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Home My WebLink AboutPermit Plumbing 1983-02-02/ INSPECTION tINE 72&3769 CITY OF SPRINGFIETD INFORIIAI]ON IINE 72&375?COMBINATION APPI.lCATION / PERI$II ENERGY SOURCES: Heot - Woter Heoler - Sq. Frg. A{oin Job Address Sq. Ftg. Access. oq 3 Sq. Frg. Other legol Description New-Add Alter-Rep. Fe nce-Demo-Chonge/ Use - Other -_- Volue of Work: ner Building Permit lnfo:Describe Work (i.e., Build Single Address Phone Fo Residence uclion Lender .A,ddress Phone DESIGN TEAM (nome)(oddress)( lics (phone Primo ,lvlechonicol CONTRACTORS Plumbi Electricq I Mechonicol PTUMBING ETECTRICAI.MECHANICAL NO.FEE CHARGE NO.FEE CHARGE NO rEE CHARGE I Eoch sinqle fixture f.lb Residence of fr furnoce/burner lo__BrU',s Relocoled building (new {ix. qdditionol) New circuits, olterotions or exlensions Applionce vent seporq te S.F. Residence (l borh)SERVICES Stolionory evop, coo ler Duplex (l bolh) eoch Temporory Conslruclion Vent fon with sinqle duct Addirionol both Amps. Vent system oport from heotinE or A.C, Wsler service Mechonicol exhqust hood ond duct Sewer Wood stove/ heoter Storm Sewer FE EDERS Heot Pump Ampr Air hondler to r0.000 crM Air hondler over r0,000 cFM ISSUANCE OF PERMIT TOTAT CHARGES TOTAT CHARGES TOTAT CHARGES WHERE TT AIE LAW REQUIRES lhst lhe Electricol work be done by rhe Electricol Conlroctot,the electricorl Portion of rhis Permit :holl not bc Yolid until o lobel hqs bee n signed by Elactricol Conlroclor ond otto ched lo lhe eleclricol ponel. HA,VE CAREFUtt Y EXAMINED the completed oll work performed sholl oPPli cotion for permit,nd do hereby ce rtily thot oll info rmotion hereon I s lrue ond correct,ond further certify ihot ond be done tn occordonce with rh e Ordinonces of lhe , of ony slructure required by ORS City of Spri without the ngfield q nd the Lo of the Stote of Oregonony il be de Permr ssron of the Bui lding Division.furtherpertoini ng to the work descri bed herin,ond lhol NO OCCUPANCY mo erllfy thot registrotion with the Builder's Boord ts tn ful I force ond effect o 70 .055,thot if exempt the bosis for exemPtion ts nofedmy who tn ,lione ith ORS 701 .055 will be used o n rhi s proiect.heron.q nd thot only subcontroclors ond employees qre comP Bosis for Euilder's Boord exemptionr CU DATENAME (pleose print)SIGNATU FOR OFFICE Zone -fype/Const.-Units -----Sq. ttg. Moin x -------Voluex -Jolue 1-lqlyg TOTAT VATUATION. Fire Zone-Bedrooms occy Lood Sq' Ftg' Access tlood Plqin -Storie3 OccY GrouP Frg. Other=.-- EUII.DING PERMIT Plon Ck. Comm/lnd Chorges ond Surchorges Per tee Plon Ck. Res Per Fee System s Choroe Development (1.5%) PTUMBING PERMIT Chorges ond Surchorges Demo Tolol Comb. Permil EI.ECTRICAL PERMIT Chorges ond Surchorges Sidewolk c MECHANICAT PERMIT Chorges ond Surchorges Curb Cut TOTAT 6.n"r, Slructuro I Electricol {e"u, on Fe nce COMBINATION APPLICATION/PERtv.-_ (CAP) l. Applicont to furnish A. Job.Address B. Legol Description L exomple-lox lot 100, Lone County Mop Reference I7 03 43 2. exomple-Lot I. Block 3,2nd Addition to Springfield Estotes C. Nome, etc. of owner ond construction lender D. Energy SourcesI. exomple-heot/electricol ceiling,/or forced oir gos 2. exo mple-woterTeoGr/elEcliiEol / ", @- E. Squore foologe or voluotion, elc.I. exomple-I250 sq. foot house, 500 sq. foot goroge 2. exodilE-iT new proiect, check -new-if oddition, check odd, etc. F. Building permit informotion:l. exomple-conslruct single fomily house with on ottoched goroge 2. exomple-remodel existing goroge into fomily room 3. exompl-e-convert single fomily residence into restor-rront (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Specio lty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Division Stoff must be oble to conloct oppropriote persons regording design informotion or iob site correclions, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A,. Except where blonk spoces occur in the description porlion of the Mechonicol ond Electricol Schedules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriole item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division 'l . To conserve spoce on the permit form the schedules hove been obbrevioted 2. lf rhe item(s) to be instolled ore not covered on the obbrevi- oted schedules you should consult rhe full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Building Division Stoff will prepore o typewritten copy ond return it to the oppliconl ot the lime the octuol permit is issued for his signolure. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicotion, ond no plons will be processed until these fees ore poid. All other fees ond chorges ore due ond poyoble when the permit is issued. V. FOR OFFICE USE ONLY 'ERMIT VATIDATION Permit Clerk PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY: Additional Proiect lnformotion: PLANS REVIEWED BY: nome signolure dote CTTY OF SPRINGFIETD COIABINAIION APPIICATION/ PERTIIT INFORIAAIION tINE 726-3753INSPECTION I.INE 72{'376i Address Ro ENERGY SOURCES; Heot - Wqter Heqter --.