HomeMy WebLinkAboutPermit Plumbing 1981-05-14INSPECTION IINE
7763769
CITY OT SPRINGTIETD
COMEINAIICN APPIICATION / PERMII
INFOTAAATION tINE
72*7753
ENERGY SOURCES:
Heot
-
Sq. f ,9, Other
-New._-Add -Alter-ReP'- -[ence-Demo-Chonge/ Use
-Other
Rq
Woter Heoter
(\snel
Volue of Work:
ng Permit lnfo:
ArochedRe
Describe Work (i.e., Bui ld Single
Fomil
Bui\-n PhoneAddrerr
U
Addre rr Phone
(phone(expirer)(lics. no.)(o dd res r)DESIGN IEAM (nome)
Electricol
Machonicol
(nome no
Plumbinq (
Electrico I
+t
ETECTRICAT
FEE CHARGE
MECHANICAL
No.CHARGENO.I IEE
Mcchcnicol
PTUMBING
CHARGEr?l
furnoce/burner lo
---BTU'S
Re:iCene oi
-_:q:
fr.Eoch ringlc fixturc
NU.
Applionce vent
:eporq leNew <ircuils, olteroiionr
or exlen!ionsRelocoted building
(ncw {ir. odditionol)Stolionory evop.
coolerSERV ICESS.F. Reridenge
(l both)Vent fqn with
sinqle ductTemporory ConstructionI both) eochDuolex Vent system oPort from
heoting or A.C.Ampr.Acidilionol borh Mechonicol exhoust
hood ond duct
Woler tervi(e
Wood stove/ heoter
Scwer
Heot PumpFEEDERS
Air hondler to
r0,000 cFMAmpr.
Scwcr
Air hqndler over
10,000 cFM
TOTAT CHARGESTOTAT CHARGES
DATE
plon Ck. Comm/lnd
I
Zone TYPe/Conrt'
unrilYalid dthirnot:hsll beofContrsclcctricslthrpcrmilE!erlriccl clo?,porlior.bework dcnccol byElcctrinwUEOE5IRrhclhotsrWHERE,IEA tA'the pcnel.electricolloondctorottothedEl!Grrics Conlrononhorlsbalbcobyrig ned
correcl, ond
of the Stote
, of ony
req uireci
furtherndIhereoninformotionItuel3ollthorndohdolorcertiflerebyir,the ,leied pplicotion PermYETUt[EXATAINED c0mPHAECAR of OregonlheondLow sofiheofeOrdino nces Ciry Spri n9f ie ldrhwithtndoneocordqncebeshoIIIofklhqtqndpcrforrcd
^Y IDivision.furlhercertifyolihethenwithoutBuilding5tructurepermi:siodeIIDENOthotOCCUPANCYondc,work r(riixd herin,the,o I notedngtheexem:ls forbopertoini70rifrhqt ptionoRs.055,exemptbyeffectond5qfor cefulll5Boordlntherh8ui lder':thoi my rcAiinotioncertify bewill oured rhisn proiect.irh oRsronceowhoreomplondrubontroclor:emP ioyeesndthothero n,only
Syltems DeYeloPmenl
lssu{NcE oFTPERA\IT
IOTAL CHARGES
Bo:is for Builde/r Eoord excmPtion;
Fee
Fee
Plon Ck. Res
30"h1 sl
FOR OFFICE USE ONTY
SIGNATURE
BUI!DING PERMIT
Chorger ond
Surchorge:
* Volue
a Vo luc
a Volue
TOTAL VATUATION
Fira Zonc
-
Bedroomr
--------3"YFlood Ploin
-Slotict
O(GY
ls Sq' Flg' Moin
Lood Sq. Ftg. Access
Group-Sq- Ftg. Other
Fence
Totol Comb. P"l.!!-Demo
PI,UMBING PERMIT
Ghorges ond
Surchorger
ETECTRICAT PERMIT
Chorge: ond
5urchorger c
Sidewolk
d)
TOTAI
MECHANICAI. PERMIT
Chorger ond
S urcho rg e s
Curb Cut
rhe
NA,!{E (ploorc print)
6)
coMBINATION AppLtcATtoN,lpERMtT tsAp)
l. Appliconf to furnish
A. Job Address
B. Legol DescriptionI. exomple-tox lot 100, Lone County Mop Reference l7 03 432. e-fEmEiE-Lot I. Block 3, 2nd Additlon to Springfield Esrqres
C. Nome, etc. of owner ond construction lender
D. Energy Sources
l. exomple-heot/elecrricol ceiling/ or forced oir gost. exomote-woter heoter,. eleclricolz'or solor
E. Squore footoge or voluotion, etc.I. exomole-1250 sq. foot house,500 so. foot oorooe2. eEmFiE-i?;;w proiect, check new-ii odditi"on, cieck
odd, etc.
