HomeMy WebLinkAboutPermit Plumbing 1981-5-1
!INSPECTlON LINE
726-3769
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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
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I Electrical
I Mechanical
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INFORMATION LINE
72~753
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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 ,
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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
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I TOTAL CHARGES
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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
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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
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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:
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AdditionQI Project Information:
PLANS REVIEWED BY,
nom""
~ignatur""
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Permit Clery
PERMIT VALIDATION
.;ot....