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Home My WebLink AboutPermit Plumbing 1981-1-13 INSPECTION LINE 726-3769 . CITY OF SPRINGfiELD COMBINATION APPLICATION/PERMIT . INfORMATION LINE 726-37S3 ,"-' , ~~~'~n d\n ENERGY SOURCES: Sq. Ftg. Main Heat Sq. Ftg. Access. Water Heater Sq. Ftg. Other Ranqe _New_Add_Alter_Rep. Value of Work: 'f' _Fl!nc9',Demo_Change/Use '~CD-O'''"', B~i1di~g Perm-W Info~ Dewibe- Work (i.e., Buil(CSi~gle Re$ide...~~_Wilh Attached GaraQe) Job Address tf)25 Legal Description I Ow..:~'\:,\C\~. \.~'" \ '0 "-\ I Add,... ~CY2 P, L -lo1 J'\~ \ t.-.)h~ '--. I ~I:::la ,~.~, '\\J\o-~~ I Co.",,";o. loU I Address I DESIGN TEAM I Primary I Structural I Ebctriccl N"\:t> (L.. phone (nome) (address) (lies. no.) (expires) (phone no.) N.echcm:..d CON1R.\CTOR$ (nome) _G.."o" ~~l\C"\f\r-, Plumbina \j (address) (lies. na.) (excires) (oh~,u. roc.) I I .,.1.. Electrical Mechanical I.__ CHARGE J NO. I I PLUMBING ELECTRICAL MECHANICAL -'---~ FEE CHARGI; 'NO. ~ I I FEE FEE CH ARGE NO. I Residence of furnace I burner to '.>TU's Appliance vent separate , I Stationary evap. cooler Vent fan with single duct Vent system aport from heatinq or A.C. Mechanical exhaust hood and duct ~~: ft. . New circuits, alterations or extensions Each sin!=lle fixture Relocated building (new fix. additionoJ) S.F. Residence (1 bOlh) SERVICES Duolex (1 both) each Temporary Construction Additional l:ioth Amps. Water service Sewer Wood 5tove/heoter Storm Sewer FEEDERS Heat PumD Air handler to 10.000 CFM Air handler over 10,000 CFM Amps. I r I TOTAL CHARGES I ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES t~. - Q V \j {j' __J WHERE STATE LAW REQUIRES that the Electrical worll: be done by the Electrical Contractor. the electrical 'portion. of this permil shall. not be valid until a label has been signed by an Electrical Conlractor and attached- to the electrical panel. I HAVE CAREFULLY EXAMINED the completed application far permit, and do hereby certify lhat all information hereon i5 true. and correct, and I further certify that. any and all work perfor(1)ed 5holl be done in accordance' with the Ordinance5 of the City of, Springfield and the laW5 of the State of Oregon pertaining ,to the work de~cribed herin, and that NO OCCUPANCY will be- made of any ~tructure without the permission of the Building 'Division. I further certify that my regi5tration with the Builder's Boord is in full force and effect a5 required by ORS 701.055, that if exempt the' ba~is for exemptic;m is noted heron, and that only ,subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project. SIGNATURE / i?4-J- fOR OffiCE USE ONLY" Ba5is for Builder's Board exemption' NAME (plea," Pd.t)~1 ~l\,\A DATE Zone Typel Canst I 'nits Sq. ftg. Main F"ire Zone Bedroom- l1ccy load Sq. Ftg. Access Flood Plain c'-ri..... '"'ccy Group Sq. Ftg. Other BUilDING PERMIT Plan Ck. Comm/lnd Chorge5 and 65%/ Bld~ Per Fee Surcharges Plan Ck. Res 30%1 BldQ Per Fee PLUMBING PERMIT \0,00 Charge5 and Fence Surcharge5 Demo . ElECTRICAL PERMIT Charge5 and Sidewalk Surcharges AI C Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharges ~------- x Value x Value x Value TOTAL VALUATION Systems Development Chame ll.5%l Total Comb. Permit TOTAL \ C) .OJ \-\~-~\ i. COMBINATION . APPlICA nON/PERMIT (CAP) .' .. I. Applicant 19 furnish A. Jab Address . B. legal Description , 1. example.tax lot 100, Lane County Mop Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates , C. Name, etc. of owner and construction lefnder D. Energy Sources 1. example.heat/ electrical ceiling/or forced air gas 2. example.water heater/electrical/or solar E. Square footage or valuation, etc. I 1. example-1250 sq. foot house, 500 sq, foot garage 2. exam~le-if new project, check new-if addition, check odd, etc. F. Building permit information: 1. examole-construct single family house with an attached garage 2. exampJp.