- Legol De Volue of Work:-New,-Add-Alfer-neP. -Fence-Demo-Chonge/ Use -Other Sq. Ftg. Moin Sq. Ftg. Access. Sq. Ftg. Other PhoneAddress Permit lnfo: Describe Work (i.e., Build Single With Atoched PhoneAddress (odd ress)(lics. no.)DESIGN TEAM no.) Pri I Electricol Mechonicol Electricql Mechonicol MECHANICALETECTRICALPTUMBING FEE CHARGECHARGENO.FEECHARGENO.NO.FEE furnoce/burner loResidence of -=---sq. ft.,q. DoIle lixture Applionce vent sepo rote New circuils, olterotions or extensions Relocoted building (new fix. odditionol) Stolionory evop. coolerSERVICES S.F. Residence (l both) Vent fqn with single ductTemporory ConslruclionDuplex (l borh) eoch Vent syslem oport from heoting or A.C.Amps.Additionol both Mechonicql exhsusl hood ond ductWoler service Wood stove/heoterSewer Heot PumpFEEDERSStorm Sewer Air hondler to r0,000 cFMAmpr. Air hondler over t0,000 cFM ISSUANCE OF PERMIT TOTAT CHARGESTOTAT CHARGESTOTAT CHARGES {F,u, DATESIGNATU WHERE STATE fAW REOUIRES thot th. Elsctricol lobel hor becn signed by on Electricol Contro.tot work be done by the Electricol Conltdclor, snd oioched to thc eleclricol ponel. th. oh{trica! portion of this permit shcll not br volid until o CAREFUTTY EXAMINED rhe completed oll work performed sholl olllhot hereoninformation s ondtrue ond furtherdoondcorrect,cerfifyherebytorHA,VE permit,opplicotion of the ofSlotelheofOrdinoncestheoftheondLowslndonewithocordonceCitySpringfieldbendolhotonycerlify Oregon furthertheof,Division,lhebeoImodeslructurewithoutwilllhotondOCCUPANCYNOonypermission Buildingtolhedescribedworkherin,pertoining uired 701oRs thot if bosilhe for ts notedlnilfuforecseffect.055,exempt exemptionthewithSuilder',llBoord teqr bythotcert?fy regi sirotionmy oRswilh .055701 il usedbe ,hisonondorewho proioct.tnondthotsubcontroclors complionceemployeerheron.only Bosir for Builder's Boord exemption: NAME (pleqse print) FOR OFFICE USE ONI.Y FloodPloin-Stories-occyGroup-Sq.Ftg.other- x Volue x Yolue x -Yolue Ftg. lvloin So-Ftg. Access TOTAT VATUATION Zone fire Zone-Bedrooms occY Lood Const. -Unils .-.==-Sq. Plon Ck. Comm/lnd 65oil Blda Per Fee Systems Chorge Development (t.s%)BUITDING PERMIT Chorges ond Surchorger Plon Ck. Res 3O%/Bldg Per fee Fence Totol Comb. PermitDemo Chorger ond Surchorges PTUMBING PERMIT Sidewolk A/ C Povinq Chorges ond Surchorges ELECTR!CAT PERMIT TOTAT 6,reo MECHANICAT PERMIT Chorge; ond Surchorges ?,c!lp,et i-J, Vt Nt/ C*a 4f Curb Cur COMBINATION APPLICATION/PERrv\v (CAP) l. Applicont to furnish A. Job Address B. legol DescriptionI. exomple-tox lot 100, Lone County Mop Reference 2. exomple-Lot I. Block 3,2nd Addition to Springfield ' C. Nome, etc. of owner ond construction lender D. Energy Sources LII r \.rr )rKttY\rrttrLt, Ciry Holl pringfield. Oregon Depii'rtment of Public Works OFFICIAT RECEIPT (' rl Dole 3- ,Ltl J{0. B 58285 e 8.L q (l(rom exo m p I e- h e" t/g!ggl4:gkg!.!.!I_9,/or f orced o i r s o s eiJfrFlE-wo te r TEEGTelEc t rko I /" @-2. E. Squore foologe or voluotion, etc.I. exomple-1250 sq. fool house,500 sq. foot goroge 2. exomFlE-i-f new proiect, check nE-w-if oddition, che< odd, etc. F. Building permit informotion: l. exomple-conslruct single fomily house with on otto 9oroge2. exomple-remodel existing goroge into fomily room 3. @-convert single fomily residence into restowont (chonge of use) G. Volue of work os defined in Section 303 (q) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construclion deloys, Building Divisi, Stoff must be oble lo contocl oppropriote persons regc design informotion or iob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricql Schedules A. Except where blonk spoces occur in the description por of the Mechonicol ond Electricol Schedules, the opplicc need fill-in only the No. Boxes odiocent to the oppropr item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division 'l . To conserve spoce on the permit form the schedules hove been obbrevioted 2. lf rhe item(s) to be instolled ore nol covered on the oted schedules you should consult rhe full scheduler C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES,AN. CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Building Division Sfoff will prepore o typewritlen copy ond return it to the opplicont ot the iime the octuol permit is issued for his signolure. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicotion, qnd no plons will be processed until lhese fees ore poid. All other fees ond chorges ore due ond poyoble when the permit is issued. V. FOR OFFICE USE ONLY ( (I 4r""Ah (. ,I ( il (l (l ,:l .l ( ( € ( AUTHORIZED SIGNATURE sxELYOt-tuii!utL ptrNtti3 . Eu6ExE oh 9raol Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformolion: nome signoture dqte PTANS REVIEWED BY: ( .l Received For: 4,(t -*rl'- o Amount Received 0A fi u;.p ?1 \,