The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 1981-9-18 . ~~ . CITY Uf SPRINGFIELD COMBIIIATlON APPLICATION/PERMIT " EilERGY SOURCES: ~ Heat Hater Heater . \ lIIISPECTION LIIIE 726-3769 INFORflATlON liNt 726-3753 Sq. Ftg. 1,Iain ~q. Ftg. Access. Sq. Ftg. Other _ ~d Alter Rep, ~~O_Change/Use . I 00 5 ..-- Job Address ~ )~C\ ~ 51 ~\~ U\ Legal Description () . \ ~ cz (/U no () ?Sl.CXo owne"'~r~o m ~, C\ ~ ~ fet ~ -C\) AddreSS$rD~ ~)\ &1ZS::~il(-f(: Construction ~ \t~ X\[\Q J Address Phone \ OlSIGU TEN' (name) (address}) flies. Range ValuE of 140rk~r:o BuilriinQ Permit Info: Describe Work(;.,e" Familv nesidence With Attached GaraQe) no. ) (exo; res) Build Single ~ J' (ahone no.\ Primary j Structura 1 Electrical II i Mechanical , CONTRACTORS , ~~ l' - General ~ .... , Plumbino U~ ~ , Electrical (name) ___ (address) ~ ~l ~S\ 't. \L~ ~ ll(U\-t'- (j (lies. no.) (exnil"es) (ohone no. ) <::.. ,~~"U2j1l tc: ') -t'j '(\- , '-../ - N~ -~...-....o--=>~---=-c , FEE Each single fixture CHARr,F Nn 'IL..cJlAJlli< Nn "__~ ___ _= z. ____ ~ I, J ~ .-1 CHARt,F H Mechan!f~_~~_ --_._._._,.---=--=.=~=. PLUIIBIrIG ELECTRICAL MECHANICAL SQ. FT. furnace/burner to' BTU's . 'IL Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath} Duplex (1 bath) each IAdditional bath ~!ater service SERVICES Recessed wall Sn~~p hp~tpr ~prl vpnt Storm Sewer Of amps. I Appl iance vent seDarat~ I S'tationary evap. cooler I Vent fan with sinole duct I'Vent system apart from heatina or A,C, Mechanical exhaust hrlOd and du~t Wood stove/heater Sewer Temporary Construction Change in existing rPsjd.fJ1r:p multifamily. comm. or lndll"trial COMM./IND. FEEDERS Insta11/alter/relocate di"trih. fppdpr" Of amps. 9 ISSUANCE nF PFR!1lT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE UI~ REQUIRES that the Electrical work be done by an' Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EX~~INEO the completed aprlication 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 Oregon pertaining to the work described herein. and that NO OCCUPAI~CY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. Zone Fire Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy Load Occy Group SIr,IlAT~"'''''/_~''--'/)1''J.f/ /_1:17..;,/ FOR OFFICE US OIlLY ~. Ftg: riain Sq. Ftg. Access Sq. Ftg. Other DATE9-/.~ -81 IWIE(please print'i)O n.:'- '" /1/), (L/,.-6,' <:. x Value Value Value ,x x TOTAL VALUATION BUILDING PERfltT Charges an~ Surcharges Plan Ck. Comm/lnd 65%/81do P.fr Fpp ------------ Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development CharQe (1.5%) PLUI~BING PERMIT Charges and Surcharges D~mo \~,c::cJ [ I I ELECTRICAL PERI~IT Charges and Surcharges 'Sidewalk A/C Paving ITotal Comb. Permit flECHANICAL PERMIT Charges and Surcharges Curb Cut I I TOTAL CiS) I [8, \" . ,. COMBINATION APPLICATION/PERMIT (CAP) :. I. Applicant to furnish A. Job Address B. legal Description 1. ~xample- Tax lot 100. lane County Map Reference 11 03 43 2, example- Lot I, Block 3. 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinqjor forced air Qas 2. examDle- waterheater/electrical/or solar E. Square footage or valuation, etc. - I, example- 1250 sq. foot house, 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. exam~le - remodel existing garage into family room 3. examyle - 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 TEM1 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, 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. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is .not authorized to sign the electrical "label. --- III, Applicant to sign and date Whenever possible, the initial application will be. used as a worksheet only. ~here 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 ~f 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 CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . I. \ " PERMIT VALIDATION Permit Cl erk . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date ;1 , , ,t , ,; 4 " ; , 1; ~ .', 'w " .:, , " i ;1 '; ., ,! ;: " J' \. . CITY Dc SPRHIGFIElO COIIBIIIATION APPLICATION/PERMIT E,IERGY SOURCES: ~ Heat !'Iater Heater'.# . INFORlIATION LINt 726-3753 50. Ftg. 1,Ialn ~q. ~tg. Access. Sq. Ftg. Other ~d,~= Alter rep. ~O_Change/Use . "...i\ \.....1'-) - ) ..-- I IrISPECTIOII L1IIE , 726-3769 Job Address ~.'{ Legal Description >l.)!