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Home My WebLink AboutPermit Plumbing 1982-4-15 ~ I ~, 0-- INSPECT}ON... lINM 726-3769'~- . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 I tb Address ~,-;r~-/'" Itegal Description I I O:ner I o,Ar,-,..IAf /7-03- :n. -;zo J I ENERGY SOURCES: Sq. Fig. Main t:;;;"O./'ln.."I!~<L /I Heat Sq. Fig. Access. V' I Water Heater Sq. Fig. Other /7t>o Range _New_Add_Alter_Rep. Val,. af3,OOC)?" I =~t~::_D.mLChang./u,. Building Perlflit Info: Describe Work (i.e.. Bvild Single Familv Residence With Attached Gorooe) ;7/./77Y.Q ..""ATL,.h/> /7~ D" V2 ~ c::; ~ Add,...::r ~ "3''':- 5~")~LJ.fN/7Jh~..) .4f!,an.~?q,?_/'fr// 'i? ,7'/#1",'1 /.IX! / '77 ;1.,...- "r ~/1L .(:1":-;76<'":' i:>0 t ~ J.J ~ Construction lender Address Phone DESIGN TEAM (nome) (address) (lies. no.) (expires) (phone no.) Primary ~YU 7 "Y1 ,?# ,,1 Structural- Electrical Mechanical CONTRACTORS (nome) (address) (lies. no.) (exDires) ("lhone noJ General A"2<T'n :>'"i? - Plumbina Electrical Mechanical PLUMBING elECTRICAL MECHANICAL NO. fEE \ CHARGE NO.' fEE i CHARGE NO. I fEE I CHARGE SERVICES furnace/burner to ~TU's Appliance vent separate Stationary evap. cooler Vent fan with sin~le duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Residence of Each singleo fixture Relocated building (new fix. additional) S.f. Residence (I bath) ~,... ft. New circuits, alterations or extensions Duplex (I bath) each Temporary Construction Additional both Amps. Water service Sewer Wood stovel heater Storm $ewer fEEDERS Heat PumQ Air handler to 10.000 CfM Amps. Air handler over 10,000 CFM ISSUANCE Of PERMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Conh'actar and attached to the 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 ,Division. I further c:ert1fy thot my registration with the Builder's Board is in full force and effect as required by ORS 701.055, thot if exempt the basis for exemption is noted heron, and thot only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption: NAME (please print)/" 'j. ~ '" ~ I /~-r?.'.o/~.<?7A/ SIGNATURE 4 /~~--- Ld..-<~ DATE -s/~'i'/<77 '" ,,- .... fOR OffiCE USE ONt Y Zonr Fire Zone Flood Plain Type/Canst. Bedrooms Ctori"'. Units Occy Load l"'lccy Group Sq. Ftg. Main c.~. Ftg. Access Sq. Ftg. Other Value Value Value TOTAL VALUATION x BUILDING PERMIT Charges and Surcharges plan Ck. Comm/lnd 65%1 BldA Per Fee Plan Ck. Res 30%1 BldQ Per Fee Systems Development Chorae 1l.S%) PLUMBING PERMIT Charges and Surcharges Fence I g, v'V Demo Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk AI C Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 1)1 g. &0.0 F"i/, " I"' T'. ~,' ' ~. -~1~~""'7- -, ":-or.. ~"....... '" -" ~. .-....".... COMBINATION APPLlCATlON/PER.~CA:} . .,. I. Applicant to furnish A. Job Address B, Legal Description 1. exomple-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estotes C. Name, etc. of owner and construction lender . 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. r' 1. exomple,1250 sq, foat house, 500 sq. foat garage 2. example-if new project, check new-if addition, check odd, 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. Abbrevioted Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanicol ond Electricol Schedules, the applicant need fill-in only the No. Boxes odjocent to the appropriate item(s} to be installed B. Full Plumbing, Mechonical, ond 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 instolled are not covered on the obbrevi- ated sohedules 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 payoble ot 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: name "'ignatur.... _._- - .ERMIT VALIDATiON"" , -,' "'IIIIIl I , , .' Permit Cler~ ..late 'NSPEcnON l,""r 726a3769 I ~b Address . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 ~ -;r"-'\-n (::JAr"'~.J""'V , 1 I ENERGY SOURCES: 9OL7.rl'''S''!/,<L /7 Heat '-'" I Water Heater Range I Yalue of Work: Sq. FIg. MClin Sq. FIg. Access. Sq. FIg. Other _New_Add_Alter_Rep. _Fence_Demo_Chonge/Use _Other ~ ~ '-' 00j Jj ~ legal Description 04- Owner _7/1"'r:r,,,7 'M.a Thh.", ,,-,1 fJ, h-? ~ ...; .... Address ~ ~ q~ <;/./)/,.}r.!.6'JV/JVt~L>) ..4f}lone?47_/"IY// Building Permit Info: Describe Work (i.e.. Build Single Familv Residence With Attached Garaae) e ...-7'/ ..hi/? hP:I 9..,'2"7":'- >r '~., / .(I~r1d r Construction lender Address Phone OESIGN TEAM (nome) (addreu) (lies. no.) (expires) (phone no.) Primary ,1'7.