HomeMy WebLinkAboutPermit Plumbing 1983-10-12Lx* 7<s<€,+->?6->66>
iirsPEcTtOt,l LillE
7?6-37 69
CIiY (]F SPRIi{GFIELD
COIIBIiIATION APPL ICATION/PERMIT
INFORIIATION LiIIE
726-3753
EIIERGY SOURCES:
ueaT€1PO. Dl:e72.
l.later Hea ter Sq. Fto. Other_
-f'lew
AddJlfer-P-e,. -
_Fence_Demo Change/Use
ntho"-
'it I scr
5d
nc.
I
1n
e.,ng
Val ue of tlork i
Ranoe
l,lo rk
Ga
Sq. Ftg. Access._
Phone j"rr i,'7'
6/
-&
Owner
/#3/-
Job Address oc
l-eqal Description
/rysz.c^ AFF/<e. / ,,7* ,?a*s
Construction Lender .4t €rts zzt., a [4zz a>ro us F
Bat Dt*--, b? Vn€f,4ap,
hw
^,(dl
s
Addre s s Phone
name address exni res ohone no.
Pri ma
E l ectri cal
Hecha ni ca I
CONTRACTORS n ame addres s lics- no-'FYN 1 TPq ohone no.
Genera I
P >4.J
,/
nl
El ectrica l
PLUIlB I IIG ELECTR I CAL MECHANICAL
N0-FFF CHARGE NO FFF CHARGF l.l r FFF .HA PGtr
q Each single fixture fn ?Q"furnace/burner to
BTU' s
I
/FRelocated building
(new fix. additional)
New circuits alts.
or extensions2 anDtan e
Floor furnace
and vent
S. F. Pesidence(l bath)SERV I CES Recessed wal l
Snarp hpaier and vpnl
0uplex (1 bath) each
Addi tional bath Tempora ry Constructi on Apol iance vent
seoa rate
llater service Change in existing
rpc i dcnre
Stationary evap.
cool er
9o'tSewer /Q,^multifamily, conrn. or
I ndustri a I z Vent fan with
sinole duct 7'e*
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
COI4H./IND. FEEDERS Mechanical exhaust
hood and duct
Instal i /al ter/relocatedistrit)- fpeders lJood stove/heater
0f ampr
tls'UA$effif-FRtltT-
WHERE STATE LAN REQUIRES that the Electrical work be done byshall not be valil untiI the label has been signed by an Electri,
an Electrical Contractor, the electrical portion of this perr,rit
cal Supervisor and returned to the Building Division
ct5TOTAL CHARGES e TOTAL CHARGES TOTAL CHARGES
Il/U.lE(please print)I GiIATURE r4//ekl
for oermit
pe rfo rmed
and enrnlfe(
and f5r
the
i HAVE CAREFULLY EXAMINED the completed apnlication , and do hereb.y certi fy that alI infocorrect, and I further certi that any and all work
State of Oreoon oerta
shall be done in accordance with theof Springfield and the Lavrs of 'ining to the work described herein, and that tl0of any s
Board i s
tructure without the permission of the Builbinin full force and effect as requirsd by ORS 7
g Division. I further certify that my registrati
01.055, that if exemDt the basis for exemption isonly subcontractors oyees who are in comcli ance with ORS 701.055 will be used on this r;roject.F*n tz Y 7q6 ^a ?f"7
rmation hereon is true
Ordinances of the City
0CCUPAI'ICY will be made
on vrith the Builder's
noted hereon, and that
I
PIan Ck. Conrn/lnd
657,/B1dq Per Fee 6.do'Svstems Deve
charqe (1.52 opment /9-,4.EUILDIIIG PERI,IIT
Charges anC
S u rc ha rges Plan Ck. Res
307./B'ldq Per Fee
oo
S
OrFlood Plain
-
S tori es '\
its \
c)e>c.y Group.R-
Fire Zone - Bedrooms -l- -Occy Load
. l'lainq. Ftg
\ l?A-her Value ?
t
. Ftg. Acces
TOTAL VALUATI ct>
lue
13. s>
FencePLUi4BING PERMIT
Charges and
Surcha rges
-a
.?6 Demo
Si dewa I k t$.i,xr\prl Phnck +" f.. 5AELECTRICAL PERI:IT
Charges and
Surcha rges
___/o-
4,6 Tota'l Cornb. Permi tA/C Pavi ng
Curb CutI,IECHAIIICAL PERMIT
Charges and
Surc ha r9e s
G,/o
76 iOTAL *\ot 'to
br{ tLAI.!
I
Residence of
sQ. FT.
I \tv
COHEII{ATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description ' .l. glaT?lg: Tax Lot 100, Lane County Map Referenceli 03 43?. example- Lot l. Block 3, Znd Addition to
SETin-E-fi el d Esta resq. ilame, etc. of orner and construction lender0. Energy Sources
I examole- heat/electrical ceil inq/o
examo I e- wa terFEI'@EEEEI ci]Toruare footage or valuati6il-EE-
r forced air gas
2 sol arE. sq
I examole- 1250 so
examole- if newE[iEI-Tod, etc.
foot house, !0-0 sq. foot 9a ra 9e
?.project, check-new -if addition,
II.
F. Buitding permit information:1. g3rnp.!S. - construct single family house with ana1;tached qar,rge
?. example --rem6del existing garage into family roomJ. €xam!te - convert single family residence intoEGIiint (chanse of -use)
G. Value of work aj defined in Section 303 (a) of the. Structural Specialty CodeH. DESIGN TEAI.I AND CON1RACIORS
To avoid design or construction delays, BuildingDivision Staff must be able to contalt appropriitepersons.regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanica'l, & Electrica.l SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adji6ent_ to the appropriate item(s) to 6e installedB. Full Plumbing, Mechanicil, and Electrical Schedu.lesare available at the Building Division1. To conserve space on the-permit form the schedu.leshave been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consu.lt theful'l schedul esC. BUILDING DIVISION STAFF I.JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricai -
supervisor. The general conlractor ii.not authorizedto sign the electrical labelApp'licant to sign and date
I'lhenever possibie, the initial application wil.l be used asa.worksheet only. IJhere possibtb, su;lding Divisr.on itaiiwril.prepare a type written copy and return it to theapplicant at the time the actuai permit is issueO io" fris
s i gna ture .
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiil-be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III.
IV
v
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
PERMIT VALIDATION
Permit Clerk
,1flV
fi?
l'{ }@
h{"
Permit applicant exempt from registration with the Builder's Board because:
A
Additional Project Information :t2
\\.\(1
PLANS REVIEWED BY:
s'l gnatu r date \C\Z\-e6\