HomeMy WebLinkAboutPermit Plumbing 1980-11-5
I INSPECTION L1IIE . CITY Uf SPRIIIGFIELO .
726-3769 COMBIIIATION APPLlCATION/PERMlT
Job A.iires;;-'.'\ \ ~~ VJ..J\. 'ilo:1:\.9-- ~~;~GY SOURCES~
Legal Description 7 CJJ, 110'32.7 '7-2- ,~
INFORlIATION LINE ~.',
726-3753
Sq. Ftg. /.Iain
. ~q. Ftg. Access.
Sq. Ftg. Dther
New Add Alter Rep.
Fence_Demo_Change/Use _
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'-
Owner~(~~ (') \ A.C-:C..C:L~ D "-
Address \ \ n~ ()n ^ Q12,fllL Phone
YJLj(O lof'Y)q
Va1u, of l-Iork:(\JA
BUildina Penmit Info: Describe Work(i~e.. Build Single
Famil v Res; dence l'ii th .A,ttached Ga raQe)
,-~.NI\ 0 Q. ri l. f\t\ (./....'X'; .D..hu fL ---
Construction lender
Address
Ut~lGlI ItAII
(name)
Phone
(address)
'1
,,'fY><<1fY[ 11 .f)O li!'J.I f'().
Ilics. nolt (exnires)
(phone nO.'J
Primary
Structura 1
Electrical
!1echan i ca 1
CotlTRACTORS
(name)
(address)
(1;c<;. no.'
(exn;res)
(nhonf> no.)
Genera 1
Plumbina ~Q....f..-
Elect rica 1 --.A o...u nJ2.A-...
"~chanical
SERVICES
Recessed wa 11
So~rp ~p~tpr ~nrl
Vl'>rlt
l
I..EEL ..cHAB.liE
I
I
I
I
I
PLOIIBIrlG
ELECTRICAL
MECHANICAL
;,'Q. !
lEaCh single fixture
I Relocated buildina .
(new fix. additional)
IS.F. Residence
(1 bath)
IDuP1ex (1 bath) each
Additional bath
FEE
CHARGE
NO
':J:L.I J1lARG.E. 110 .
SQ. FT.
furnace/burner to
BTU's
Residence of
New circuits alts.
or extensions
Floor furnace
and vent -
Sewer
Temporary Construction
Change in existing
rpside.nrp
multifamily. comm. or
Industrial
Of amps.1
COI~I'I.II ND. FEEDERS I
Install/alter/relocate I
distrih. fep.ders
I Appl iance vent
c;,eoarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system apart
heatina or A.C.
Mechanical exhaust
hnon and duct
Wood stove/heater
from
Hater service
Storm Sewer
Of
amps.1
ISSUANCE OF PFRI11T
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
TOTAL CHARGES
TOTAL CHARGES
that the Electrical \...ork be done by an Electrical Contractor. the electrical rortion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore~on pertaining to the work described herein. and that riD OCCUPAUCY 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 OP.S 7nl.055 will be used on this project.
IWIE(please print) It, OWl Ct 5 R. (A) a I j{fJ1'
Zone
Fi re Zone
Flood Plain
Tyee/Const.
Bedrooms
Stories
Units
Occy Load
Dccy Group
SIGil^TURE~Lat~- J~~/,,}.r." I~.,I
FO~ OFFICE USE O;JLY
Sq. Ftg. riain x
Sq. Ftg. Access x
Sq. Ftg. Other ,
DATE J/~ 5 -fln
Value
Value
Value
TOTAL V ALUA Tl ON
BUILDING PERmT
Charges an':
Surcharges
Plan Ck. Comm/lnd
65X/Blda Ppr Fpp
--------------p;an Ck. Res
30%/Blde Per Fee
'Systems Development
CharQe (1.5%1
11ECHANICAL PERMIT
Charges and
Surcharges
h. 00
---~~------
~O
_<!;JS,-c?_CJ___ 'Sidewa1k
I. c.J U lAIC Pavin9
I Curb Cut
I
Fence
PLUI1BING PERI~lT
Charges and
Surcharges
ELEErRICAL PERr:IT
I ,Cha rges and
P Surcharges
Ocmo
~i.CCAq~
I ~
,Q(')
Total Comb. Permit
I TOTAL
I-~l ,LlO
, . .-.-.
.