-1 , Y1,- 111 Structural Electrical Mechanical CONTRACTORS (name) (address) (iies. no.) (exlOires) (phone no.) General A"Z. T7-1 S- "J7 PlumbinQ Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. FEE CHARGE NO.' FEE ' CHARGE NO. FEE CHARGE Each single fixture Relocated building (new fix. additional) S.F. Residence (1 both) sq. ft. New circuits, alterations or extensions furnace/burner to o,TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system aport from heating or A.C. Mechonicol exhaust hood and duct / .' Residence of SERVICES Dualex (1 both) each Temporary Construction Additionol both Amps. Water service I I Sewer Wood stove/heater Storm Sewer FEEDERS Heat Puma Air handler to 10.000 CFM Air handler over 10,000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Elemical Contractor, the elemical portion of this permit shall not be valid until a label has b..n signed by an Electrical Contractor and attached to the electrical panel. I HA VE CAREFUllY EXAMINED the completed application far permit, and do hereby certify that all information hereon is true and correct, ani I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will bet mode of any structure without the permission of the &uilding Division. I further certify that my registration with the Builder's Boord is in full force and .;ffoct os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractan and employees who are in compliance with ORS 701.055 will be used on this project. Basis far Builder's Board exemption- NAME (please print) /1 '1.. ./ ~ / /~...d'1~."77";:"/ SIGNATURE,4 ./ ~X____ ~d../__.# OATE -$/h~'/<77 " ., - .... FOR OFFICE USE ONLY Zone Fire Zone Flood Plain Type/Canst l\edrooms c;,torir-" Ilnits nccy load 0ccy Group Sq. Ftg. Main "<I. Ftg. A<<ess Sq. fig. Other x Value Value Value x TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%1 BldQ Per Fee Plan Ck. Res 30%1 BldQ Per Fee Systems Development Charae n.5%1 PLUMBING PERMIT Charges and Surcharges Fence I g. r..-'tJ Demo Totol Comb. Permit ELEGRICAL PERMIT Chorges and Surcharges Sidewalk Alc Pavintl MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL I 1)/ f t),() Date CIT~OF SPRINGFIELD' . City Hall Springfield, Oregon Department 01 Public Works (I OFFICIAL RECEIPT No.8 58893c 'I . COMBINATION APPLICATION/PERMIT (CAP) I. Applicont to furnish ( A. Job Address B, Legal Description 1. example-tax lot 100, Lone County Mop Referenc. 2. example-Lot 1. Block 3, 2nd Addition to Springfie 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 0" valuation, etc. 1. exomple-1250 sq. foot house, 500 sq, foot garo~ 2. example-if new project, check new-if addition, c add, etc. ( F. Building permit information: 1. example-construct single family house with an ( garage ( 2. example-remodel existing garage into family rc 3. example-convert single family residence into restaurant (change of use) c- G. Value of work os defined in Section 303 (0) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays. Building [ (iC' Staff "!ust be able to contact appropriate persons design infor~otion or job site corrections, etc. II, Abbreviated Plumbing. Mechonicol & Electrical Sche. A. Except where blank spaces occur in the descriptic of the Mechanicol and Electricol'Schedules, the a -" need fill-in only the No, Boxes adjacent to the af , item(s) to be instolled B. full Plumbing,'Me~hanical, and Electricol Schedl are available at the Building Division 1. To conserve space on the permit form the sch ..... . have been abbreviated ".. 2. If the item(s} to be instolled are not covered . , ;.:. ated schedules you should consult the full sc/ C. BUILDING DIVISION STAFF WILL FILL OUT ALL F, CHARGES ON THE SCHEDULES c ( 4-- / ':,~ 19 g 2- Rec'd From ..).., nL.. -J-', r/ 11 /?Aof A A AA....,l..d-Y AF ~ Address :3 39~ ~ LU iku~l.1r 1.Jr6~i . a..~ ( " c Received For. 'o/-~A~CL- t.f4nu;;t t"-tf. R-J.!:j:5-l) ( ''Il/ r Ov ( ( ( ( (.' ,s .c, I I l5'P till vv .( ., Amount Received P h J~ G_ ,k~ I (ul, BY ,~.. ~~.~~i. ( AUTHORIZED SIGNATURE: (' ,.., ( I .-'. ;"'. , . ~1t~QQ~ ':"~N~EItS/UTHOGItA"Hl[R...l[UGl[NlE. OR"GON . . . , . 'III. Applicant to sig~ ;:'nd dote , . .. When'ever possible, the initial application will be used as a. worksheet only. Where possible, Building Division Stoff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issued for his signature. . I " ,IV. Fees and Charges ." ..... ~ 1.-'- Plan check fees ore due' ond poyable at the time of the applicatian" and no plans will be processed until these fees are paid. All other fees and charges are due and payoble when the permit. . :.;.fis issued. '~~1:.>";:" . ",1 ".' ,. "..',;' :,,:.. .i" ',- . ",. ".. . , , tl, ,f;' '. ", ", .,' . t. ~ " '>-,'.~i;' -, ~:' "::.:':;.';'" .' '\.;':f.~~::" '1"" V. FOR OFFICE USE ONLY '. . ".., - '.' ,I,'.. Permit Cler~ '. ,'" "';'. .,..... '-.1 J'.... PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: :- :~,.~ ,". ":.'1."- .. '-~- ,:.~-~. ,. '"{ '. , .. .. ," "'..,' ...... io' ,1'...; 1'-,' \--~i"'" ",I '1;\_ . . ." " .,', " ' 1.:: ,"' ,,',.:. , I;,~ ," :;.:: '.. , .- .. ,~.- . . .' ";:' ~. . . :.....:"';<. :';,::,1' ......:. ". , " ";::'.. .. " . ~ j .. " '.:...-, ~ .... " '.'" ., ~ ..~: . ~': ' .' Additional Project ,Information: " " ..,- " -:~~' " ~ ....,i;. 'C, ~.~~., ;'.';:" " ". .,'.. " , .... '.f:. :.:.r,. ;~jl.t . " .. ,'. ~- "'r ,:;"1 PLANS REVIEWED BY, , . ",':.' name ..;gnatur.... -iatf' '~, - - ....... :-.::- ~ ..... ""I