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Home My WebLink AboutPermit Plumbing 1981-03-02rNF{eTr . i-r.tNE 72{.J769 CIIY OT SPNINGTIETD COMBINATION APPTICATION / PERI\AIT INFORMAIION TINE 72(>37s3 OZ qtnJob Ro ENEN,GY SOURCES: Heot Woter Heoler De scription Owner - -New- -Add -Alter-Rep.- --Fence-Demo-Chonge/ Use Other Sq. Ftg. Moin Sq. Ftg. Acces3. Sq. Frg. Orher Address ne Building Permit lnfo: Describe Work (i.e., Build Single Volue of Work: chedFomi Phone Consfruction Address aa D, -H N DESIGN TEAM (nome)(lics. no.)(phone no.)(ex Pri col Mechonicol RACTORS Generol Electricol O Mechonicol PTUMBING EI.ECTRICAT MECHANICAL NO.FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE Eoch sinqle fixture Residence of -'-tq. ft. furnoce/burner to -----BTU'TRelocoled building (new Iix. odditionol) New circuils, olterotions or extensions Applionce vent seporqle S.F. Reridence (l both)SERVICES Stotionory evop. cooler Duplex (l both) eoch Temporory Conslruclion Vent fon with :ingle duct Additionol both Amps. Venl syslem oport from heoting or A.C. Woler rervice Mechonicol exhoust hood ond duct Sewer Wood stove/ heoter Slorm Sewer FEEDERS Heot Pump Ampr. Air hondler to 10,000 cFM Air hondler over 10,000 cFM ISSUANCE OF PERMIT WHERE STAIE tAw REQUIRES thot the Electricol work be done by thg Electricol Controctor. ,he clectricol porrion of this permit shsl not bc volid unrit olobel hqs been signed by on Elactricol Controctor and attochrd to the electricol ponel, I HAVE CAREFULTY EXAMINED the compleled opPlicotion for permit, ond do hereby certify ,hot oll informotion hereon is true qnd correct, ond I furthercertify thot ony ond oll work perforred sholl be done in qccordonce with the Ordinonces of the City of Springfield ond the Lows of ihe Stote of Oregonperfoining to lhe work de:cribed herin, ond thot NO OCCUPANCY will be mode of ony structure without the permirsion of the Building Division. I furthererlify rhot my registrotion wilh the Euilder's Eoord is in full fore ond effect os required by ORS 701.055, thot if exempt the bosis for exemption is notedheron, ond lhot only subconlroctors ond employees who ore in complionce wirh ORS 701,055 will be used on this prolecr. SIGNATURENAI'IE (pleose Bosir {or Builder's Eoord exemption: TOTAI. CHARGES TOTAT CHARGES TOTAI. CHARGES u\)FOR OFFICE UsE ONLY V \] Fire Zone-Bedrooms occy Lood Sq. Ftg. Access x Volue x Yo lue 1-Volue TOTAI. YATUATION. floodPloinSlorier-occyGroup-Sq.Frg.other- 5q. Ftg. MoinZone -Type/Const. -Units Plon Ck. Comm/lnd 65%/Bldg Per Fee Syslems Development Chorqe (1.5%) BUII.DING PERMIT Chorges ond Surchorges Plon Ck. Res 30%/Bldg Per Fee FenceChorges ond Surchorges PTUMBING PERMIT Demo Tolol Comb. Permit Sidewolk ELECTRICAT PERMIT Chorges ond Surchorges A/C Povino Curb Cut MECHANICAT PERMIT Chorges ond Surchorges TOTAL I DATE(3-a--6+ cc coMBINATTON AppLtcATrON/P. ArT (CAP) l. Appliconr. to furnish A. Job Address B. Legol DescriptionI. exomple-tox lot I00, tone County Mop Reference I7 03 43 2. eiomple-Lot I. Block 3, 2nd Addition to Springfield Estotes C. Nome, elc. of owner ond construclion lender D. Energy Sources I. exomple-heot/electricol ceiling/or forced oir gos 2. exo mFG-woterTEole-iEGctiiEo I 1 o, g- E. Squore footoge or voluqtion, elc. l. exomple-1250 sq. foot house, 500 sq. 2. exomple-if new proiect, check new-if sdd, etc. F. Building permit informotion: foot goroge oddition, check I. exomple-construc, single fomily house with on ottoche'l goroge 2. exomple-remodel existing goroge into fomily room 3. exorrlpl-e-convert single fomily residence into i6!tou,ront (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 conslruction deloys, Building Division Stoff must be oble to contoct oppropriote persons regording design informotion or iob sile 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 oppiicont 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 permit form the schedules ! hove been obbrevioted 2. lf the item(s) to be instolled ore nol covered on the obbrevi- . oled 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 iniliol 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 the fime the octuol permit is issued for his signqture. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicotion, ond no plons will be processed until lhese fees ore poid. All other fees ond chorges ore due ond poyoble when the permif is issued. V. FOR OFFICE USE ONTY PERMIT VATIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformolion: PLANS REVIEWED BY: nome signoture dote CIIY OF SPRINGFIETD COMBINAIION APPTICAIION / PEN TII tN'-ECil ,,a_uNE 72U3769 INFOIMATION tII{E 72L37s3 OZ qTn ENERGY SOURCES: Heot Woter Heoter -New-Add -Alter-Rep. -Fence-Demo-Chongei Use --.Other Sq. tr9. ^1oinSq. Ftg. Access, Sq. Ftg. Other Addrers Describe Work (i.e., Euild SingleBuilding Permit lnfo: Fo Re With Atto(hed Addrcrr Phone D -F. N DESIGN TEAM (oddress)(lics. no.)