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, .
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COMBINATION APPLICATION/PERMIT (CAP)
m
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examDle- Tax lot 100,. Lane County Map Reference
17 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air qas
2. examole- \'Jaterheater/electnca(/or solar
E. Square footage or valuation, etc. -
1. e,amole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, ch~ck-new - if addition,
check. add. etc.
F. Bui ldir.g permit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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. DESIGi~ TEAr-I AND CONTRACTORS
To avoid design or-construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. :xcept 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 Piumbing, 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 abbreviated schedules you should consult the
full schedules
C. BUILDIiiG DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 011 THE SCHEOULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
suoervisor. The general contractor is .not authorized
to' sign the electrical label. -
Ill. 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 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.
V. FOR OFFICE USE ONLY
.,
.i."
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
I
.
1
1
1
i
.
,
.
,
i
~
PERMIT VALIDATION
Permit Clerk
'I
-Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
~
"......
"
"
"
.
.;,
,.
\:
LeIJa 1 Oescri pt i on
. - CITY UF SPRI1IGFIELD
C0I1BlilATlON APPLICATION/PERMIT
,,_ EilERGY SOURCES: .....---
\_ IJ..J\.CLo'C\.Sl...-.-- Heat ~
."'.'1....,:=.. ~'!ater~. '~r; .
.~ ~-_..-~
~ Va1u, of Hor~:i\JA
BuilcHna Permit Info: Describe t-Iork(Le.. Build Single
Familv nesidence l'lith J1.ttached r.itraae)
,~.rW\ 0<:), ri l. f'\\\r .l'Jr1l1}) Q fL .-/
.
INFORlIATlDN LlIit
726-3753
Sq. Ftq. 1.lain
. ~Cl. FtiJ. Access.
Sq. Ftg. Other
New Add Alter ~ep.
Fence_Demo _Change/Use
c....::!...)TI;1 _'"
~
u
tl?
'D
I IrISPECTlOII LIIIE
726-3769
Job Addi-ess --, \ ~'::::!.
Owner\S(-;-~" f':"', \ ...."X--..<:LXQ
Address \ \()~ f:'1n ^ 0 Qjl Q_
Y)GJ(o /d'y')q
Phone
Construction Lender
Address
Ul:.:iU;iH rl:.N1
(name)
Phone
(address)
'l ,,'lY)t0 rn (') J:) 0 Ii II. I f'l ()
(lies. nolf (exoires) (ohoneno.l
PrimJry
Structural
Electrical. .
~~echdnica I
CC:;TR....Ci'0RS
{:lr.~e I
(address)
(l ics. no. \
(pxoires)
(ohnnp nn \
Genera 1
?1"",oina ~Ol.-L)(\Q.A-
"ee:riea! .~Cu...::>n~
"~,:;":!.~ical
?LWIBIr:G
ELECTR!ChL
11ECHArllCAL
i EdCn singie fixture
FEE . CHf.Rr.E ~Jn C'~C' I r~AIU~;: I r:o !
Residence 'of I furnace/burner to
SQ. FT. BTlI's
I C';:r: I rltAOr.;;
:?elocateo :uildinQ
I (new fix. JCditlonal)
I S.F. Residence
(] bath I
Duple, (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Snace heatpr and Vl"nt
Sewer
!Storm Sewpr
Of
amps.
Appl iance vent
<:;poaratp
Stationarv evao.
cooler ~ .
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood itnd duct
I ~'lood stove/heater
Additional bath
Temporary Construction
Change in existing
rp<:;ir:l\."nc:p
multifamily, COITU11. or
fnrlu<;triill~
~!ater serv i ce
COr11-1./lIID. FEEDERS
Install/alter/relocate
distrih_ f~erlers
Of
amps.
TOTAL CHARGES
I'HEnE STATE L,\I' REOUIRES
shall not be vali~ until the
TOTAL CHARGES
ISSUANCE OF' PFR'HT
TOTAL CHARGES
that tile 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
I HAVE CAREFULLY EXA~IINED the completed aprlication for ~ermit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerforrr.ed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore(]on pertaining to the work described herein. and that rlO OCCUPArJCY will be made
of any structure without the permission of ~he Building Division. I further certify that my regist~ation with the Builder's
Board is in full force and effect as 'required by ORS 701.055, that if exemot the basis for exemption is noted hereon. and that
only subcontractors and er:mloyees \...ho are in compliance with O~S 701.055 \'1111 be used on this rroject.