F. Building permit informorion:
l. exomple-construct single fomily house with on ottochedgoroge
2. exomple-remodel existing goroge inlo fomily room3. exfiFl-e-convert single fomily rlsidence into
restouront (chonge of use)
G. Volue of work os defined in Seciion 303 (o) of the
Structurol Speciolty Code
H. DESIGN TEAM,AND CONTRACTORS
To ovoid design or construction cieloys, Building Division
Stoff must be oble ,o contoct oppropriote p.rror,. regordingdesign informotion or iob site correclions, etc.
It. AbLievioted Plumbing, Mechonicol & Elecrricol Schedules
A. Except where blcnk spoces occur in the description portion
of the Mechonicol ond Electricol Schedules, the oppiicont
need fill-in only rhe No. Boxes odiocent to the oppropriote. item(s) ro be insrolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot rhe Building DivisionI. To conserve spoce on the permil form the schedules .:
hove been obbrevioted
2. lf the item(s) to be instolled qre not covered on the obbrevi-. oted schedules you should consull the full schedules
C. BUITDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dore
Whenever possible, the iniriol opplicotion will be used os oworksheet only. Where possible, Building Division Sroff willprepore o typewritten copy ond return it to the opplicont ot
the time the oouol permit is issued for his signotuie.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot rhe time of rhe opplicotion,ond no plons will be processed until these fees ore poid. altother fees ond chorges ore due ond poyoble when ihe permit
is issued.
V. FOR OFFICE USE ONIY
FeRmIr VALIDATIoN
Permit Clerk
PROJECT CCNDITIONS TO BE SATISFIED EEFORE OCCUPANCY:
(
Additional Pro[ect lnformorion:
nome signolure dote
PLANS REVIEWED BY:
INSPECIION IINE
726316?
DESIGN I€AM
CITY Of SPRINGTIETD
COMsINATICN APPTICATION /PERMII
(oddresr)
INfONMAIION tINE
72(h3753
a)
(lics. no.)(ex (phonc(nomc)
tion
Addre::
tegol De
-New -Add -Alrcr -ReP.
-.. -Fence -Demo-Chong.f
Ura
ENERGY SOURCESI
-Other
Woter Heoler
Sq. Ftg. Moin
t{eo t
-
Sq. Ftg. Accett.
Sq. Frs. Orher
Volue of Worl:
Attoched
Dercribe Work (i.e.,8uild SingBuildinq Permil lnfo'
Fc mi\!'\PhoneAddres
Addra rr Phone
uan!tot
Plumbinq
Electricol
+t
EI.ECTRICAL
Alcchcnicol
PI,UA{8ING
rsE CHARGEc!'t^RGEi FEs
furnoGe/burner to
-BTU'S
Re:iCance of
Eo<h :inqlc {ixturc Appiionce venl
5eporq te
New circuiir, ollerotioni
or exieniiontRelocqted building
(new fir. odditionol)Stolionory evop.
coolerSERV ICES
S.F. Reridence
(l both)Vent fon with
single ductTemporory ConrlruciionDuolcx (l both) coch Vent 5yrrem oport from
heoring or A.C.Ampr.Aciditionol borh I
Mechonicol exhouil
hood qnd ductWoler service
Wood rtove/ heoter
Scwcr
Heol PumpFEED ER5Sbr.m Sa-ar Air hondler to
r0,000 cFAiAmpr.
Air hondler over
10,000 cFM
rssuANcE otrPERAtlT
TOIAL CHARGESTOTAL CHARGES
SIGNATURE DATE
(
correct, ond I
of the Stote of
of ony
requireci
ond Itu r therttuehereont3informotionollthstonddocerlifyforEolionh arebylheletedprrmit,Y EXAA{INED comP oP PliIVEHACARETUTT'ond LowsofncellheoflherhnoCitySpringf ie ldlheOrdicordceontnbcdonaolIkrhollcerlilhoqndpcr{orrcdonyly IDivision.
