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Home My WebLink AboutPermit Plumbing 1980-06-17L CITY OF SPRINGFiELD COI{BI IIATI ON APPL I CATI ON/PERMIT 726-37 53 Job Address EIIERGY SOURCES Hea t Ran tg.n Sq. Ftg So. Ftg l,leur Access 0ther Add Al teF--Pep. - -Fe nce Demo Cha nge/ U se--bther /- r\\-I-/,-....-i If '- {- '-l.".-r>i 'J) l-ega1 Descripti Value of l,lork: 0wner Addres s tl - Phone Bu i ltli n Fami'l y q Permit Info: Describe l.lork(' Residence tiith Attached Garaqe .€., Build Single ( c"*t.r.tioI LhL." Addres s Phone DES I GN TEAI.I name addre s s (lics. no.l EXD']res phone no Pri ma i Structura I Electrical ! l'|ec ha n i ca I CONTRACTORS name a ddres s (lics. no.) (expires)ohone no. Ge 'al Pl umbi no El ectri cal l'1ec ha n i ca I ;I PLUIIB I NG ELECTR I CAL MECHANICAL; N0.FEE CHARGE NO FFF CHARGF Each si ngl e fi xture Residence of SQ. FT furnace/burner to ; BTU's I Relocated building (new fix. additional) New circuits alts or extensions Fl oor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal l Soace heat-pr and vent Duplex (l bath) each Additional bath Temporary Construction Apol iance vent seDa ra te \llater servi ce )(X)Change in existing res i dence Stat.i onary evap cool er Sewer multifamily, comm or Indrrstria l Vent fan with sinole duct- Storm Sewer 0f S. Vent system apart fram heatinq or A.C. coMr.r./lND. FEEDERS Mechanical exhaust hood and duct I nstal I /a1 ter/rel ocate di sfri h fppdprs l'Jood stove/heater 0f ISSUANCF OF PFR!{IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.v certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinancer of the Cityof Springfield and the Laws of the State of Oreqon oertaining to the work described herein, and that NC 0CCUPAIICY will be madeof any structure without the permission of the Building Division. I further certify that m.y reqistration vrith the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and ernoloyees who are in comcliance with 0l?S 701.055 vrill be used on this Dro,ject. I'lAl.lE(please pri nt)o 3a S I G|IATURE ,rE / */7-b FOIl OFFiCE USE Oi{LY Zone e/Const. Uni ts Sn Ftq. l4ai n x Val ue Fire Zone Bedrooms Load Ftg. Acces s X al ue Flood Plain Stories Gro Val ue i TOTAL VALUATTON i Ftg .0ther BUILDING PERI'IIT Charges and Su rc ha rges Plan Ck. Comm/Ind 65%/81dq Per Fee Svs Cha tems Deve rqe ( 1.5c opment Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surc ha rges Fence Dgrno ELECTRICT.L PERI!IT Charges and Surcl.i rges IIECHANICAL PERMIT Cl,.rges and Surc ha rges Si dewa I k A/C Paving Curb Cut Total Cornb. Fermit TOTAL \040 l.Jater Heater u FFF WHERE STATE L1l.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit shall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division COMBINATION APPLICATiON/PERMIT (CAP) I. Appl icant to furnishA. Job AddressB. Lega l Description I. example- Tax Lot 100, Lane County 17 03 432. example- Lot 1. BIock 3, 2nd Addit Springfield EstatesC. Name, etc. of owner and construction lD. Energy Sources l. examp]e- heat,/electricai ceiling/o2. example- waterheatei/elbttilca7orE, Square footage or valuation, etc. Map Reference ion to ender r forced qir gas sol ar 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition" check add, etc.F. Building permit informat'ion: j 1. example - construct single family house with an attached garage 2. example - remodel existing garage into liamily room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structura'l Specialty Code iH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc.IL Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere bjank spaces occur in the descriptionportion of the Mechanical and Eiectrical Schedules, the appiicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful'l Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult the ful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUI ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date Hhenever possible, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gna tu re.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. All other fees and charges are due andpayable when the perm'it is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s'l gna tu re da te ,l 1 Eil - erTY 0F SPRINGFIELD_- --COMBItIAiiON APPLICATION/PERMIT 726-3753 Job Address \--\ l-ega1 Description l.Jater Heater Ranqe Hea tEIIERGY SOURCES Ftg. l.lain-..-- Sq. Ftg. Access.-- Sq. Ftc. Other-_ l,leri Add AI ter P.eP. --T e n c e-O e mo-C h a n g e / U s e 0therVal ue of llork: Owner .