NAI.IE (p 1 ease print) -n, cHM ~( 5 R, G):,! KlJ r SH~jj^TURE 7./--- .L/ ,p /~ ),1 I/OJ DATE //... 5 -~"
FO~ OFFICE USE Dill,
Zone Type/Canst. Units Sq. Ftg. Hain X Value
Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other , Value
iDT AL VALUATlOII
BUILDIIlG PERI.IIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65!/Blda Ppr Fpp
------------ Plan Ck. Res
30%/Bldo Per Fee
,5 00 . Fence
--- ))_()nn Domo
_ J:)s.'-C?_c:__~S;dewa I k
1.0 U AIC Paving
Isyste~s Development
Charae (l.5r,1
I
I
JLCO=tC\ \-\
i
.QC)
PLUI~BING PERI11T
Cha rges and
Surcharges
.-
, ELECTRICAL PERI:1i
jjCharges and
Surcharges
IIECHAN I CAL PERM Ii
Charges and
Surcnarges
Total Comb. rermit
Curb Cut
I TOTAL
,-~l ,LjO
.
..... ~,_ I . ,
.
,
.l'~
"
.
COI:BINATION .~PPLlCATION/PERMIT (CAP)
~
n
~
j
j
I
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference
-17 03 43
2. examole- Lot I. Block 3. 2nd Addition to
Sprlngtield Estates
C. :lame, etc. of owner and construction lender
O. Energy Sources
1. exa~Dle- heat/electrical ceilinq/or forced air cas
2. eX~~Dle. waterheater/electrlcal/or solar
E. Square t-ootage or valuation, etc. -
I. examole- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. ch':!ck nel" - if addition, .
cneclo:. add. etc.
F. Buil.::1ir.g pernit information:
1. exel7:ple - construct single family house with dn
a. nJcnea gar~ge
2. eXd~c]e - remodel existing garage into famiiy room
3. eXdffiole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section.3D3 (3) of the
Structural Soecialty Code
H_ DESIG:i TEAi.; AiID CDrITRACTORS
To avoid design or.construction delays. Building
aivisio~ Stafr ~ust be able to contact appropriate
persons regarding design information' or job site
corrections. etc.
II. Abbreviatea Plurr:bing, j'lechanical. & Electrical Schedules
A. ~xceDt where blank spaces occur in the descriPtion
::r:10n or tr.e Mechanical and Electrical Schedules.
the aoplicant need fill-in only the No. 'Boxes adjacent
:0 :ne aODropriate item(s} to be installed
B. full Pi~~bing. ~echanical. and Electrical Schedules
are available at the Building Division
1. 70 conserve space on the permit form the schedules
have been abbreviated
2. .:f the item(s) to be installed are not covered on
:he abbreviated schedules you should consult the
full scnedules
C. BUILDI;:G DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 0:1 THE SCHEDULES
D. As noted on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
sUDer~isor. The general contractor is .not authorized
to sian the electrical label. -
III. Applicant-to sign and date
Whenever possible. the initial application will be used as
a worksheet oniy. Where possible, Building Division Staff
will preoare a type written copy and return it to the
applican~ at the time the actual penmit is issued for his
signature.
IV. Fees and Charges
Plan cneck 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 penmit is issued.
I
j
I
v. FOR OFFICE USE ONLY
._ - ,_ .. I .", ".......~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
1
PERi.IIT VAll DATION
l:ITY OF SPRI NGFI ELD
(
City Hall
Spr{nglield. Oregon
Depa~rl ent 01 Public Work.
OFF CIAL RECEIPT
No. B
\\ -") 19 (30
/'
From mc;rrn- .D \ J...'ti~, () ro h
-ess \ \ ~~ r'l ~1\ Q () DO
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55099(
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For:
(
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Received <..~1__ 4( )-
Rv, ft.
"'U)Io<O,,'Z(O SIGN"'TU.-E
~
...ILTO....U.....ULL .......a.... IUGI..I 0" ....0'
Pern;it Clerk
g
~
"
-.
. Permit applicant exempt from registration with the Builder's Board because:
"
I
I
Additional Project Information:
i,'.I.
PLANS REVIEWED BY:
name
signature
I
.
.-;
'~
date