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Home My WebLink AboutPermit Plumbing 1981-6-7 INSPECTION LINE 726-3769 . CITY OF ,SPRINGFIELD COMBIN::"ON ~LlCATlON/pERMIT Job Add",. my (PATEII.II4Y J....6(")~ Legal Demiptian 17- n~- ~ - .;;2. PI4IZCE:L D. ENERGY SOURCES: Heat.r:.. A. eo. Water Heater ~s.. Ranqe Value of Work: 'P04ernpT.l.. ;I.</no -AUnT,/... aNlP 1\'3<1 Owner .J'AMcc. L. ~UJ..J~ Add,... .5'31"1 1'.511rEP N'.E- Phooe3t.r.8'1oo SALEM.Oe€ . MEc/'I. PEL'MIT, ~:HJa.E-LU)5 . ; ';''1,>,1')/ . COn!truction Lender Address phone DESIGN TEAM (address) (Iics, no.) (nome) Primary Structu~al Elert..ical ".~('.chanicc;1 CONTRACTORS (nome) (address) (lics. no.) General Plun.binc: Electrical ~~.::~,:~..~_IJtt(\..\- (1.,( /\ . PLUMBING (j I elECTRICAL _.- 'r---' NO, Each sinqle fixture Relocated building (ne..... fix. additianol) S.F. Residence (I bath) CHARGE NO. I I I FEE FEE CHARGE ResidencCl of ,,:ft, New circuits, alterations or Clxtensiani SERVICES Duplex (1 bath) each Temporary Canstruo:tion Additional both Amps. Water service Sower Storm Sewer FEEDERS Amps. r TOTAL CHARGES TOTAL CHARGES . INfORMATION LINE 726-37 S3 (expires) (expires) MECHANICAL NO. J furnace/burner fo ~t""rV"\ BTU's Appliance vent !eparate Stationmy evap. cooler Vent fan with single duct Vent system aport from heatin!=! or A.C, Mechanical exhaust hood and duct ~ C) Cy ..... ~ (phone no.) (Dhone nl).) FEE CHARGE II.ClQ . ~.Q). 3.0/1 IS,{)f') if,50 9,~ 'Iso '."oS;"> I !to.l)" :l.4/.~, I I I ::1. '.lQ. /I).on 'l9; on WHERE STATE "LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical. portion of this psrmit shall not be valid until.o label has b..n signed by an ElectTical Contractor and attached to tho electrical panel. I HAVE CAREFULLY EXAMINED 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 herin. and that NO OCCUPANCY will be made of any structure without the permission of the Building Oivision. I further certify that my registration with the Builder's Board is in full forC1l! and effed as requited by ORS 701.055, that if exempt the ba!is for exemption is noted heran, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project, Sq. Ftg_ Main Sq. Ftg. Accen. Sq. Hg. Other _New_Add_Alter_Rep. I_Fence_DemO_Change/U!e _Other Building Permit Info: Describe W;;~k (i.e.. Build Single Fomily Residence With Attached Garagel / S ~ .3 .Wood stove/heater If Heat Puma Air handler to 10.000 eFM Air handler over 10,000 CFM l'DA~ "'TO ..,.~. ISSUANCE OF PERMIT TOTAL CHARGES Basis for Builder's Boord exemption: NAME (please prinH/< .'7'[2:( W!./L f :...k /7) SIGNATURE C:#J-.?J.J~---1: Zone C-i/ Fire Zone Flood Ploin FOR OFfiCE USE ONLY I Sq. Ftg, Main -1a..K.flt. cl. Ftg. Access Sq. Ftg. Other Typel Canst.:5i[-}./ Bedrooms Stories_' ~nih f"Iccy load Occy Group R-.3 BUILDING PERMIT Charges and Surcharges PIon Ck. Comm/lnd 65%/ Bld~ Per Fee Plan Ck. Res 30%/ Bids. Per Fee I MELlI. Pl."''' /UII16</ &m;e Z5~ ,J:-'. J</ PLUMBING PERMIT Charges and Surcharges Demo ELECTRICAL PERMIT Charges and Surcharges Sidewalk AIr. PI"'I""" MECHANICAL PERMIT Charges and Surcharges _____.!BJ..oa C"b Cut .3.st.1 I TOTAL x Yalue x Valul x Value TOTAL VALUATION Systems Development Charae (1.5%1 Total Comb. Permit OAT~-7 -&'/ .;!JIS: t"JO COMBINATION' APPLICA TION/P.T (CAP) /. ...... I. Applicant ~ furnish A. Jab Address B. legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot I. 