The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 1981-10-16 ':/" ,> . CITY OF SPRINGFiElD COMBINATION APPLICATION/PERMIT INSPECTION LINE 72~769 Job Address 2/0 - N/1/;U S7. f!! i7 - 03 - .3 s-- 32- OIfR ()() ,L~gal Desc;ription Own" 60~ocoiL. L ~'u.oo.s Add"....J'.R-RS-.EL /,?/.e.q /Eh Pho~- /'.P/J CPGe"/l/8 c;?'74M~ Construction Lender Address phone DESIGN TEAM (name) (oddren) Primary Structural Electrical Mechanical CONTRACTORS (nome) (address) General P]umbina 1(11) ; Electrical Mechanical PLUMBING NO. I FEE I CHARGE NO. I Residence of Eoch slnRle fixture Relocoted building (new fix. additional) S.F, Residence (1 bath} ~.... ft. New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Construction Additional both Amps. Woter service Sewer Storm Sewer FEEOERS Amos. TOTAL CHARGES A//J k c: TOTAL CHARGES . INFORMATION LINE 726--3753 ENERGY SOURCES: Heat Water Heater RanQe I Value of Work: Sq. Ftg. Main Sq, Ftg, Access. Sq. ftg. Other _New_Add_Alter_Rep. _Fence_De~o~Chdnge/Use _Other ~ ~ ~ ~ Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached Garaae) &pl9ie,~ 7f, ~.....ee ~P/"v 6 CoI9"o ,,;Jr'& h;:rO.e~S A./o r;; E (lies. na.l (phone no.) (expires) (lies. no.) (phone no.) (expires) IA. ~ ELECTRICAL MECHANICAL FEE I CHARGE NO. I FEE I CHARGE ,: \ . furnace/burner to I\TU's Appliance vent separate Stationary evap, cooler Vent fan with single duct Vent system aport from heating or A,C. Mechanical exhaust hood and duct Wood stove/heater Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM ISSUANCE OF PERMIT TOTAL CHARGES WHERE STATE LAW REQUIRES that Ihe Electrical work be done by the Electrical Contrador, tho elodrical porlion of this permit shall not b. valid until a label has been signed by an Electrical Contrador and attached to the eledrieal 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 ond the lows of the State of Oregon pertoining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. 1 further certify that my registration with the Builder's Board is in full force ond effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS ~70~Loss~wm b. uood V,s roiect. &asis for Builder's Board exemption: ~,_ NAME (please print) ~A.Ii'L)C'""~ cl),~nJr_;Q-A/ SIGNATURE DATE /b ~ /~ -.~ '7 FOR OffiCE USE ONLY Zon~ Fire Zone Flood Plain Typel Canst. Bedroom. Cjtori-- Units nccy Load nccy Group BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/Bldo Per Fee Plan Ck. Res 30%/ BldR Per Fee PLUMBING PERMIT Charges and Surcharges Fence Demo ELECTRICAL PERMIT Charges and Surcharges Sidewalk Ale PavinQ MECHANICAL PERMIT Charges and Surcharges Curb Cut ~ Sq. FIg. Main Sq, Ftg. Access Sq. Ftg. Other x Value Value Volue x TOTAL VALUATION Systems Development Charne (1,5%) Tota] Comb. Permit TOTAL C/ .. COMBINATION APPLICATION/PERMIT (CAP) . '!~ . I. Applicant ta furnish A. Jab Address B. Legal Descriptian 1. example-tax lat 100, Lane Caunty Map Reference 17 03 43 2. example-Lat 1. Black 3, 2nd Additian ta Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. exomc,le-water heater/electrical/or solar E. Square footage or valuation, e!c. . 1. example-1250 sq. faot hause, 500 sq. faat 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 af wark as defined in Sectian 303 (a) af the Structural Specialty Cade 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 wnere blank spaces occur in the description portion af the Mechanical and Electrical Schedules, the applicant need fill-in anly the No. Baxes adjacent ta the appropriate item(s) ta 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) ta be installed are nat cave red an the abbrevi- ated schedules you shauld consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 111. Applicant ta sign and date , Whenever possiblerthe initial application will be used _/0- warksh.e.et anly. Where possible, Building Divisian StaffIWill 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 af the applicatian, and na plans will be processed until these fees are paid. All ather 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: nam"" "ignaturr.- . <.:._~'''''1 PERMIT VALIDATION . .... I, I I ! I \ I '\ Permit Clerk ." ~ate .a