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Home My WebLink AboutPermit Plumbing 1981-02-02INSPECIION I.INE 72C3769 CIIY OF sPRINGfIETD COIABINAIION APPTTCATION/PERA{II iloN UNE oa Ootr,C t,IJ CDescriplion ENERGY SOURCESI Sq. Ftg. Accesr.Heot Woter Heoler Sq. Ftg. Orher -New--Add-Alter-ReP. -Fence--Demo-Cho nge/ UreVolue I Owner ,-0'. Address C Phone ,Jlldlrg P"r"rlt lrf"' D"r.,b" Work (i.e., Build Singla Fomily Reridence With Arloched Goroge) ,r ucrion tY I (.-)U Addre sr Phone DESIGN TEAM (nome)(oddress)(lics. no.)(expires)(phone no.) Electricol I nerol Plumbi Electricol Mechonicol PIUMBING ETECTRICAT MECHANICAL NO.FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE Eoch single fixture Residence of furnoce/burner lo_--.-BTU'S Relocoted building (new fix, odditionol) New circuits, olterolions or exlansions Applionce vent sepq rqre s.F (l Residence both)SERVICES Slotionory evop. <ooler Duplex (l both) eoch Temporory Consiruclion Vent fon with single ducl Additionol both Amps. Vent syslem oport from heoting or A.C. Woler service Mechonicol exhqusl hood ond ducr Sewer Wood stove/heoter Slorm Sewer Ampr. Hqq! Pump Air hondler to I0,000 crM Air hondler over 10,000 cFM ISSUANCE OF PER',TIT TOTAI CHARGES TOIAT CHARGES TOTAI CHARGES WHERE STAIE tAw REQUIRES thot th.Eleclricol work be done by rhe Electricol Conlroctor,rha cleclricol portion of thislobalhqsbenbyqnEloctricolContrsCToTordottochedthoelectricol permit sholl nof ba volid until otoPonel. HA VE CAREFU u"Y EX IN ED the comple ted oppli cqtion for permit,ond do h ereby certi{.y thot oll nformo tio hereoncertify thot ony ond o pertoining to the work I work performed sho il be done n s ,r ue ond correct ond furlhertnoccordoncewithrhOrdinoncesoftheCityofSpringfieldondtheLowoftheStoteofOregondeSCrtbedherin,ond thol NO OCCUPANCY will be msde of ony structure nd effect os required by ORS s erllly thot i slro tion wilh the Euilder's Boord without the permission of ihe Buildi n9 Division.I furthe ( hero n, my reg tt tn ful I force a 70 .055,tho t if exempt the bosis for exemption notedondthoonlySUbcon tro ctors o nd ore tn with oRs 701 .0s5 will be *d this rs U on proiect. Bosis for Builder's Eoord exemption:/'. NAI{E (pleose prinr)SIGNATURE &-. DATE FOR OFTICE USE ONTY Zone Fire Zone.- .Type/ Const. -So.Ftg. Moin x Volua x --Yoluex -Yolua Bedrooms Occy Lood So Ftg. Access Flood Ploin Stories Occy Group Sq: Ftg. Other TOTAT VATUATION BUIIDING PERMIT Chorges ond Surchorges Plon Ck.Comm/ lnd ?er Plon Ck. Re: 3O/"1 Per fee Syslem s Chorqe Development (1.5%\ fnr -tlPTUMBING PERMIT Chorges ond Surchorges Demo [r.]e^ Totol Comb. PermiiPERMIT Chorger ond Surchorges Sidewolk MECHANICAT PERA,IIT Chorges ond Surcho rges Curb Cut TOTAT t(0 ttD Moin ---).'Itl FEEOERS :igned \OCT?Fence A/C Po"i^. - . PERMIT VALIDAIION Permit Clerk COMBINATION .APPTICATION/PI l. Appliconr to furnish A. Job Address B. Legol Description (cAP) or forced oir gos l. exomple-toxlot .l 00,-Lone County Mop Reference .l 7 03 432. exomple-Lot l. Block 3, 2nd Addiiion ro Springfield EstoresC. Nome, etc. of owner ond construction lenderD. Energy Sources 't 2 exom le-heot exom or solor E. Squore fooroge o. rolrotion]Jl- foot goroge oddition, check L