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Home My WebLink AboutPermit Plumbing 1981-4-8 ~~---., . INSPECTION LINE 726-3769 . - . CITY Of SPRINGFielD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 ..) ;:b Add,o.. U2:1 cu..;; ~ r1. Il09al Do",'~~_11 () ~ ~4 2 4 I '1"A.....L..D\. '2..01 n _ k' u- 1. r.l.A 1"'1 r/.. l)0~+-1'v\ 0 ! It "S L\ \J.trl ty\ PrYYj Ph:~oll.ill.n - n~s;g' . ~ rl 0)0 oSAfri.? ' Conuruction Lender \ ) . I ENERGY SOURCES: )~j. Heat Water Heater Ranqe Value of Work: ! Sq. Ftg. Main; Sq. Ftg. Accin~. Sq. ftg. Other _New._Add_Altor _R~p. __Fence__Domo_Change/ Use __Other, ::xl. ~p UOA -l- r .F'rY\ ,VI n 1'1'")./TYIJ fn", " c 9; ...r:: I~ I ,/ c:;; "Owner Addren Building Permit Info: Describe Work (i.e.. Build Single Familv Residencp. With Attached Garaoe) Addren Phone DESIGN TEAM (nomel (addren) (lics. no.) (expire,) (phone no.) Primary ", Structural Electrical Mechanical CONTRACTORS (name) (address) ~ 0""01 QJ) r"\ \ U AD ho. m fl (rtI~ 1 Plumbing (Iic,. no.) (expires) (phone no.) Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO, FEE . CHARGE NO.' FEE 'CHARGE NO. 1 FEE . CHARGE Residence of furnace/burner to "TU's Appliance vent separate Stationary evap. cooler Vent fan with s1n910 duct Vent systom apart from heating or A.C. Mechanical ollhaust hood and duct Each sinqle fixture Relocated building (new fix. additional) S.F. Residence (I both) ..,:ft. Hew circuits, alterations or extensions SERVICES Dual.... (1 bath) each Temporary Construction Additional bath Amps. Wat.r service Sewer Wood stove/heater Storm Sew!!'r FEEDERS Heat Pump Air handlor to 10.000 CFM Air handler over 10.000 CFM Amps. r I TOTAL CHARGES I ISSUANCE OF PERMIT TOT At CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that tho Electrical work be dane by the Electrical Contractor, the electrical portion of Ihis permit sholl not bo valid until a label has been signed by an Electrical Contractor and attached 10 tho .Iectrical panel. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is tru.and COrrect, and I further certify that any and all worl.: porformod shall be done in accordance with the Ordinances of the City of Springfield and the laws of the Slate of Orogon pertaining to tho work. described herin, and that NO OCCUPANCY will be made of any structure without the permission of the, Building Division. I further certify that my regillTation with the Builder's Soard ilin full force and affect os required by ORS 701.055. that if exempt tho binis for exemption is' noted he,an, and tho. only ,ub"'nt'a<l.n a~d employ... Wh;r;1/.n,lJt/-compliasn,''''o'NWATituhROE RS 701.~055 W~'/l1 be used7n th~;~S Pro', I. Basis for Builder's Board exemption: J I.. ! NAME (ploa,e p"nll ~ I cH/JI..,O ). _." DATE ..!i./i:,Lp'1 FOR OFFICE USE ONLY -- Zone Fire ZOne Flood Plain Type/Canst. Bedrooms C:torie- Units rlccy load -'Jccy Group Sq. FIg. Main Sq. Ftg. Acceu Sq. Ftg. Other value. Value Value TOTAL VALUATION . x BUILDING PERMIT Charges and Surcharges I I /0. 00 I .40 Plan Ck. Comm/lnd 65%/Bldq Per Fee Plan Ck. Res 30%/ BldCl Per Fee Systems Development Charae /1.5%1 . ~olllon(f\nn Demo Total Comb. Permit } ()O'CX) I I I I &\ 110,YO I PLUMBING PERMIT Charges and Surcharges Fence ElECTRICAL PERMIT Charges and Surcharge, Sidewalk Alc Pavino MECHANICAL PERMIT Cho'ges and Surcharge, Curb Cut I I TOTAL ~~ E\ .:.....__.1... .:.....\.