HomeMy WebLinkAboutPermit Plumbing 1982-5-3
Job Address 6.r~ UJ, C?<V 7/ MF1-?L
Legal Description J 7 - 0 .3 -;;. 7 - 'Y :? rL.~<9
,.. ....--
rJ --
~-_.- -
~I' iNSPECTION LINE
: 726-3769
~ CITY OF SPRINGFIELD
~ CmlBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
.
INFORtlATION UNt.
726-3753
Sq. Ftg. r.1a in
Sq. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
\l)
N
\)
..(
N
Q
Range
ValuE of Hork:
Owner ilIA fT 8t?o.r, Ccl~S'T
Address &&3 lAJ, C "F-vT,;.......,4 ~c:
Construction Lender
Address
. DES I GN TEAr~
. ; Primary
! Structural
!
: Electrical
Phone
Buildinq Permit Info: Descr be Work(i.e., Build Single
Family nesidence With Attached Garaqe)
JAd"
f -f.11mJJ {)p lL,iruJzJ
I I I
(name)
Phone
(address)
(exoires)
(ohone nO.'J
(lics. no.)
~ Mechanical
: CONTRACTORS
'Tv-4"v K. j'.(.JIC r/,~
General
1 Plumbinq
, Electrical
~1echani ca 1
NO.
(name)
(iiddrp.ssr------ ('jics. no.)
(exoires)
(ohone no. l
PLUtlBI NG
ELECTRICAL
MECHANICAL
FEE I CHARGE NO
... . rHARGFI NO.
FFF rHARI;F;
S:'- 10.....
Residence of
furnace/burner to
BTU's
Each single fixture
SQ. FT.
2
Relocated building
(new fix. additional)
I
New circuits alts.
or extensions
Floor furnace
and vent
/4-
IS,F. Residence
(1 bath)
IDuPlex (1 bath) each
IAdditional bath
I ~Iater servi ce
Sewer
Storm Sewer
ISERVICES
I
I Temporary' Cons'truction
IChange in existing
residence
multifamily, comm. or
Industrial
Appliance vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
I Vent system apart
heating or A,C. .
Mechanical exhaust
hood and duct
from
Rece$sed wall
Soace heater and vent
amps.1
1
I
Of
ICOMM./IND. FEEDERS
Install/alter/relocate
distrib, feeders
I
I Of amps. I I
I I
I I
I 1
/ ()..I> TOTAL CHARGES /~.o. TOTAL CHARGES
that the Electrical work be done by an,Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Wood stove/heater
ISSUANCE OF PFR1m
~ "-. ~
TOTAL CHARGES
WHERE STATE LAH REQUIRES
shall not be valid until the
I HAVE CAREFULLY EXA11INED 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 performed 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 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
tW1E(please print) T 1//-1- A.l
K
Hv Icl-I u:",S SIGrMTURE ~~
FOR OFFICE USE ONLY
Sq. Ftg. tlain
Sq. Ftg. Access
Sq. Ftg. Other
./<'. /M~ DATE S- ~ ?- 8'~
x Value
x Value
x Value
Zone c:::: .. :<
Fire Zone H.A .
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLur~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERtHT
Charges and
Surcharges
tlECHANICAL PERMIT
Charges and
Surcharges
Tyoe/Const.~.N' '5~ ~nits
Bedrooms Occy Load
Stori es I Occy Group
"E-2
TOTAL VALUATION
J.~""" ,dE" Plan Ck. CommlInd
L~~'YI 65%/Bldq Per Fee
--- -------- Plan Ck. Res
30%/Bldq Per Fee
_____Lq~_~~J Fence
. '-/ C> D6mo
It:::>. PO Sidewal k
- --- -- -~~~-l A/C Paving
_ _ _ 'Y-e: !L ~_ _I Curb Cut
I
Systems Development
Charge \1.5%) ,
~J. A--
!Total Comb. Permit
,- A
IIOT L
::l~. ,8tD
" <'~B<\t
'.
.
..
COMBINATION APPLICATION/PERMIT (CAP)
".
~;.. ----.:....?~... Co
. !'-
PERMIT VALIDATION
<'
I. Appl.icant to furhish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceil inq/or forced air qas
2. example- waterheater/electricalior solar
E. Square {ootage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-n€w ~ if addition,
. check add, etc. '
F. Building' permit information:'.
1. example - construct single family house ~ith.an
attached 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. 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
~ortion ~f the Mechanical ~nd 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 Eiectrical Schedules
are available a~ the Building Division
1. To conserv,e space on the permi t 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 schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
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 ~sed 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.
~
'f1J'
V. FOR OFFICE VSE ONLY
Permit Gl erk
..
(
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
5'
/0.00
.40
/O.OQ'
. LjD
----- ,^
~o.fu
.-'
f~/
Permit appl i cant exempt from regi strati on with the Buil der IS' Board because:
Additi ona 1 Project Informati on:
~.' .
PLANS REVIEWED BY:
name
L.~IV~' ~~~.
~'~~.
, ".
signature
da te S-:r.-4S ~