exomple-construct single fomily house wilh on ottoched goroge 2. q."lplq-remodel existinq goroge into fo:nily room 3. exompG-convert single fornily residence into E!I6wont (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structuro I Speciolty Code H. DESIGN TEAM AND CONTRACTCRS To ovoid design or construction deloys, Building Division Sloff must be oble to contoc, oppropriole persons regording design informotion or iob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the description portion of the Mechonicol ond Eleclricol Schedules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriote 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 not covered on the obbrevi- . oted schedules you should consull the 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 typewritlen 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 lime 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 CONDIIIONS IO BE SATISFIED BEFORE OCCUPANCY: l. exomple-l 250 sq. foor house, 500 sq.2. exEmFle-iT-i-ew proiecr, check nE-w-ii odd, erc. F. Building permit informotion: Additionel Proiect lnformotion: PLANS REVIEWED BY: signolure dotenome CIIY O' SPNINGFIETD COTABINATION APPTICATION / PERfrIII INFORAIA'ION udetst tINEINSPECIION TINE 72U376i oa Cctr,C Addresr \h ENERGY SOURCES:Moin Heot 5q. Frg. Accerr. Woter Heoler Sq. Ftg. Olher -New --Add-Alter-ReP. -Fence --Demo-Chonge/ Ure Ron Yolue ther Owner t^,,\U\ Address Q yc So, ' dzi- Phon" /fg ZSzl ffie work (i.e., Build Single Fomily Residence With Aroched Goroge) Construction lender tY ;..Y ( Addrcsr Phone DESIGN TEAM (nome)(oddre (lics. no.) Primory Slruclurol Electricol Mechonicol CONTRACTORS (nome)(oddre:s)(lics. no.)(expires)(phone no.) Plumbinq Eleclrico I Mechonicol PIUMBING ETECTRICAT MECHANICAL No. I FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE Eoch single fixture Residence of -sq. ft. furnoce/burner to ,z Relocoted building (new {ix. oddirionol) New circuifr, olterotions or exlensions Applionca vent sepo rqle S.F. Reridence (l both)SERVICES Stotionory evop. cooler Duolex (l both) eoch Temporory Conslruciion Vent fon with single duct Additionol both Amps. Yent sysiem oport from heoting or A.C. Woier service Mechonicol exhousl hood ond duct Sewer 'Wood stove/ heoter Storm Sewar TEEDERS Amor. Heot Pump Air hondler lo I0,000 cFM Air hondler over 10,000 cFM ISSUANCE OF PERMIT TOTAT CHARGES TOTAT CHARGES TOTAT CHARGES WHERE SIAIE tAW REQUIRES rhor thc Electricol work be done by the Eleciricol Contrqclot, tha clectricol portion of this permit tholl not bc volid until o lobcl hor been signed by on Elcctricol Coniroctor ond ottochcd to the elcclricol ponel. HA,VE CAREFUL['Y EXAMINED rhe completed rmed shsll pplicotion for permit,ond do hereby certify lhot oll inform otion hereon t3 lrue nd correct,ond further cerlify thot ny ond lt k perfo be done I o ccordq nce ih the Ordinonces of the ci tl of Springfield and the lqws of the Stote of Oregon pertoining lo lhe work dercribed herin, ond ihot NO OCCUPANC'Y will be mode of ony slructure ond gffect os required by ORS without lhe Pe rmt5slon of the Building Division,further certlfy thot my regirtrotion with the Builder's Boord t5 tn fu force 70 .055,thot rl exempl the bo sis lo f exemption ts noted hero n,ond thot only subcqntroctors ond ore n NG with oRs 701 .055 will be u*d on this proiect. Bocis for Builder's Boord excmption: NAr\AE (pleose print) SIGNATURE *-/DATE FOR OTTICE UsE ONTY Zone -Type/Consr.