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Home My WebLink AboutPermit Plumbing 1981-11-30INSPECIION TINE 726-3769 TNTORilAT]ON TINE 72&375tCITY OF SPNINGFIEIO COISBINAiION APPTICATION / PERMII 5- Ro ENERGY SOURCES: Heot Woter Heoter Descri 3 Sq. Ftg. Moin New. -Add --Alter-ReP' Fence -, Demo-Chonge/Use Other Sq. ftg. Access. Volue of Work:lr*0a Permit lnfo:Bui (,o Describe Work (i.e',Build Single Address Phone Address DESIGN TEAM (expirer) (odd ress)(nome) PTUMBING furnoce/burner lo Residence of MECHANICAL ETECTRICAL NO.FEENO.C'HARGErEE fr. Electricol Mechonicol fixtureEoch Relocotd building fix. odditionol) Applionce vent seporqleNew circuits, olterotions or extensions SERVICESS.F. Residence Venl fon with single duct TempororY Conslruclion I eoch heoling or A.C. Vent syslem oPort from Amps.Additionol both Mechonicol exhqust hood ond duct - Woler Wood stove/ heotet Sewer Heot Pump FEEDERS Storm Air hondler io CFMAmpr.Air hondler over CFM ISSUANCE OT PERMIT Zonc -fype/Consr.-Units _.-._-Sq. ttg' Moin Fire Zone-Bedrooms occy Lood Sq' ttg' Access Flood ploin Slories Occy Group.-_Sq. Ftg. Othcr-.-- DATE CHARGESAtTOTcATHARGESIOT,CHARGESTOTA untilvolid ono,:holl bcthisofelcctricolthopermitConltoclor,porliontheElectricolbeworkdoncEl.ctricol bythethotREQUIREStAwSTATEWHERE lhe olcclricol ponel.ottoched loondContrqctorElectricslonhosbeonbysignedlobel t furtherondondlruecorrect, ofLqws Stotethe ofthe Oregon furiherIofDivislon.the Building ts notedbolheforstsexemption FOR OFFICE USE ONLY SIGNA' Bosis for Builder's Boord exemption: NAME (pleose Print) TOTAT VATUATION x ________Volue x Volue x Volue DevelopmentSystems Chorge (l.s%)BUITDING PERMIT Chorges ond Surchorges Plon Ck. Comm/lnd Per Fee Plon Ck. Res Fee34"/o fl r.goTotol Comb. Permit PTUMBING PERMIT Chorgos ond Surchorges L@_ Demo PERTtAIT SidewolkChorges ond Surchorges TOTAT f,t.st MECHANICAL PERMIT Curb CulChorges ond Surchorges T'n 0rr4+3_ Q-izz-- No. I Slolionory evoP. coo le r PERMIT VALIDATION Permit Clerk COMBINATION APPLICATION/PL (cAP) Applicont to f urnish A. Job Address B. Legol Description l. exomple-tox lot'l 00, Lone County Mop Reference'l 7 03 43 2. exomple-Lot I. Block 3,2nd Addition to Springfield Eslotes C. Nome, etc. of owner ond construction lender D. Energy Sources exomple-heot/electricol cei ling/or forced oir gos eiomp-16-woterTEot"r.T-eh.tricolior;g/5g-2 E. Squore footoge or voluotion, elc.I. exornple-l 250 sq. foot house, 500 sq. foot goroge 2. exomFlE-ifrlew proiect, check new-if oddition, check odd, etc. F. Building permit informotion: L exomple-conslrucl single fomily house with on ottoched goroge 2. exomple-remodel existing goroge into fomily room 3. exomple-converl single fomily residence inlo reltour6nt (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construclion deloys, Building Division Stoff must be oble to contoct oppropriote persons regording design informotion or iob site corrections, elc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the description porlion of the Mechonicol ond Electricol Schedules, lhe 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 permil form the schedules hove been obbrevioted 2. lf the item(s) to be instolled ore nol cove'red on the qbbrevi- oted sohedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Appliconl to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Building Division Sroff will prepore o typewritten copy ond return it to the opplicont ol the time the octuol permit is issued for his signoture' 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 permif is issued. V. FOR OFFICE USE ONLY PROJECT CONDTTIONS TO BE SAIISFIED BEFORE OCCUPANCY: Additional Proiect lnformotion: PLANS REVIEWED BY: nome signoture -->. * dole b I ENER,GY SOURCES: Heot - Woler Heoler -=--Ro Sq. Ftg. |{oin Sq. Ftg. Access. Sq. Ftg. Other -New-Add-Alter-Rep.--Fence-Demo-Chonge/ Use -Other legol Description ,' Volue of Work: # trrsOwner Address I )/,\ ./,..., /-lr, <t .1ft,-n"Building Permit lnfo: Describe Work (i.e., Build Single Fomily ResidencqWirh Attoched Goroqe) Le nder J Address Phone DESIGN TEAM (nome)(oddress)(lics.