-remodeJ existing garage into fan lily room 3: example-convert single family residence into restaurant (change of use) " 'G. Value of work as defined in 5eelion 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 regarding design information or job site corrections, etc. "-V ." II. Abbreviated Plumbing, Mechanical & Electrical 'Schedules A.' Except where blank-spaces occur in the description portion of the Mechanical and Electricai 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 at the Building Division '1: To conserve space on the permit form the schedules have be'en Cibbreviated 2. If the item(s) to,be installed are not covered on the abbrevi- ated schedules'youshouid 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 octual permit is issued for his signature. " IV. Fees and Charges Plan check fees are due and poyable'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: -.-,- ~- A .l~ Additionol Project Information: PLANS REVIEWED, BY: nam"" ...,ignatur.... ., PERMIT VALIDATION ... " - " , c. Permit Clerk 'J. '(11 ': "j I',. ;1 -iate INSPECTION LINE 726-3769. . !. '~_.(,11~~~ . INfORMATION LINE 7'2:6-3753 ,I , ." CITY Of SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Addreu t"{J~n . '--' -ol. ~l ,t\>{\ ~ n '") (j" ,r\n I ENERGY SOURCES: Sq. ftg. Main Heat Sq. Ftg. Acceu. I wO',er Heater Sq. Fig. Other Range New__Add_Alter_Rep. Vol" of WO\k' " C)::.) ~~7r',9D,mO_ChOng.1 U., .,dd;n. p"mJ~; Wo,k'{; e" ."Id S,ngl. FamilResidencft With Attached Gara'C'o:\ Itegol Descriplion I I Own"~\.\~'l~ ~\ ~ .~~._-- I Add.... nCY? P, , 1m ,1".1 ~"'" \ f-,\'^">e ' I, '~8N ~_rf)_ Canstruction LeW I Addreu 'I DESIGN TEAM I Primary I Structural I EI~ctrical ,I Mechanical I ~~l,",-~:Jj_ Pnone (namel (address) (lies. no.) (upires) (pnone no.) , CONTRACTORS G,n..ol, R..~ ~ l \('\ \'\. T.> PlumbinQ l.J (nome) (address) (lies. no.) (expires) (phone "c,.) I Electrical Mecnanicol NO. FEE CHARGE NO. MECHANI;:~'-=- CHAR~~ furnace I burner to Il.TU', PLUMBING 1.-- ELECTRICAL -;:;0-1- I FEE I CHARGE I I I Residence of I I I I I I I I I I I I I r I TOTAL CHARGES I Each single fixture Relocoted buildina (new fix. additio~o]l. S.F. Residence (1 bath) . s9: ft. . New circuits, olterations or extensions SERVICES Appliance vent seporcue Stationary evap. cooler Vent fan .....ith sinC'lle duct Ven, JOystem apart from heatinq or A.C. Mechanicol exhaust hood and duct ./ Duplex (I bOlh) each Temporary Constructio.f! Additional both AmpJO. I I Water service S~wer Wood stove/hooter Storm Sewer FEEDERS Heat Pumo Air handler to 10.000 CfM Air handlo)r over 10,000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHAR.GES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical wor. b. done by the Electrical Contractor, the electrical portion. of this permit sholl. not be valid until a label has been signed by an Electrica) Contractor and attached to the electrical panel. BaJOis for Builder's Board exemption: NAME (pl,o.. p,;n')~) - ~'j~l\J-\ I HAVe CAREFULLY EXAMINED