-Units ---.---Sq. Ftg. Moin x Vqlue 1------V6lue x -Volue Fire Zons-Be drooms occy lood So Ftg, Access Flood Ploin Storie:-Occy Group-Sq: Flg' Olher IOTAT VATUATION BUITOING PERMIT Chorgcr ond Surchorges Plqn Ck. Commf lnd 6596/Bldq Per Fee Systems Development Chorse (l .5%) Plon Ck. Res 3oolo/8ldq Per Fee Act r1 PI.UMBING PERMIT Chorge: ond Surchorges @ Fe nce sh^:€-r-.tcr).oc Demo Tolol Comb. Permit PERMIT Chorger ond Surchorges Sidewolk A/C Povinq MECHANICAL PERMIT Chorges ond Surchorge: Curb Cut TOTAT ttC Lto L1 (expires)(phone no.) COMBINATION APPTICATION/F !. Applicont to furnish A. Job Addre.s B. legol Description PERMIT VAI.IDATION ITY OF SPRINGFIELD I (CAP) I. exomp]s-rox lot I00, Lone County Mop Reference l7 03 432. exomplC-Lot l. Block 3, 2nd Addiii"n'ilspringfield EsroresNome, etc. of owner ond construclion lender .Energy Sources / Ll. exomple-heot,/electricol ceiling /,or forced oir gos2. e-x o mElE-w o re. I?E rE,l-EE#=ri - r I. r;#-- Squore footoge or roluotioil[._ ,I. exomPlg-l=219 tq. foor house, 500 sq. foor gorogr "l. ex.qmple-if new proiect, check new-if oddition, chodd, erc. F. Building permit informotion:I. exomple-construc, single fomily house with on ott,goroge 2. exomple-remodel existirrg goroge inlo fomily roona. exompte-convert single fir;ily r"esidence intJ rGEEITEnr (chonge o] use) G. Volue of work os defined in Section 303 (o) of theStructurol Speciolty Code H. DESIGN TEAM AND CONTRACTCRS To o-void design or construction deloys, Building DivisicSroff musl ba oble to contoct opprop.iot. p"..o-n, ."godesigninformo?ionoriobsitecorrections,elc' ll. Abbrevioted Plumbing, Mechonicol & Electricol SchedulesA. Except where blonk spoces occur in the description oortiof lhe Mechonicol ond Electricol Scheciules, th; ";pi;;;need fill-in only the No. Boxes od[ocent t"ii,. "ppirpriiitem(s) to be insrolled B. Full Plumbing, Mechonicol, ond Electricol Schedulesore ovoiloble ot rhe Building DivisionI. To conserve spoce on the permit form the scheduleshove been obbrevioted2. lf the item(s) to be instolled ore not covered on the ob,. ored schedules you should consult the full schedulesC. BUILDING DIVISION STAFF WILT FILL OUT ALL FEES ANDCHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os oworksheer only. Where possible, 'Building Division Sroff willprepore o, typewritten copy ond return it to the oppliconl otthe ,ime the oouol permit is issued for his signoruie. lV. Fees ond Chorges Plon check fees ore due qnd poyoble ot the time of the opplicoond no plons will be processed unril these f"., or" ooia. iI - other fees ond chorges ore due ond poyoble *i.i if.,. p"r.itis issued. - r --""' l-- V. FOR OFFICE USE ONLY c D E. Ci[ Holl Sorinqlield, Oregon o"oJl."-tt ol Public Works--6rFtclAt REcEIPT No. B ( ved For 55725 CD 9 \,(t ( il ( QS ( I ( t Recei ved !AGLIOi'TUNfl EUL! PRIiTEi9 5IGN ATU R E EUoETE OR 97AOI-( ( Permit Clerk PROJECT CONDITTONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: nome signolure dole PLANS REVIEWED BY: t ( (