HomeMy WebLinkAboutPermit Plumbing 1981-5-1 (2)
I INSPECTION LINE
72~76'
I lob Addre"
I legal Description
I
I Own" h,.fJ,Qj"\Q. i )IY K.I(\o1:l!:eda)
I Add..../ n41 l2.AI (\ Wont1 Phone
I I~ U(\P n{i" ()E- --
I - I
Construction Lender
I Addre"
,I DESIGN TEAM
.
,.",'; .''''
.
INFORMATION LINE
17~7 53
001
CITY OF SPRINGFIELD
COMBINAJlON APPlICAJlON/pERMIT
t\J(J()
. ~
1'C1 Oq 'S()I) th A ~S-t
1163'31oC! '?
ENERGY SOURCES:
Sq. Ftg. Main
Sq. Ftg. Accus_
Sq_ fIg. Other
_New__Add _Alter _Rep.
~__Fence_Demo_Change/ U se
_Other
o
Q)-
o
r
Heat
Water Heater
~4. '2- :f131. -11J1 j
Range
I Volve of Wor~:
I -
I--e;"'i-lding Pe;.:n-it Info:'~ -Oeu:ribe Work (i.e., Build Single
Fomilv Rf',idll'nce WithAlfoch",d Garooe)
p UJ/rYl bl1l Q J.) JI fl.. .1 V
, ~f - /) <f-
~
Phone
(nomel
. (oddreu)
(lin. no.)
(eJCpires)
(phone no.)
Primary
Structural
Electricol
Mechanical
CONTRACTORS
(nome)
(addreu)
(lics. no.)
(expires)
(phone no.) -
I
.f
General
Plumbinq "'-
Electrical
~
Mechanical
PLUMBING
I
fEE I CHARGE j NO. '
I~op
I
I
!
ELECTRICAL
MECHANICAL
NO. ,
FEE
I_CHARGE
NO_
FEE
I CHARGE
SERVICES
furnoce/burner to
"-lU's
Appliance vent
separale
Stationary evap.
cooler
Vent fan with
single dud
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
/-
I
Residence of
Eac;, lingle fixture
Ro!lacared building
(new fi.ll. additional)
S.F. Re,iden~e
(1 balh)
s~: ft.
New circuits, alterations
or extension,
Dualel( (1 both) each
Temporary Construction
Additional balh
Amps.
Woler service
Sewer
Wood stove/heater
Slor.m Sewer
FEEDERS
Heat Pumo
Air handler to
10.000 CFM
Air hcmdler over
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE lAW REQUIRES Ihol the Eledrical work be done by the Ele..tricgl Contrac,or. the electrical porlion of Ihis permi' shall not be valid until a
label has b_n signed by an Eledrical Contractor and attached 10 the electricol panel.
NAME (pleo.o p,~ (.7f( /.} ../{,'/ r&
I HAVE CAREFULLY EXAMINED the completed opplicalion for permil, and do hereby certify that all information hereon is true and correct, and I further
certify IhQt any Qnd 'Ill work performed sholl be done in accordance with Ihe Ordinances of the City of Springfield and the lows of Ihe State- of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be- mode of any structure without the permission of the Building Civisian. 1 further
certify thai my registration with the Builder's Board is in full force and effect as required by ORS 701.055, thai if exempt Ihe basis for exemption is nohld
heron, and that only subcontracton and employees who are in compliance with ORS 701.0.5.5 will be used on this projecl.
SIGNATURE~~fLd_2-/ X.
/"
Basis for Builder's Board exemption:
I( ~ 4<::$d4/
FOR OFFICE USE ONLY
Zone
Fire Zone
Flood Plain
Type/ Consl.
5edrooms
(.Iori,-.
Units
r"occy Load
("Ieey Group
(.". Ftg. Mai'
c:". Ftg. Aeeess
Sq. Ftg_ Other
x
Volue
Value
Value
x
x
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
plan Ck. Camm/lnd
65%/ Blda Per Fep.
Plan CIi:. Res
30%/Sldq Per Fee
Systems Development
Chorae (1.5%'
PLUMBING PERMIT
Charges and -
Surcharges
60()
1n
Fence
Oemg
Tolal Comb. Permit
elECTRICAL PERMIT
Charge, and
SUff.horges
Sidewolk
Ale. Povina
TOTAL
]
MECHANICAL PERMIT
Charges and
S",rcharges
Curb Cui
('. Rec'd From r-:
.
COMBINATION APPLICATION/PERMIT (CAP)
. I. Applicaro. to furnish
A. Job Address
B. legal Description
1. examole-tax lot 100, lone County Map Reference. 1.7 n, A:l
2. example-Lot 1. Block 3, 2nd Addilion to 5pringfie\. ('.
C. Name, etc. of owner and construction lender
0.. Energy Sources
1. example-heat/electrical ceiling/or forced oir gas
2. examole.water heater/electrical/or solar
E. Square footage or valuation, etc. . -
1. exomple-1250 sq. foot house, 500 sq. foat garage
'2. exarnple.if new project, check M;W.if addition, cr., (
odd. etc.
F. Building permit information:
1. examole-construct single family house with an att
garage
2. example.remodel existing garagE=- into family rOOl
3. example.convert single fam.ily residence into
restaurant (change of use)
G. Volue 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 Divi
Staff must be able to contact appropriate persons re
design information or job site corrections, etC.
II. Abbreviated Plumbing. Mechanical & Electrical Sched~ll
.
(
Date
Address
,
\'.
.
PERMIT Y ALIDA nON
\;~:\~i,:.:s .
CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
. Department of Public Work.
OFFICIAL RECEIPT
(I
('
,
f1)-
C2 No. B
19r) J
5~415(
, .
{
+(Y:i~_(
/Uh
.(
. A.
Except where blank spaces occur in the description F
of the Mechanical and Electrical Schedules, the oppl'
need fill.in only the No. Boxes adjacent to the apprc
i.tem(s) to be installed
8. FuB Plumbing, Mechankal, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedu
have been abbreviated
2. If the item(s) to be installed are not covered on tl
aled schedules you should consult the full sched,
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES.
CHARGES ON THE SCHEDULES
... . .
-----
Received For:
,(
,.
,
'--1JJV
4e>/D
5.00
20'
(
(.
(
("
./'
(.
.\
. ,
i
"
(
Amount Received ? '20
III. Applicant to sign and dote
Whenever possible, the initial application will be used
worksheet only. Where possible, Building Division Staf /1;
prepore a typewritten copy and return it to the opplicc \..
the time the ac~ua\ permit is issued for his signaturE.
Fees and Charges ,(
Plan check fees are due and payable at the time of thE
and no plans will be processed until these fees are paiC:- ..-....
other fees and charges are due and payable when the permit
is issued.
\.
~
(
IV.
V. fOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEfORE OCCUPANCY:
q
Additional Project Information:
PLANS REVIEWED BY,
name
..ignaturl""'
~..
,
Cb
(
AUTHOR1':l:Etl SlG"'ATURE
."ILTO".TU~".ULL ~"'''TI''S . IUGI..I. 0.. .7"0.
....... (
(
...
Permit Clef'l.
I
I
I
I
dot""
.....
<' ,