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 Qas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. foot hause, 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, Me<:hanical, and Electrical Schedules are available at the Building Division L To conserve space on the permit form the schedules have been abbreviated 2. If-the'item(s) to be insta!led 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, AOa- nam":' ~, ~ignatur'" Permit Cler~ . I PERMIT VALIDATION '" F -'ate k7-? I I ~ ~ . 7 .~"~"t..r."~"'-l:?~."r . (INSPECTION LINE I 726-3769 (ITY Of SPRINGfiELD COMBIN~T10N (Ai"PLlCA HONI PERMIT ENERGY SOURCES: Heat.t;.A c.. Woter Heoler~A Ron~e Value of Work: . v / i7tj G~TEII.II4Y J...6e>" Pt9JZCEL Job Addren Legal Description /7- n~..;;;L2 - ~ D. '1(>,</ 'P,Q~T' "I' To!... ~ <loa - ~a Owner .J'14MF'c" L. ~ULJ.I!! T.L, ANlP INFORMATION LINE 726-3753 Sq. ftg_ Moin Sq. Fig. Accen. Sq. FIg. Other _New_Add _Alter _Rep. _Fence_Demo_Chonge/Use _.Other ~ C). ~ '- o<l. Add,." 53() ~EN1"EE' /I/. E. Phon.3t:.Y.8lfao '&{)a..L..!::ftJ8 I SALI:M / Oet: 9'1,~" I 'CoflslTuction lender "Buiiding Pe-;;"ir Info; De wi be W~~k- (i.e., Build Single Family Resjdence With Attached Goroqel M EcI-/ _ PEb...IIT. Address phrme DESIGN TEAM (address) (lies. no.) (nomel Primary Structural Electrical Mechonicc:l CONTRACTORS (nome) (address) (lies. no.) General Plumbinq Electrical M"han;rnl ,) t) 1-- ~\-(\ ~ (1. ,( "' \ PLUM:ING (j ELECTRICAL r-NCiT--' I I I I I I I I I I I CHARGE NO. FEE ' CHARGE fEE Residence of SQ: ft. New circ~i1S,. olterotions __1__'__ or e:densJons , Each sinerte fixture Relocated buildinq (ne..... fi.. additiar>oll S.F. Residence (1 bolh) - --I I SERVICES DupJu (1 bolh) each Temporary Con5fru-::tion Additionol bath Amps. Woter service Sower Storm Sewer FEEDERS Amps. r TOT Al CHARGES TOTAL CHARGES (expires) (expires) MECHANICAL NO. ) furno::e/burner to lI!So.~ STU', . Appiionce vent separote Stationary "yap. cooler Vent fan with single duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and duct I'Wood stoye/heater (phone no.) (ahone no.l FEE I CHARGE /I.t){) ! ---7--1 K!>?l 3.011 '1,50 'ISo IS-On 9.00 J3,sr'l, / S ;l, 3 'I ~eat Puma Air horidler to 10.000 CFM Air handler oyer 10,000 CFM t,.~<1 I ;Ul.~ - / lC..", I .,. 0 .... OchLG:r5... 2.,.,,, I Ill. on 'if9;Orl WHERE STATE-LAW REQUIRES that the Elemical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until.a label has bHn signed by on Electrical Contractor and attached to the electrical panel. I HAVE CAREFULLY EXAMINED the completed opplication for permit, and do hereby nrtify that 011 information hereon is true and correct, ond I further certify thot ony and all work performed sholl be done in occordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work dC$cribed herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further certIfy thot my registration with the Builder's Soard h in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and thot only 1ubcontroctars and employees who are in compliance with ORS 701.055 will be used an this project. /7') U f ,\,1 SIGNATURE M V~J-, ......It> -';;1 , FOR OFFICE USE ONLY I 'q. Ftg. Mo;n ...G.K k' t. Sq. Ftg. Access Sq. Ftg. Other Bosis for Builder's Soard exemption" NAME(pl.o.ep.;ntlfr"< :7'Q/ ~t.