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HomeMy WebLinkAboutPermit Plumbing 1981-5-1 !INSPECTlON LINE 726-3769 I I I I own..0hO.f\Q/ )LY KJ/\o7JeLtnl I I 4" () ,1"'1 tt"\ } I ~o ..A Building Permit Info: Describe Work (i.e.. Build Single Address n I ~ll J Ll...J nr l Phone FomBv Re\id~.,r,. With Attoched GaroC'el : con"'U'~:'l~~~~np'l ()E. ~4'2-~31.J)rLR ,. I Address , DESIGN TEAM I Primary I Structural I Electrical I Mec:honical I CONTRACTORS I I I Electrical I Mechanical I . ......~ '" '- . INFORMATION LINE 72~753 ~ o uJ- o t'J CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Addren legal Description 4 J I.g OCJ S()I) th {j S-t 1"163'310'1 '7. I ENERGY SOURCES; Heat , Sq. fIg. Main Sq. fIg. Accen. Sq. FIg. Olher _New_Add _Aller _Rep. ___Fence_Demo_Chonge! Use _Olher n() Waler Heater Ronqe _ I VoJue, of Work: P 1LlR]J bLfI~ If 1:11 J itl , ~ Phone (nome) (address) (lin. no.) (expires) (phone no.) (name) (address) (lies. no.) (eJlpires) (phone no.) G..neral Plumbinq '/..- PLUMBING ELECTRICAL MECHANICAL ). Each single f'Jllure ReloCOTed building (new fi:ll. additional) S.F. Residen~e (l both) I FEE I CHARGE NO. It; ob FEE I CHARGE NO. I FEE CHARGE . NO. I Residence of furnace/burner to ll,TU's Appliance vent separate Stalionary evap. cooler Vent fan with single duct Vent system apart from heatinq or A.C. Mechanical e:llhaust hood and d~ct Sq: ft. New circuits. alterations or e:lllensions SERVICES Duolelt (1 bOlh) each Temporary Construction Additional bolh Amps. Waler service Sewer Wood stove/healer I I I I I I r I TOTAL CHARGES I Slor.m Sewer FEEDERS Heal Pump Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. I TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE lAW REQUIRES that the EI.ctritol work be done by the EIertricol Cont'ottor, the eledrical portion of this permit sholl not be yalid until 0 label has boen signed by on Elottricol Contrador and oftach.d to the eloctricol pone!. 'v c.:"'/I : NAME (please pri~/J. ../L~/ IP.. I HA VE CAREFUllY EXAMINED tho completed application for permit, and do hereby cortify that all informotian hereon is true and correct, and I further certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield Clnd the laws of the State of Oregon perlClining to the work described heri~, and that NO OCCUPANCY will bl) made of any structure without the permission of the Building Division. I further certify that my registratian with> the Builder's Boord is in full force and e<ffect as required by ORS 701.055, thot if eJlempt the basis for OJlemption is noted heron, C1nd that only JoubCCTntracton and employees who ore in compliance with QRS 701.055 will be used on this projed. . SIGNATURE '& 44~fi.- 2:1 ~ 5/ (, rl /' Basis for Builder's Board eJlemption: If 4 A-,76dA-t" FOR OFFICE USE ONLY Zone Typel Const. Units Sq. Ftg. Main Value Fire Zone Bedroom' nccy load Sq. Ftg. Access . Valuo Flood Plain <;torie- nccy Group Sq. Ftg. Olher . Value TOTAL VALUATION BUilDING PERMIT Plan Ck. Comm/lnd Systems Development Charges and 65'%1 Blda Per Fe~ Charae (1.5%) Surthorges Plan Ck. Res 30%1 Bide Per Fee PLUMBING PERMIT 6. 00 Charges end Fence Surcharges 2n Demo Tolol Comb. Permit elECTRICAL PERMIT Charges and Sidewalk Surchorges AI C Pavina MECHANICAL PERMIT Charges and Curb Cut Surchorges -------- TOTAL . COMBINATION APPLICATION/PERMIT (CAP) . I. Appl;ca~ la furnish A. Jab Address B. Legal Description 1. example-tox lot 100, lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition ta Springfield Estates C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced oir gas 2. example-water heater/electrical! or solor E. Square footage or valuation, etc. 1. exomple-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 ottoched garage 2. example-remodel existing gQrQg~ into family room 3. example-convert single fom.ily residence into restaurant (change of use) G. Volue of work as defined in Section 303 (0) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid 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 Sched~les 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 i.tem(s) to be installed B. FuH Plumbing, Mechanical, and E~ectricol 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 ore 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 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 typewritten copy and return it to the applicant at the time the oc!uol 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 pions 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: ~. , AdditionQI Project Information: PLANS REVIEWED BY, nom"" ~ignatur"" . Permit Clery PERMIT VALIDATION .;ot....