(expires)(phone no.) Structuro I Electricol Mechonicol rl I Plumbi Electricol Mechonicol PI.UMBING ETECTRICAT MECHANICAT NO.FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE /Eoch single fixture c?, r-t Residence of It. furnoce/burner to -BTU'S Relocoted building (new fix. odditionol) New circuits, olterotions or exiensions Applionce vent seporole S.F. Residence (l both)SERVICES Stotionory evop, coo ler Duplex (l borh) eoch Temporory Conslruclion Vent fon with sinEle duct Additionol borh Amps. Vent syslem oport from heoting or A.C. Woter service tl{echonicol exhoust hood ond duct Sewer Wood stove/heoter Storm Sewer FEEDERS Heot Pump Ampr Air hondler to 10,000 cFM Air hondler over 10,000 cFM ISSUANCE OF PERMIT TOTAL CHARGES 7 {t)TOTAI. CHARGES TOTAI. CHARGES WHERE STAIE tAW REQUIRES lhst thc Elcctricol work be done by the Elcctricol Conlroclor, th. clccricol portion of this permit shalt not bc votid until olcbel hos becn signcd by on Electricol Contraclor qnd ottcchad to the electricol ponel. I HAYE CAREFUILY EXAMINED the completed opplicotion for permit, ond do hereby certify thot oll informotion hereon is true ond correct, ond I further certify thot ony ond oll work performed sholl be done in occordonce with the Ordinonces of rhe City of Springfield ond the Lows of the Stote of Oregonpertoining to the work dercribed herin, ond rho, NO OCCUPANCY will be mode of ony structure without the permission of the Building ,Division. I furiiercertlfy lhot my registrotion with lhe Builder's Boord is in full force ond effect os required by ORS 701.055, rhot if axempt the bqsis for exemption. is noted heron. ond thot only subconlroctors ond employees who ore in complionce with ORS 7OI.055 will be used on this proiect. Bosis for Suilder's Boord exemption: NAME (pleose print)SIGNATURE .' ( 1,/DATE FOR OFFICE USE ONTY Zone -Type/Conrt. nils Sq. Ftg. lrloin x Volua x Yolue x...........=-Volue Fire Zone-Bedrooms occy Lood Sg. Ftg, Access Flood Ploin Storier-Occy Group-Sq. Frg. Orher- TOTAT YALUATION BUILDING PERI,{II Chorges ond Surchorges Plon Ck. Comm/lnd 65%/BldE Per Fee Systems Developmenl Chorqe (1.57o) Plon Ck. Res 30%/BldE Per Fee PTUMBING PERMIT Chorges ond Surchorges ----J*La-Fence Demo Totol Comb. Permit fr2 s'o ETECTRICAT PERMIT Chorges ond Surchorger Sidewolk A/C Povinq MECHANICAT PERMIT Chorges ond Surchorges Curb Cut TOTAT 4? so INSFECTION tINE 72&376r' CITY OF SPRINGFIEID COTBINAITON APPIICATION/PERiITI INFOR'$ATION TINE 72C3753 ?4 .- ^- D * 2i PERMIT VATIDATION Permit Clerk COMBINATION APPLICATION/Pt,.,vilT (CAP) l. Applicont to furnish A. Job Address B. Legol DescriPtion r.-gglPl-gjlox lot 100, Lone County Mop^Reference.IT 03 43 2. exfi;E-Lot I. Block 3, 2nd Addition to Springfield Eslotes C. Nome, etc. of owner ond construction lender D Energy Sources l. eiomple-heot/electricol ceiling/or forced oir gos 2. exo m-F]E-wo te rTEoiErzEGctri co l, o i solo r E.Sq I. 2. uore foologe or voluotion, etc. exom le-1250 sq foot house,500 sq. foot goroge new-lf oddition, checkexomnew P roiect, check etc. F. Building permit informotion: I. exoirPle-conslruct single fomily house with on otloched goroge Z. Jxomple-remodel existing goroge into fomily room 3. exomFle-convert single fomily residence into i6liEu?Ent (chonge of use) G. Volue of work os defined in Seclion 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Division. Stoff must be obte to contoct oppropriole Persons regording design informotion or iob site correclions, etc' ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the description portion 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 I. To conserve sPoce on the permit form the schedules hove been obbrevioted 2. lf the 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 relurn it to the opplicont ot ihe'ti-e 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 PROJECT CONDITIONS TO BE SAIISFIED BETORE OCCUPANCY: Additionol Proiect lnformolion: dotesignoturenome PLANS REVIEWED BY: INSPECIION LINE 72f-3769 cllt or SPRINGFI€Iu COMBI}.IATION APPTICA TION/ PERMIT INFORMAIION TINE 72G3753 Owner Legol Description iiesidence !VithFomiAdd ress 5 P-- Goro s_T _ NiutNq leBuildscribeDeWorkSi ngfo:uirl lJi erm Rcn 5q. Ftg. Other Sq. Ftg. Acces:. Volue of Work: Ei.IERGY SOURCES: Heot =.------ \{oler Heoter Sq. ilg. Moin # tros Orhe' __--.._.- -- New Add Alter-RcP' Fence ---Demo-Chonge/ Usa Addresr Phone (lics. no.)(oddres:)DESIGN TEAM no.)