Oregon
furtherthethoutrm I ttto n iheolPe Building3truGturedemooewill'ANCYNOOCCUPondihollorhckhcrin,dcrcriixdpcrtoining notedittheforbosisIterem70roRsthoption.055,PtexemoeffeclbylorendtsBoordful IlnthcwithBui lCer':thot i:iotionmyre9c!tlit,l rhi 3RS701Iwilured pror ie ct.be,h oorewhotncomplionccondcmpioyec:sub6nt?ostottond,hot onlyhcron,
orhirofrhalivalidnotborleclricolthrIElcriricoonlroctoT.portiorr permilcbsdcnclheworkElectricolbyu,EO ESIR lhcrholst,WHETE IEA LA'nel.thc alcaricollo PooltochcdondEhctri(s Conlro clorbcrnncdonhor!is b,1lqbcl
NAME (ploorc print)
Bosir for Builda/r Boord cxcmplion:
TOTAT CHARGES
1 Voluc
r Voluc
1-Voluc
TOTAL VAIUATION
FOR OFTICE USE ONI.Y
Fira Zone-&droomr
Zone
-Typc/Conrl.
Unilr 5q' Frg' /rloin
ccy Grovp-Sq. Ftg. Other_-
Lood Sq. Ftg- Accels
flood Plqin --------Jtorier O
Syrtemt DevcloPment
Chorqc (l'5?i)Pton Ck. Comm/lnd
65211 Bldo ?et Fe.
Plon Ck. Rer
3oo,/o/ Bldq Per fee
BUITOING PERMIT
Chorger ond
Surchorgc r
Fence
Totol Comb. PermitDemo
Chorge: ond
S u rcho rgc r
PTUMBING PERMIT
Sidewolk
l/C Pov;nq
Chorger ond
5urchorger
ELECTRICAT PERMIT
Curb Cut cx)
TOTAL
ATECHANICAI PERMIT
ChorEcr ond
S urcho rE e r
Mechonicol
no
S (nomc)le
MECHANICAL
NO.FEC
(
n.]
NO. I
unlil
@\C\,
/6)
I
:
.
,
Additional project lnformorion:
signolurenome ),ole
PTANS REVIEWED BY:
{
Td
.it4I
coM8tNATION AppUcATtoN,'pER,i]--T (CAp)
l. Appliconr lo furnish
A. Job Address
B. Legol Descriptionl. exomole-roxlor.lOp,^Lole.Counry Mop Reference IZ 03 43
_ 2: eE;F6-Lor t. Block 3, 2.d AJJiri"n to Sprinsfietd EsroresC. Nome, etc. of owner ond construction lenderD. Energy Sourcesl' exomole-h""/_...,9$-ling /or forc.ed oir gos2. ;E;;i-E-wo rer heorer/ elecrri co l,,,or solo rE. Squore footoge or rolrorioillI]_l. exomole-l 250 sg. foot house, 500 sq. foot goroge2. eioF;E-iG;w proieo, .1.,".[ ""*-if oddirion, checkodd, erc.
F. Building permit informorion:I. exomole-construc, single fomily house with on ottcgoroge
2. exomole-remodel existing goroge into fomily roon3. Exo,"nFj-e-converr ,ingle fJr;ily residence into- reslouront (chonge of use)
G. Volue of work os defined in Section 303 (o) of theStructurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction cleloys, Building DivisiStoff musr be oble to contoc, opp.opriot. p.rro-r,. .ug,designinformo'ionoriobsiteco.rrec,ions.etc.
ll. Abbieviored plumbing, Mechonicol & Electricol SchedulesA. Excepr where brcnk spoces occur in the descriprion ooof rhe Mechonicol onci Electricol S.hedules,;:;;;il
need fill-in only rhe No. Boxes od[ocent t" th" ";;;;;. item(s) ro be insrolled
B. Full Plumbing, Mechonicol, ond Electricol Schedulesore ovoiloble ot rhe Building Divisionl. To conserve spoce on thJpermii form the schedulehove been obbrevioted2. lf the irem(s) to be insrolled ore not covered on the. oted schedules 7ou should consult the full *t;;i;C. BUILDING DIVISION STAFF WILL FILI. OUT AtL FEES A}CHARGES ON THE SCHEDULES
lll. Appliconr to sign ond dote
Whenever possible. the iniriol opplicotion will be used osworksheer only. Where possible, building Division Stoff ,,rprepore o typewriilen copy ond return it to the opplicontthe lime rhe oouol permii is issued f"i f,i" ,ig."il;.'--"'
tV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the orond no plons will be processed inril rhese i;;;';;td-orher fees ond chorges ore due "na p"ytbtu;;;; fi;;.is irsued.
V. FOR OFFICE USE ONLY
-PER/\flIT VALIDATION
r- CITY OF SPRINGFIELD
City Holl
Springfield, Oregon
Deportment of public WorksOFFICtAt RECEIPT
llo. B 5EjlSg
Address tc n I c.tr\
For:
Amount Recei'
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f'
C)
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e (rPROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPA AUTHORIZEO
.TUiX.ULL
'iIXIEiS
. EUGEN€ Oi 9,.OI
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