(nomc) Primo Sfructurql Electricol o Electricol Mechonicol PI.UMEING EI-ECTRICAT MECHANICAT FEE CIJARGE FEE CHARGE Eoch si fi xture Residence of fr, furnoce/burner lo Relocoted building fix. odditionol) New circuits, olterotions or exlension5 S.F. Residence both)SERVICES Applionce vent Stotionory evop coo ler both) cochDu Consiruclion 5t le duct Yent fon with Additionol both Am Vent syslem oport from or A.C.heoti Woler rervice hood Sewer Storm Sewer FEEDERS Pum t. Air hondler b crM Air hondler ovar I CFM ISSUANCE OF PER/IAII TOTAI. CHARGES TOIAT CHARGES WHERE STATE IAW REOUIRES thol ihe Electricol work be done by lha Electricol Contrsclot, thc Gl!(tricol portion of thir pGrmit shqll not be valid un$t clobel hor boen rigned by on Electricol Conlroctor ond ottqchad to the clcctricol ponal. TOTAT CHARGES I HAVE CAREFULI'Y EXAMINED the completed opplicotion for permit, ond do hereby cerlify thol oll informotion hereon is ,rue qnd correct, ond I furtherceriify thol ony ond oll work performed :holl be done in qccordonce with the Ordinonces of rhe City of Springfield qnd the Lows of the Stote of Oregon Pertoining to tha work dcscribed herin, ond thot NO OCCUPANCY will be mode of qny structure withou, the permirsion of rhe Euilding Division. I furr-hercertify thot my ragistrolion wirh thc Buildar's Boqrd ir in full fore ond effect os required by ORS 7O1.A55, ?hot if exempt the bosis for exemption is noted heron, ond lhot only rubcontrostorr ond employees who ore in complioncs with ORS 701.055 will be ured on thit proiecf. SIGNATURE .-(:'-*-r1NA-A{E (pleose Bosir for Builder's Eoord exemption: u\)FOR OFFICE UsE ONIY V \J fire Zonc-Bedroom: occy lood 5q. Ftg. Accesr Ftg. Other-x -Voluc TOTAI, VATUATION Sq. Flg. /vloinZone -Type/ Con:t. -Unils x Volue x ---YolueFlood Ploin -Storier-Occy Group (l .5"t1\ s DevelopmentI sy,r'- I cho.o" BUITDING PERMIT Chorges ond Surchorges Plon Ck. Comm/lnd Per Fee Plon Ck. Res Per Fee Totol Comb. Permit PTUMBING PERMIT Chorges ond Surchorge: o Demo Chorger ond Surchorger PERMIT c Sidewolk TOTAT MECHANICAT PERIilIT Curb CutChorges ond S urcho rg e r Volue of Work: NO NO-NO.FEE CHARGE sepo rote Mechonicol exhoust Wood stove/ hc.t". tb 4c COMBINATION APPLTCATTON/i-.,,tilT (CAp) l. Appliconl ro furnish A. Job Address B. Legol Descriptionl. exomple-tox_lot-l 00, Lone,County Mop Reference I7 03 432. exomple-Lot l. Block 3, 2nd Addition ro Springfield Esrore. CC. Nome, etc. of owner ond construction lender \ D.. Energy Sources PERMIT VALIDATION ITY OF SPRINGFIELD City Holl Springfield, Oregon Deportment of public Works OFFICIAI. RECEIPT I exomple-heotz"electricoI ceilinq/ ffi-m-E]E-woterTeo-IET6lEcTiiiol ! I { or forced oir 2.or so E. Squore footoge or voluotion, elc.I. exomp!e-1_250 sq. foot house, 500 sq. foot goroge 2. exomple-if new proiect, check new-if oddition, ch< (eaa;a; \ F. Building permit informorion: l. exomple-conslruct single fomily house with on ott ft goroge ( 2. exomple-remodel existirig goroge into fomily roo 3. exornple-convert single fomily residence into iEITowont (chonge of use) ( G. Volue of work os defined in Section 303 (o) of the Structurol Specio lty Code H. DESIGN TE,AM AND CONTRACTORS ( To ovoid design or construction deloys, Building Div \' Stoff must be oble to contoct oppropriote persons re design informotion or iob sire corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedul A. Except where blonk spoces occur in the description 1of the Mechonicol ond Electricol Schedules, the oppl need fill-in only the No. Boxes odiocent to the opprr 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 schedr. hove been obbrevioted 2. lf lhe item(s) to be instolled ore nol covered on t . oted schedules you should consult the full schedr C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be-used worksheet only. Where possible, Building Division Stof prepore o typewritten copy ond return it to the opplicr the time the octuol permit is issued for his signoiure. 5-z For I9 I{0. B I 55949 o r C ( ( (c ( ( (ltt OL Amounl Received BY AUTHORIZEO SIGdAIURE,,o 16 3[. AlV. Fees ond Chorges fPlon check fees ore due ond poyoble ot the time of th, \ ond no plons will be processed until lhese fees ore pok ,-.. other fees ond chorges ore due ond poyoble when the perm is issued. V. TOR OFFICE USE ONIY ir Permit CIerk ( ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: nclme signoture dote PTANS REVIEWED BY: - (