
South 002'30" West 267.75 feet to the place of beginning, in Section 36, Township
l7 South Range 3 West of the Willamette Meridian, in Lane County, Oregon.
Scwer hookup charge:
front feet @ $4.50 per front foot =
19.863
square feet @ $0.03 per sq. ft.
= $595.89
This agreement has been computed as being one-half (~) of the equivalent cost
of an <,ight (8) inch lateral sanitary SCHer at the rate of $4.50 per abutting
front foot and does not include the cost of a house connection to said city sewer,
se,,,er user charges, plumbing permits or other such costs to be assumed by the
property OIoll1er.
CITY OF SPRINGFIELD. OREGON
By: ~8"L/X-"Vi<<_) V iJjjl?~.
PROPERTY o\.INERS:
t.,(\,.~!,\O~
o"'>LA
----
Dat8:
_cn....L/Lf..Ft"-, /CZZ~
sT~rE Of OREGON )
) 5S
County (Jf 1."<:10 )
BE IT PJ':;';Si'iBERED, that on this / {,. day of /(;7 It \/
before me, the undersigned, a Notary Pllbl).c ~..n ,''lld f.:or ..the said
1] d.' /.' \ 1/ I;
pCrSOTI3 .y appcarc the \vithin named )-- (.I' &t1:,?i_.('(/~"ar;;/v1-
19
County and
/,cz--
State,
identical i.ndividll31
and acknm.Jledged to me that
clCSC1-ibcd in
/~.I- t7..
knO\ID to me to be the
.:1nd \1ho cxccuted the \vithin instrumcnt
.executed the same freely and voluntarily.
IHTi.:ESS my hand ane! seal this day and year last above \1ritten.
/--, - .7
(, / 4P--- ~ 11/
...~ . , >L..-...... ..t!./
(::.?--74/J/1 .' / /" /7/# f:/
Notary Pub lic ,/
'"
:f&f/ iV- If" ;:~
Hy Comrni~-;~;i.on J';;-:pir(~s
\