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HomeMy WebLinkAboutPermit Plumbing 1981-7-6 Jr/ .~ INSPECTlO'N LINE 726-3769 CITY O'F SPRINGFIELD CO'MBINATIO'N APPlICATlO'N/PERMIT '" Job Address 1+~6 --- C~A/7eA/AJ/;e; L tBLi/LJ " Legal Description __ Jf)00d~~~ O'wner~.D. noL_ Address/4.26 -- CeNT )3L 1/.lJ n X (Y)C) ENERGY SCURCES: Heat Water Heater Range Value of Work: <'. INFO'RMATlO'N LINE 726-3753 ---~-- _ ' ~......-;-_.....>'::';L .......:~ _; _ '::._ '--,of ".;.:- Sq. Ftg. Main Sq. Ftg. Access. Sq. r-tg. Cther _New_Add_Alter_Rep. _Fence_Demo_Change / Use _Cther '7/// rh/ ""3 Building Pe.rmit Info: Describe Work (i.e., Build Single ..... Phone/Tb-7~V F,amily Residence With Attached Garage) r-l?e/.JA~/2J .k>-~5bwEe ,t:3pp::- L.,.'9'T, ...... Construction Lender Address DESIGN TEAM (nome) Primary Structural Electrical Mechanical CCNTRACTCRS (nome) General y.. Plumbing /J;,/h~ /LIB;e. Electrical Mechanical PLUMBING NO'. I FEE , CHARGE Each single fixture' Relocated building (new fix. additional) S.F. Residence (1 both) Duplex (1 both) each Additional both Water service Sewer Storm Sewer I TCTAL CHARGES ;f...0 k'c #.emjl-, Phone (address) (address) NO'. ' Residence of . 'q, ft. New circuits, alterations or extensions SERVICES \ Temporary Construction Amps. FEEDERS Amps. TCT AL CHARGES (lies. no.) .', (lies. no.) ..., ELECTRICAL FEE 'CHARGE (expires) (phone no.) ~ ~ ~ ~ ~ FEE I CHARGE I I I I I I I I I I I I I (expires) (phone no.) WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREFUllY. EXAMIN'E'D the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I fur.ther certify that any and 011 work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Cregan pertaining to the work described herin. and that NO' CCCUPANCY will be mode 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 0 s required by ORS 701.055. that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with CRS 701.055 will be used on this project. ' Basis for Builder's Boord exemption: X NAME (please Print,2::>..ezM A J)~ J3o,L' Zonp Fire Zone Flood Plain Type/ Const. Bedrooms c\'torip.., BUILDING PERMIT Charges ond Surcharges PLUMBING PERMIT Charges and Surcharges elECTRICAL PERMIT Charges and Surcharges I I I ---------, MECHANICAL PERMIT Charges and Surcharges "IGNATURE FO'R O'FFICE USE O'NLY 'Inits Occy Load Occy Group Plan Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per Fee Fence Demo Sidewalk A/C Pavin!! Curb Cut "q. Ftg. Main c;q. Ftg. Accesr Sq. Ftg. Other '- MECHANICAL NO'. furnace/burner to BTU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct , Wood stove/heater Heat Pump Air handler to 10,000 CFM Air handler over 10,000. CFM ISSUANCE O'F PERMIT TOTAL CHARGES DATE7~g/ ,/ ,/ , '( Value "clue Value x '( TCTAL VALUATICN Systems Development Charae (1.5%) .1 Total Comb. Permit I I I I TCT AL COMBINATION APPLICATION/PER^,- (CAP) I. Applicant to furnish 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 ceiling/or forced air gas 2. examp,le-water heater/electrical/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 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 (0) 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 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 installed are 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 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: Additional Project Information: PLANS REVIEWED BY: namp ~ignaturf" ...... , - I- .... lERMIT VALIDATION Permit Clerk date