HomeMy WebLinkAboutPermit Plumbing 1980-12-11
B~iTding:-Perl,:,it .Into: Desc;ibe Work (i.e., Buil~ Single \ -.:::::
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INSPECTION LINE
726-3769
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I. CITY OF SPRINGFIElD
, COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
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...5tl.!tifct y
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JQb Arl,.{res'
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Sq, ftg. Me;n \ U (1( ~
Sq. FIg. Access.
Sq. Ftg. Other
__New._Add_Alter_Rep,
__Fence _Demo_Chonge/ U Sit
Other
(')w V- V UL- V\I
/7_n7:-:?7-1
Hoat
Woter Heoter'
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:.ILL:/' ,
legol Description
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Ranqe
Value of Work:
L.of f3- 11~ gqD
Owner f".... Kpl~ ~~_C'
Addren qZLI e ",,--~'!.n '
Ci.J&eNe, I"J~ <?7/{o..
?n \ ~\\^ '2,0
Phone LI
Construction lender &:A~ l.I/I=!C-r"
Address ~'-rutuN ..c:;::v,cPHp
OESIGN TEAM . (name) \
Phone
Primary
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&zIrtl./-o/~1
$tr...ctur.,1
Electrical
\
Mechcnical
CONTRACTORS
(nome)
(address)
(phone no.)
(lics. no.)
(expire:)
G~nerol
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I;?vGi:'EN~ PLu.....RINA-
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Plumbi!"!Q
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I Electr;cal
I Mechanical
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PLUMBING
ELECTRICAL
MECHANICAL
FEE
NO,
FEE ! CHARGE r NO.
CHARGE
Residence of
furnace;burner to
BTU's
Appliance vent
separate
Stationary evop.
cooler
Vent fan with
single duct .
.-Vent system.opart from. .,'
he~ti~q'~'':'A.C:' ".. .-~,
Mechanical exhaust
hood and duct
~.: -, '..
\q: ft.
Eoch sinol!? fi:ll;ture
Relocated building
(new fj:>:, additional)
S.F. Residence
(l bOlh)
New circuits, alterations
or extensions
SERVICES
Duplex {1 bcth} each
Temporary Construction
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'Wood stove/healer
I
Additional both
Amps.
W..ferslE!r...;ce
s':~:;~' ~f,~~ '~',,7jJC ,~:.:
~:(! I.\~~ ;" (\lJe
I (,J{) i'~ ,'1
StOlm Sewer
FEEDERS
Heat PUmD
Air handler to
10,000 CFM
I Air handler over
," .', '10,000 CFM
Amps.
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ISSUANce OF PERMIT
TOTAL C10fARGES
r: ii or} TOTAL CHARGES
/,c. .
TOTAL CHARGES
C>Q
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FEE
I CHARGE i
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WHEi:E STATE LAW REQUIRES that the Electrical work' be done by the Electrical Contractor, the electrical portion of this permit ,hall not b. valid until.a
label has been ,igned by an Electrical Controdor and attached to the electrical panel.
I HAVE CAREfUllY EXAMINED the completed applicotion for permit, and do hereby certify tnot all information hereon is true and correct, and I further
. certify thaT arrY 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 herin, and thot NO OCCUPANCY will be mode of any structure without the permj~sjon of the Building Division. I further
certify that my registration with the Builder's Board is in full force and effect' os required by ORS 701.055, that jf exempt the basi, for exemption is noted
heron, and that only subcontractors and employee, who are in compliance- with ORS 701.055 will be used on this project.
Basis for Builder's Boord exemption.
~AME {please Printf t!... /\:';:-I"'T'I-J
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OAT'f... /Z-/I-f?O
SIGNATUR~
FOR OFFiCE USE ONLY
fJ.K=rz"
Zone P I
Fire Zone
Flood Plain
Type/Const,~l
Bedroom, .--
Storie' .j-
x
Units
""'ccy lo'od
Dccy Group
C-:. Ftg. Main
Sq. Ftg. Acceu
Sq. Ftg. Other
x
Value
Value
Value
"' r.J
('co.
'-
TOTAL VALUATIOt'
BUILOING PERMIT
Charges and
Surcharges
I Plan- Ck. Comm/lnd
65%/8Ida Per Fee
I Plan Ck. Res
30~~J BldQ Per Fee
I Systems Development
Chorae 11.5%\
L\loe~ I;:)'{',q-j
,~l'\*) ts"O?~%,
PLUMBING PERMIT
Charges and
Surcharges
"'['-leg
/'- ...,
. ~::6.
Fence
Demo
Totol Comb. Permit
elECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
I'~~. ~~;,~,
...A; (), -'..-
.MECHANICAl PERMir---
Charges and
Surchargu
AI C Pavin..
Curb Cut
..t( ~().g2
TOTAL
1
I. Applicant ~ furnish
',A. Job Address .
"8. legal Description' ;t :-;
1. example-t~x lot 100, Lane County Map Referenc ,.r-
2. example-Lot 1. Block 3, 2nd Addition to Spring fie '"
. C. Name, etc. of owner and construction lender.
D. Energy Sources .
1. example-heat/electricol ceiling/or.forcel'air qo", (. -.r,.'; ,
2. example-woter heater/electrical/or solar
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, ch<<
odd, etc. .
F. Building permit information: ILL (~.
1. ~ample-constr.uct sj.ngl~ f~~i y ~louse w.itn a~ attl
garage '1.,.,
2. exol""lple-remodel ex (sting garage into family, roo."
3, example-convert si~gle 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 ovoid design or construction delays, 'Building Pivisi-
. Stoff must be able to contact appropriate .persons reg( (,'"
. design' information or job .site corrections,~#tc::
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description pOl ('
of the Mechanical and Electrical Schedules, the applicc
need fill.in only the No. Boxes adjacent to the approp'
item(s) t!J 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 I
ated schedules you should consu'lt the fLiIl schedules'.'
'c.- BUILDING DIVISION STAFF WILL'flLLOUT ALL FEES ANI'::: (,;_.:;-'~~:;: ,~-
CHARGES ON THE SCHEDULES' ,\' _ Amount
III. Applicant to sign and date
Wh.enever possible. the initiol opplic:ation 'wi~1 be used as c (.
.. wO'rksheet only. Where possible. Building Division Staff wil
'prepare a typewritten copy and return it to the applicant a
the time the actual oermit is issued for his signature. .
. " . ,"
Fees and Charges
.P)gn..ch~ck..fees,9_re ~::lu.e.qnd payable at the.timeof the opp-lu~ullon, ,'1
--' and no plQns will be processed until these fees ore paid. All
. other fees and charges ere due and payable when the permit
is issued.
COMBINA TION ~PPlICA T10N/.N~(CAP)
IV.
,.",
V.' FOR OFFICE USE ONLY
/:
PROJECT CONDITIONS.TO BE SATISFIED BEFORE OCCUPANCY:
.Additional Project. Information:
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PLANS REVIEWED BY,
'nam'"
r,ignatur":,,
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" PERMIT VALlOATIOIi.r-:,'; ,.
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S~RI'NGFIElD
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CITY ,OF
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. City ,Hall. :., ',' ,
Springfield, Oregan: ' ,:,'
- 'Oepai;tme,nt_af Pu~lic..Wark.,
OFFiCIAL RECEIPT
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S5352(
No. B
Dote I Z - ) I 191--0
Rec'd From (, ' k:.pi t-h f-) -\( p '(:,C'"
AddressCl'Z.4- ~ A-3vrL.,,5"t '.
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Received For,:
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