the completed application for permit, Clnd do hereby certify that all information hereon is true. and correct, and I furthor certify that any and all work perform.cd snail be done in occordonco. with the OrdinanceJO of the City of Springfield and the laws of the State of Oregon pertaining .to the .....ork deJOcribed herin, ond that NO OCCUPANCY will be made of any structure without the permission of the Building .Oivision. I further certify that my registration .....ith the Builder's Boord is in full force and effect as required by ORS 701.055, that if exempt the' basis for ....emprion is noted heron, ond that only subcontractors and employees who ore in compliance with ORS 701.055 will be uMd on this project. SIGNATURE / 1? _ ~ -J- "" FOR OfFICE USE ONLY ~ \ DATE \-\~-~\ Zon" Typel Canst. Unih ""'i. Ftg. Moin Fire Zone Bedroom' nccy Load ",. Ftg. Access Flood Plain O::torie~ "1ccy Group Sq. Ftg. Olher BUILDING PERMIT Plan Ck. Comm/lnd Charges a.nd 65%1 Bide Per Fee Surcharges Pion Ck. ReJO 30%1 Bldg Per Fee PLUMBING PERMIT \'0.00 Charges ond Fence Surcharges Demo .ELECTRICAL PERMIT ChorgeJO ond Sidewalk Surcharges AI C Pavint:l MECHANICAL PERMIT Chorgu and Curb Cut Surcharges --------- I x Voluo Voluo Valu x TOTAL VALUATION Systems Development Cnarae (1.5%1 Total Comb. Permit TOTAL \ C).eo 'I',l 'I j I , ~ ? 1/ I }'i .I "'.'_,' 'hl/'ll;ffll . ~ . I' 'j ;'1 ~. Illne of the appllcanOll, I. "",q"" 'd All '(1'" ",.;sare pal. ,f", _ . when the permit ~ -~ al'l ,.. --~". . - " ,,1"=- '" -0'- " ---.... ,'I ~\i" -. '"" ,~D Reference 17. ' 'II " , '0 Springfield Es ..1"11 . '<~er - n." .... ...,,/-/. .....~... /",j' hilI " . _ '~ed air qas !II..,,' _ ~lar '.~. -'- .::.--......' 'i .-",..'....!I "I I . :oot garage '\ddition, check _. =:- ~.... ~;... ~ --~--; 5~-__""... " ~:.~... '<i hll I 'with an attach ,.. . . .., '1I1q t '1~1 .' . fonlily room 1'11. . 'r;e mto ::-.:::....-- ......::=-.,...... -~:;::'.. ' ." .', "'II' :,,) of the ...-'~., " ""~#' :..:~;",.-1'...... '/ii'l\,,!.. ... '!lfll" ,;ddmg DIVISIOI ", . - . 'cersons regor ''1111 ' . etc. '..", 'Ifill", , ,.,1 Schedules '/,1, dol. . . .1dl I 'scrlptlon port 'll', I' '-" I '" the opp lcar , I" h . :. t e oppr,?pn -~'-:"'" ~, ~::-:-...-...-:.~ ~.:::---.;....~ :::::':=:--.../ -=::-::.-0:'_ ~'-....//, ~:r:-'-"l- ,/ ....~ I~~~ ~ . ':"~---~',;.( , / / ""111 "1;,! Schedules "lIf I . q I-.'he schedules .~ .....ol....._......._,-~.....~ , , " /. . ' J/ '-'/tlll /'11 '\:eredonthec 1/11, I ", , -;ull schedu es ,III ALL FEES AN ".~.-:'~ ,~'---.' '.. ......~,<~.-~--... ~~~+...:~', .;. ~~:~.... --=:r: 1/" . . '. ,I,"f} /lIlt, I, ,"i', (il /(1 be used as ~ i," ;~ 'r"(sian Staff W~ . . "" '; ,., l,e applicant. "'I' Jnature. ~~~~. :::!'W!:--.~ -_. ~ .~;;"'-'---:::":....' ,,..-.. :o:.~~""""--""':::~_~ , ~~?- "Y'.. --- ~., , " 111'11 II I "'''j~E -- OCCUPANCY: -:,-- ....~:..-....- 1(' -" ,-"--,!,.-- ~.,,..-- ----~--:: ~"' '~ , ~- d."~,,... . "f!e "---. ,., .. ~ERMIT V~L1DATION .j C' CITY OF SPRINGFIELD ( ,.. I City Hall \ Springfield, Oregon , , Deportment af Public Warks ( OFFICIAL RECEIPT No. B S 5 5 77 c Data 1\l"Lr::-"\. \ ~ 19 <;< \ Rec'd ~m~ R f"'i\'\ ~ \ 1\\ ^'\ Address ~J) (\(r~.~~'l(A " ( ( .( c ( Received For: ( ( ( \C)CO ( ( ~. ~J'1e.t\ Q a ( - 5.5".. \., (I j 9' C. ( \~6.\[\O ( ( ( Amount Receive4f) ,<Y':J ~Ltt0 ( ~ A,UnolO"'ZEO StGNA,TU"E 'J"~lTO".TU"".'Hl ~"'''TE'''J . ~UC~"E. 0" ."0' ( Permit Clery "; ~:I -, , j ,.) ~ .t i i . dole .- ,