(t. f _. - -'-J \ r-_!, Zone C-l./ Fire Zone Flood Plain Type/Cons'.~}./ ~.fldraams <"":Jries_1 Units /""Ieey Load Occy Group H-3 BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ BJdCl Pllr Fee Plan Ck. Res 30%/ BIdS Per Fell IIIUJ1. P~Il" ~I&<I __ 2,,5~ I Demo oJ :'1,)</ I Total Comb. Permi, PLUMBING PERMIT Charges and Surcharges ELECTRICAL PERMIT Charglls and Surcharges Sidewalk AIC Payinn MECHANICAL PERMIT Charges ond Surc:horglls _____~:tt2a Cu,b Cut . 3.st:.1 I I TOTAL ISSUANCE OF PERMIT TOTAL CHARGES x Yalue x Value x Volue TOTAL VALUATION SY$tems DeYlllopment Chorae (1.5%) OAT~-7 -&"/ #lIS: '70 (CAP) ? ,-. . COMBINATION APPLiCATlON/PEItT PERMIT VALIDATION I. Applicont to furnish A. Job Address B. legal Description 1. example-tax lot 100, Lane County Mop Reference 2. example-Lot I. Black 3, 2nd Addition to Springfl" C. Name. etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceilinq/or forced air Qa~ 2. example-woter heater/electrical/or solar E. Square footage or valuation, etc. 1. exomple-1250 sq. foot house, 500 sq. foot garag 2. example-if new project, check new-if addition, d: add. etc. F. Building permit information: 1. example-construct single family house with an at; garage 2. example-remodel existing garage into family rOOl . J. example-convert single family residence into restaurant (change of use) G. Value of work os defined in Section 303 (0) of the Structural Specialty Code . H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuHding Divis Staff must be able to contact appropriate persons reg . design informCition or job site corrections, etc. ( 17 03 43 CITY OF SPRINGFIELD ( (, City Hall Springfield, Oregon Deportment 01 public Works OFFICIAL RECEIPT No. B 56871 . \. l\.,\ 1\ 19 X \ Date'..-f'l)U.U - !l T') \I ~J.. ~~ Reed 1;,1, f~ - N.. -~-'llc\ C')J \'J\t l LLd ~ , Address \ ) \ ' ~ \ ( ( ( , ( Received Far: , 1 /, I I 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) 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 hove been abbreviated 2. If theirem(s) to be insta!led are not covered on the c ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT All FEES AN! CHARGES ON THE SCHEDULES \, \i\ 0 K' k-\ LiCh,> " .:;.... Pl-/ OJ <2...2:1..0 c ' (I ;; 'I " (I ." (j 1I ( f n~OJ\ L'I ~ ---\ ---- ~- - .' ,.()Q, . IY ......- :1 C..AU ( ( ...n.. ( ( - ( IV. III. Applicant to sign and date Whenever possible, the initial application will be used os 0 worksheet only. Where possible, Building Division Stoff will prepare c typewritten copy and return it to the applicant 01 ( the time the actual permit is issued for his signature. Fees and Charges Plan check fees are due and payable at the time of the cppl \ti~ and no plans will be processed until these fees are paid. All +- other fees and chorges are due and payable when the permit is issued. " I.. Amount ~eceived I \ ~ () U ff\ \ fYJ ,.~WOIII'IZED SIGNATUIIIE .HI[LTOH.TU"H.U~\. .."".n". . I[UGIHl. 0" .7.0' ~. V. FOR OFFICE USE ONLY Permit CierI- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY, Additional Project Information: PLANS REVIEWED BY, nom'" ...ignatur"" It Oa-. ~ate 7-7-8"/ t .