> '. , ~,-~ COMBINATION APPLlCA T10N/PERMlreAP) l 1. Applica~ to furnish A. Jab 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/electricol ceiling/or forced oir Qas 2. cxamole-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 -ne;.,-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 (a) 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 regaiding design informction or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Excp.pt 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 ot the Building Division 1. To conserve space on the permit form the schedules hove been abbreviated 2. If the item(s) to be installed ore not covered on the abbrevi- ated schedules you should consult the fuil schedules C. BUilDING DIViSION STAFF Will Fill OUT All FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and dote Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Stoff will prepare Q 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: Additionol Project Information: PLANS REVIEWED BY, name . signature> "\.... "" .RMIT VALIDATION ," Permit Clerk I 1 I I J J ~at... "", . \ INSPECTION LINE 12~7 69 -*:b Addren . , '" . f. CITY OF SPRINGFIELD' . COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 '..--:: c;.; ...Owne' tl5~i D-u; /YY1A1J!6i<l.i/r.~, . no~ ~4 LA -n':\'<;._L.o1 '2..01 (.! ~- h I'l A t'P II'SL\ CU S.~rl , \) Constroction lender legal Description I ENERGY SOURCES: I Sq. FIg. Main H'~~"~::l&~:~.q;&.. Sq. Ftg. Acceu. ,V"."" '_ ...-,;....;. Water Healer ':. _L Sq. Ftg. Olh.r . ~ Range _NlIw._Add_Aher_Rep. I Valve of Work: 1_-Fence__oemO_Chonge/use ( l L __O.h" ~, 0<-. I V\ ~ , . , . _ j - Ilii "J n2-riil BUildi;9. p..'m.;.'lnf.o.,;'-D;'~~ribe Work (Le., Suild Single 11 .(\'\ t-~ I Phone ~n ~ ;jro Fomi!,,~":~;~":..~": W~ln A"oched~<:Jraoel " f10 0 Cj\A.\ ) c...-" J J ? OA ( .f"rYU\O f'f'Lfhv l\ +- rn1' .:.1 ..'.<;' 'Y), Add,." Phone C 9J I-C- I ~ I r. rl. Address DESIGN TEAM (name) (addren) (lies. no.) (expires) (phone no.) Primory Structural Eleclricol Mecharaical CONTRACTORS ~- .rl ... GI!~erol. K J, r'\ (nome) (address) \ l '5,0 I in. YY\ [\ ('('(\{/uAI.l. ') () I (lies. no.) (expires) (chaM no. I Plumbiraq Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL I FEE ! CHARGE I I I I / I I I I I NO, FEE CHARGE NO.' FEE j CHARGE NO. Residence of furnac.1l1 burner to llTU's Applionc.e vent separate Slo.ionory evop. c.ooler Vent fon with sinqlo duc.t Vent system oport from he'ltinq or A.C. Mechonical oxhoust hood and duc.t Each sinqle fixture Relocafed building (new fix. additional) S.F. Residence (1 bath) 1q: ft. New circuits, alterations or e.lllensions SERVICES Duolu (l both) each Temporary Construction A.dditionol bglh Amps. Water 1enice Sewer Wood stove/heator SIOrm SeWfOr FEEDERS Heat Pump Air handler to 10.000 CFM Air handl.r over. 10.000 CFM Amps. I I t I TOTAL CHARGES I TOTAL CHA.RGES ISSUAN~E Of PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be aone by the Electrical Contractor, the electrieal portion of this p.rmit' sholl not b. valid until Q label has b..n signed by an Electrical Contractor and a"ached to the elutrical panel. I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that all information hereon is true and correet, and I further cllrtify that any and all worl( performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining 10 Ihe work described herin, and that NO OCCUPANCY will be made of any structure without the perm inion of the Building Division. I furthor certrfy that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that jf exempt the basis for exemption is' noted ho..n, ond .ho. only '.'''onno''o" o~d omplo~oo. who ..0 ;n <ompl;on", wHh ORS 701.0>> W~;/II bo ..od on ,h;. p..