(ex pire(nome) , Electrico I Mechonicol MECHANICAT NO.CHARGE ETECTRICAT FEENO, PLUMBING CHARGEFEE furnoce/burner to ---BTU'T 9,5a Reridence of fr,Eoch sinqle fixtureI Applionce vent seporo le New circuits, qlterotions or extensions Relocoted building (new {ix. odditionql) Stotionory evop. coo lerSERVICES S.F. Residence (l both)Vent fon with single ductTemporory ConslructionDuplex (l both) eoch Vent sy3lem oport from heoting or A.C.Amps.Addirionol borh lvlechcnicol exhousl hood ond ductWqler:ervice Wood stove/ heoterSewer Heot PumpFEE DERSSlorm Sewer Air hondler to I0,000 cFMAmpr. Air hondlar over r 0,000 cFl,A ISSUANCE OT PERMIT TOTAL CHARGESTOTAT CHARGESTOTAT CHARGES electricol lhirof rho nolll untitbovolidrheElectricqlthepermitbeworkdoneCorlroclor,portionEle<tricol bythotrheEREWHA5TtAw,TE REQUIREs lhe electricolloondContro<lol punel.chedqitoElectricolqnhorlobelbeensignedby I HAVE CAREFUTIY EXAMINED the completed opplicotion for permit. ond do hereby certify thol. oll infomdtion hereon is lrue ond certify thot ony ond o1 *ort p"rfor-"i rholl ba done in ocordonce wilh the Ordinonces of rhe City of Springfield ond the Lowt pertoining to tire work described herin, ond thot No occupANcY will be mode of ony slructure without fhe permission of the Bui certlfy thot my regisrroiion wirh the Builder's Eoord is in full force ond effect os required by ORS 70I.055, ihot if exempl the bosis heron, ond rhot o-nly subcontrociors ond employees who qre in complionce with ORS 701.055 will be used on lhis proiect' correct, ond I furlher of the Stote of Oregon lding Division. I further for exemption is noted slNAME (pleose print) Bosis for Builder's Boord exenrption: oo.,, //-Jo-9 t FOR OFfICE USE ONI.Y Fire Zone-Bedrooms occy Lood Sq' Ftg' Access flood plcin Stories-Occy Group---Sg. Ftg' Other-- x ---Volue x Volue ; -Volue TOTAI, VATUATION Const.-Units --.---.-Sq' Ftg' MoinZone --...-- S)rstemr Development Chorqe (1.59l") Plon Ck. Comm/lnd 65%/Blds Per ree Plon Ck. Res 3O%i Blds Per fee BUITDING PERMIT Chorges ond Surchorges Fence fl t,toTotol Comb. PermitDemo PTUMBING PERMIT Chorges ond Surchorges Lrl- Sidewolk A/C Povins Chorges ond Surchorges ELECTR!CAL PERMIT Curb Cut TOTAL 4t sa MECHANICAT PERMIT Chorges ond Surchorger (i.e., ?.sD o .2i\ lr.Lll COMBINATION APPLICATION,/Pr- ./\4lT (CAP) l. Applicont to furnish A. Job Address B. Legol Descriptionl. exomple-tox lot 100, Lone County Mop Reference 2. exomple-Lot l. Block 3, 2nd Addition to Springfield C. Nome, elc. of owner ond construction lender D. Energy Sources City Holl Springfield, Oregon Deportment of public WorksOFFICTAT RECEIPT il0. B UTSS8 1 I ( r9 d r t-q I . exo mple-h"otl4S5lI."I3g{l rg /or f orced o i r gos 2. exo m ple-woter he6l6IEl-ect.i co l, "@E. Squore footoge or voluotion, etc.l. exomple-'l 250 sq. foot house, 500 sq. foot goroge 2. exomple-if new proiect, check new-if oddition, che ;da,;rc. F. Building permit informotion:I. exomple-construct single fomily house with on oll( goroge 2. exomple-remodel existing goroge into fomily roor 3. exqmpfe-convert single fomily residence into EiEiront (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Divi: Stoff must be oble to contocl oppropriote persons re( design infdrmotion or iob site corrections, etc, ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedule A. Except where blonk spoces occur in the description p of lhe Mechonicol ond Electricol Schedules, the oppli need fill-in only the No. Boxes odiocent to the oppro item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building DivisionI. To conserve spoce on the permit form the schedu hove been obbrevioted 2. lf the item(s) to be instolled ore not covered on tl oted schedules you should consult the full schedr" C. BUIIDING DIVISION STAFF WILL FILL OUT AtL FEES,. CHARGES ON THE SCHEDULES For 57 ( lr,o () (r (( (. ,oh 3Y Amounl Recei ved Permil Clerk aurxoitztD !ff a!tox.tuiiauLr ttttraaS . SIGNATURE tu6ENE Oi aTaot t ( lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Building Division Sroff will prepore o typewritten copy ond return it to the opplicont ot lhe time the octuol permit is issued for his signoture. 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 PROJECT CONDIIIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: signoturenome dote PLANS REVIEWED BY: /l-lrl tr ( I (