HomeMy WebLinkAboutPermit Plumbing 1980-11-6
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, 726-3769
Job Address "'111 '-I
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CITY OF SPRINGFIELD
CO/IBHIATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Hedt
Hater Heater
.
IrlFORlIATlON UNe
726-3753
So. FIg. 1.lain
~q. Ptg. Access.
So. Ftg. Other
Ue\;, Add .A.1ter P.ep.
--Fence Demo Change/Use
-Other - -
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Legal De~cription
Address
DeSIGN fEAl1
(name)
Phone
(address)
Ranqe
Valu, of Hork:
/<} ,000.00
Builolna Pernlit Info: Describe Work(i~e., Build Single
Famil v rtes i dence l'lith .A.t tached Garaae)
S(~ - (hnhf ~o.n-h.l1lruLt I
~~/ dn,.JrtpA0..-D2... 00-&...- I
a I () /' I.
Owner '1\\ 1'\1-1-J;:;) ~ 1\ \':"..
Address (p n ~ ~V -3-n\ r/1
~Hv.( ,\\....0 lU 11 n (;..1"7Y\)
ConstrucrtLon Len~ U
~ C:rVl '")
PhQ,.
(1 ics. no.)
(exoires)
(ohone no. )
Primary
5:r.:ctura 1
::l~ctrical
:'~:;anical
C::::-;;;"i:7QiiS
(narr:e)
(dddress 1
~ ~ rv-{\___ ,'-.rl ~..,;""1\. Q
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(1 iC5. no.)
(~xolrp<:.:\
(ohnnf' nn
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G-:?nera 1
'-f'(\(\ 1\ T I V\ t~ ^ f'\<":
Plumblnc
Electricai
"~''":.:--3nica 1
PlmmlilG
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I r:HARGF t Nn
ElECRTCAL
r.1ECHA!/ICAl
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Residence of
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no. I
I' furnace/burner to
BTU's
Floor furnace
and vent
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I rl./.dRr.~
,-
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IRelocatea building
(new fix. dddition~l)
IS.F. Residence
11 bath)
Duplex (1 bath) each
single fixture
SQ. FT.
New circuits alts.
or extensions
SERVICES
Recessed wa 11
~nnr.P he~tpr ~nrl vpnt
~later service
Temporary Construction
Chanae in existing
rp~idenLP
multifamily. comm. or
Tnrluc;tr;;d
I App 1 i ance vent
Sf'loaratf>
Stationary evao.
conler ~ .
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
honrl and dud
Wood stove/heater
Additional bath
Sewer
Storm Se\./er
Of amps.
IC0/1ft.IIND. FEEDERS
Install/alter/relocate
rlic;trih. fppdprc;
Of
amps.
ISSUANC, OF rFR!lIT
TOTAL CHARGES I TOTAL CHf,RGES TOTAL' CHARGES ,
WHEP-E STATE L"M REQUIRES that the Electrical \'lark be done by an 'Electrical Contractor, the electrical portion of this pemit .
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Zone
Fire Zone
I HAVE CAREFUllY EXN1WEO 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 Derformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Oregon pertaining tp the work described herein, and that riC OCCUPAHCY 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 ;s noted hereon, and that
only subcontractors and emnloyees who are in comoliance with Or.S m1.055 n~ used on thiS. project.
NA!.IE(please print) R,',. [, AA'",;\ UYE (I. SIG;IATURE~'" LNL/2,1 /1 D~TE 1I/r.,/10
FOr. OmCE USE O~L\; \. /, 1
Sq. Ftg. Hain x Value
Sq. Ft\:!. Access x Value
Sq. Ftg. Other x Value
Type/Const.
Bedrooms
Units
Occy Load
Flood Plain
Stories
Occy Group
TOT^L VALUATIO!l
BUILDING PERI.IIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________ 65%/Bld(l Ppr Fpp
Plan Ck. Res
30%/Bldq Per Fee
Fence
Systems Development
Charoe (1.51,)
PLU!1BING PERI1IT
Cha rges and
Surcharges
Demo
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II
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ELECTR[C~.L PERI~IT
Cha roes and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
------------
I A/C Paving
____________1 Curb Cut
I
Total Comb. Permit
-- TOTAL
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jf 84. ~
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COMBINATION APPLICATION/PEP~IT (CAP)
I.
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Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100. lane County Map Referenc
11 03 43
2. examDle' Lot I. Block 3, 2nd Addition to
)prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole. heat/electrical ceilin~/or forced air
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot gal
2. examole- if new project. checknew - if add;t'
check add. ete.
F. Building perr.Ji", information:
1. examole - construct. single family house with
attacned g:1rl;ge
2. exar:mle - remodel existing garage into famlly
3. examole - convert single family residence int
restaurant (chanqe of use)
G. Value of work as defined in Section 303 (a) of th
Structurai Specialty Code
H. OESIGN TEA;.I AllO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriat
persons re9arding design information or jOb site
corrections. etc.
Abbreviated Plurr.bing. ;.iechanical, & Electrical Schedl
A. txceot "'there blank soaces occur in the descriptir
.:lort ion 07' the :'lecnarll ca i and El ectr i ca 1 Schedu i I
the applicant need fill-in only the No. Boxes ad,
to the aporopriate item{s) to be installed
B. Full ?lu~bln9, Mechanical, and Electrical Schedu
are available at the Building Division
1. To conserve space on the permit form the sch
have been abbreviated
2. If the item(s} to be installed are not cover
the abbreviated schedules you should consult
full schedules
C. BUILOU:G DI'.'ISION SiAFF !HLL FILL OUT ALL FEES A
CHARGES 0;1 THE SCHEDULES
D. As noted on the CAP, the label must be deliverec
electrical contractor for signature by his elect
suoervisor. The general contractor is .not authe
to sion the electrical label. ---
Applicant.to sign and date
Whenever possible. the initial application will be l
a worksheet only. Where possible. Building Divisior
will prepare a type written copy and return it to tl
applicant at the time the actual permit is issued f(
signa ture.
Fees and Charges
Plan check rees are due and payable at the time of
application. and no plans will be processed until th.
fees are paid. All other fees and charges are due and
payable when the permit is issued.
.
PERMIT VALIDATION
(
CITY OF SPRINGFIELD
City Hall
Springfield, Or~gan
Department af Public Warks
OFFICIAL RECEIPT
roo'
Ill.
IV.
v.
FOR OFFICE USE ONLY
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//_ b 19JONO. B 55113C
Rec'd From fr/afltJiJ &In<.. Sf crn
Address P p '_ &-y O((Yo q V
Date
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Received For:
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(.'Yi + IIH.tw ')
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Amount ReceivedB~ 00
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A,UTHOIU%ED SIG"~TUIU!
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt frDm registration with the Builder's Board because:
l Additional PrDject Information:
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PLANS REVIEWED BY:
name signature date
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