~ ~C"\ :~ t\- \, ( (\ ;j Owne",,- r~~( '~\ ~, l \ \ \\1 \ .::-\' Address ,~' j(:C"'\::J ~'~:'L:)\ ~',-\:, '("'hOne "~~~"_~ 0--" j llIG--ILlCJ{ . Constructlon l~de~) RanQe, ValuE of Hork:80(\ Ie, ~ \----" ~ } . Buildina Permit Info: Describe Work(f.e" Familv l'Iesidence l'lith ".ttached Garaael Build Single .J r --- (l ics. no.) (exoiresl r no.'\ Address Ul:.~llir~ Itm.1 (name) Phone (addressl , " ,~ l\ChJ -\ / , (ohone: Primary f1echanical , CONTRACTORS (name) __ (addressl General \....../\~JP-';\~ u" \I, 'I((~ flkc;,. no.) (pxnirp.;;l (ohnnp "n l , , , I I' 'I ij 1 I I ~ Structura 1 Electrical PlumbinCl I Electrical ~lechanical . . --.-,..--... PlUIIBIrlG . rrQ:"l--~""-- _.- -'~FtF.i r.HAR(;F Each Single fixture ELECTRICAL MECHANICAL NO..a..-' ~~LI..cJ:iABf~ r.sn Residence of -- . t:'ct" I' " '..cHARGF. ! , i 5Q, FT, furnace/burner to. , STU's , Relocated building (new fix, additional) INew circu!ts alts. or extenslons 1 SERVICES I Floor furnace and vent S.F. Residence (] bath! Ouplex (1 bath) each Additional bath ITempOrary Construction IChange in existing r@coJ d~nc@ Imultifamily> comm. or Tnduc:trial 10f amps.1 ICOMH./lNO. FEEDERS I Ilnstall/alter/relocate 1 tiic::tl"'ih. fpprlprc: Of amps.j Recessed wall I ~narp npatpr anti vpnt I Appliance vent I sJ~D~rate Stationary evap. I' cooler Vent fan with 1 sinole duct Vent system apart from I heatina or A.C. I Mechanical exhaust I hood and du('.t. I Wood stove/heater I I I \-later serv; ce Sewer lstorm Sewer i I I I I I tS5UANCE OF PFRl1tT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHEnE STATE l~H REQUIRES that tile Electrical work be done by an, Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INEO 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 Soringfield and the laws of the State of Oreqon pertaining to the work described herein~ and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my ~egistration 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 7Ql.055 will be used on this project. Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy load Occy Group SIGi~ATU~9tt"V.'-rl/ ~;(?~_/YJ.'1.(i/., ,rl;J_".I For OFFICE USE/O~lY :So. Ftg. Sq. Fta. Sq. Ftg. OATE9-/.~ -.y / NAr-tE(please print') J....,jJ.'/,.. ib},(',,/.c.', r~in Access Other x Value . Value Value , x TOTAL VALUATION PlU'~BING PERMIT Charges and Surcha rges Plan Ck. 65%/Bldo ------------ Plan Ck. 30%/Bldo I Fence ------------ 10_ I Sidewalk I Ale Paving I Curb Cut I COI1ll1/1 nd Ppr Fpp Res Ppr Fee Systems Development Charqe (1.5~) BUILDING PERfIIT .Charges an~ Surcharges ELECTRICAL PERI~IT Cha rges and Surcharges \ Y; . (~...J I 1 I MECHANICAL PERMIT Charges and Surcharges ITotal Comb. Permit I : I'::l [8, co, " - . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. exarnole- Tax lot 100, Lane County Map Reference 11 03 'j 2. examole- lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceiling/or forced air Q3 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation. etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project, check new - if addition, cneck add. etc. F. Building pennit infonnation: 1. examole - construct single family house with an attached garage 2. examole - remodel existing garage into family rao 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. DESIGN TEAM AIIO 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. 11. 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 adjacen 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 schedule 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. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to t electrical contractor for signature by his electrical supervisor. The general contractor is .not authorized to sign the electrical 'label. - III. Applicant to sign and date Whenever possible. the initial application will be used a+- 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 / 'l' ~. I . " I , . CITY, OF SPRINGFIELD ( ( City Hall Springfield, Oregon Department of Public Work. OFFICIAL RECEIPT ( / No. B sc\'t \ ~ 198, t From '-- \ ' ~ . l\\ t J\~-hA , l: q t::: ,-..' ) -~, ~)S /_ .(\\::c:>U\~\l(\,_, i\- ( 5'31Q :. .. v ( Date ~' Rec'd <: Address ( Received For: ( ,'" I ~'..'~\ C'L L - \ U -.... \ (J' OU ,\, ( ( ( ~ Amount Received -I 5<;' ,C.:(Tt I [.-iL/ rlltj)~~ AUTHOfU,Z"ED SlC",ATUAE ( .....~'a...Tu..".U~~ ....1..'....5 . ..ua...."'. 0111 .,.al .'5".' .. ( ...!:!-, ~ ( ( Pennit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Pennit 'applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name signature tJate J