~ .. Sasis for Builder's Boord exemption: NAME (ploo.o pdn.) r I cuAW } IIP)l1/tI- SIGNATURE ,~~~ ~ FOR OFFICE USE ONLY DATE di;hl Zone fire Zone Flood Plain Typel Canst. Bedrooms Ctorie-. Units ....,'.cy load accy Group Sq. Ftg. Main Sq. frg. Accen Sq. Ffg. Other x "alue, "(alue Value x x TOTAL VALUATION PLUMBING PERMIT Charges and Surcharges If). 00 ,40 Fence I Systems Development Charllilf 11.~%1 hOlllOn{l1nVl. I } (JO,OC; BUILDING PERMIT Charges and Surchorges Pion Ck. Comm/lnd 65%1 Blda Per Fee Plan CIe. Res 30%/ BIde Per Fee Demo I Total Comb. Permit ElEORICAl PERMIT Chorgos and Surcharges I ---------1 \ . I TOTAL I , &\1l0,YO, Sidewalk Ale Pavino MECHANICAL PERMIT .'Chorges and Surcharges Curb Cut -- ...... ";;:'"1.:.-..- l! ,. , I. Applica~ to furnish A. Job Address B. Legal Description 1. example-tox lot 100, Lane County Map Reference 17 03 43 2. example-lot 1. Block 3, 2nd Addition to Springfie!~ Fo:tntes C. Name. etc. of owner and construction lender (C I T Y 0 F S P R I N G FIE L 0 0.. Energy Sources 1. example.heat i electrical ceiling/or forced air gas City Hall 2. examoie-woter heater/electrical/or solar Springfield. Oregon E. Squore footage,ar valuation. etc. - ( Department of Public Works 1. examole.1250 sq. foot house. 500 sq. foot garag' OFFICIAL RECEIPT 2. examole.if new project, check ;;e;.,-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 roc 3. example-convert single family residence into restaurant (chonge 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 Div (' Staff must be able to contact appropriate persons re .' design inFormction or job site corrections, etc. COMBINATION APPlICATION/PERMI.AP) II. Abbreviated Plumb1ingk. Mechanical & Elehctrdical Schedul ( A. Except where b an spaces occur in t e escription I of the Mechanical and Electrical Schedules, the appl need fill~in only the No. Boxes adjacent to the appn r item(s) to be Installed \, B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To con~rve space on the permit form the schedu ( have been abbreviated 2. If the it~m(s) to be installed are not covered on t, ated schedules you should consult the full schedl ' C. BUILDING DI'/ISION STAFF WilL FILL OUT ALL FEES, ~' CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used worksheet only. Where possible, Building Division Stafi prepare a typewritten copy and return it to the applicc 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 (p. and no plans will be processed until these fees 'are poi, ~I! other fees and charges are due and payable when the~~rm . is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, nam.... . ",ignaturl'" ..... ...;.0 .: ,'..a- ttERMIT VALIDATION ( ( c No. B Date LI- R -. 19F1 i Rec'd From R\r-l"\(lxrt l-.. OJ'\\"'ii'(1 t.L( Address J 15 Y ~ ;'1 , r7Ld ~-j--, ,-- ~" . '1 ~~ "~h . -..J'- '""''-I . . ( Received For: . ql L\' 1 .( 56250C ( \ \lX\ \ U. -t \. ~. n. c\::'l ~ lJi)('{Ufl+ ( . I ) l()~;:). ,(y') . . S_Q-l \,){J, r (' An. 1\ ~ LLl>-V\. t-n n .\ ( I fV"l. no / ( lom 490 .L/O c ( I . 'lid ,~ .40. (' ~ ( I ----'.- (\ ,(n(ii Q J Amount Received (' ~. AUTHO'UZEO SIGNA.TURII!:- ."ILTO"'TUIl".ULL ~'''''T[''S . l[UGIE..... Oil .7.0, .....'. C_ ( .. -.. - -... ~. -, . r Permit Cler.. I I I I -iatf" ',.. ~ :";~-..w,:",~..,~,",,_v~