€., Build SingleBui F arn h:it 'i nqvll Pernri t I nfo: Descri be l'lork ( ' esidence liith Attached l!I!-Sg-Address Phone\ terCons truc t i on Phoner\ddres s ohone no.rcs. no.exo.i resInameDESIGN TEAI1 Structura I Pri El ectri cal l'lechani ca I l ics. no.a ddres sNTn ame c.n""ut ,r -[U Plumbinq I i Electrical l'!echanigal ELECTRICALPLUIlB I IIG MECHAN I CAL FFF CHARGEFFFCHARGEN0- furnace/burner to BTLI ' S Residence of FTSQEach single fixture Fl oor furnace and vent New ci rcu i ts al ts or extensions Relocated building (new fix. additional) Recessed wal I Snacp heater and ventS ERV i CESS.F. Residence(t bath) Duplex (l bath) each Apol iance vent seDa ra teTemporary Constructi onAddi tional bath Stati onary evap cool er\D(X) res i dence Change i n exi sti ng \Uater service Vent fan with sinole ductIndustrial multifamily, comnn. orSewer Vent system apart frQm heatinq or A.C,0fStorm Sewer Mechanical exhaust hood and ductCOI.IN./IND. FEEDERS l'lood stove/heaterInsta I I /al ter/rel ocate disirih- feeders 0f amp s. ISSUAI'ICF OF PFRIlIT TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES WHERE STATE Lll.l REQUIRES that the Electrical work be done bv an Elec shall not be valil until the label has been signed by an Electrical Supe TE / */7-52SoIlAtlE(please print) : TOTAL VALUATION i Y Sq s (n Flood Plain S tori es Fire Zone Bedrooms Occy Load lue Group Sq trical Contractor, the electrical portion of this permit rvisor and returned to the Building Division 'fy f oni h Ire0n t eruherertihatatIIdonotrrnae'Ie1IdLco'I forn trmr aa ceFULLxAllENItheEDDCb.y fycomr)pl') I a of 'In'I cordancac \^J te t th 0rdhe n nc Ie the cnd1al/O rI k for rmed a I'I do nebe tyht+0ecrrecotnaIderfu rth rtce I handaf-v 1nndadLthf,l PAI,ICOCCU wl I mabe deonrtiaInthetorWOdesck'Ir hebed re'lf any of eiriIeandthedwsLa0ethStetaf0reqp gSpngf IItsIatr1Ll./ Ion tth Bu der s'I'lu dI I Di ,l S on fu tr h Cr rte 1 t ha he,IfStu retruc tw1 utho het rml Ss o'I ofn the m.ypengany a'It on I noteds reonhe th tandatht,l f e t the ba 'is fors empexORS05c7xempefcfeastureqred'I 0ndarcefUIIfonIIrdBoaby tvriIIu5be0nedthstrL505Ith70i?s 0 1 rojpn'I ubcos rnt toac rs and 1emD r,rhoS .Iare comD 'I ncea wlnoyev S IGiIATURE ValueZone Tyoe/Const Uni ts Ftg Ftg Val ue I . Ftg. l'lain Acce s 0ther Svsterls Development Charqe (1.5'.)Plan Ck. Comm/Ind 65?l/Bldo Per Fee Plan Ck. Res 30%/Bl dq Per Fee BUILDING PERTIIT Cltarges anC Su rcha rges FencePLUI4BING PERMIT Charges and Surc ha rges D6mo Sidewalk A/C Pavi ng Total Cor,:b. Permi t Curb Cut o40 ELECTRICAL PERI,:IT Charges and Surchz,rges IIECHAhICAL PERMIT Charges and Surc harge s TOTAL I nhonc noIACTORS ;I FFF .HAAGF COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. examole- Tax Lot 100, Lane County Map ReferenceI7--03-432. gegp.lS. Lot_I. Btock 3, 2nd Addition to + sprtngfield Estates9. Name, etc. of owner and construction lender0. Energy Sourcesl. examole-hea t/e l ectr i cei or ced airz. examc I e-E. squaiE-T6-ta h/a ea ter s e ec tr a or arge or valuat 0n h e 2 examo I e- exanrp I e- FFFaI--acld 1250 s 'I I new q. foot ouse,500 sq. foot s i arageproject, check new - if add tion, F. Bui ldi , etc ng permi t informa tion:gleTp]".- construct single family houseatlached garage with an 2 examo I e examc I e - remodel existing gara ge into family room3convert s ing of Ie famiI y res i dence .into res taurant c ha nge def i nr use)G. Value of work a S ed in Section 303 (a) of theStructural SpeciH. OESIGN TEAI.I AIID a l ty Code CONTRACTORS II To avoid design or.construction delays, BuildingDivision Staff must be abte t; .;;;;;; appropriatepersons.regarding design information or jbO iite--corrections, etc.Abbreviated Plunbino,. Mechanical, & Electrical SchedulesA. Except where utirir spaies-;;;r; i;-;;; des*iptionportion of the tlechanicai anO Sfeitri'caf Scfreiries,the appticant need fiil_in onri ii,e No. aor.r-JoJii.nt_ t0 the aporooriate item(s) to 6e -inrlitruo B. Fui I plurnbing, Mecnanicii, ira-Ef..iricai Schedulesare available at the Building D.ivisionI. To conserve space on the-permii iorm tne schedu.leshave been abbreviated2. II thS item(s) to be installed are not covered onthe abbreviated schedules yo, shorlO .rnrrit-iniful I schedul esC. BUILDI|IG OIVISION STAFF l,lILL FILL OUT ALL FEES AND. CHARGES OII IHE SCHEDULESD. As noted on the CAp, ah; label must be delivered to theelectrical contractor fo. sitnu[u". [, nr, e]ectrica.lsupervisor. The generar coniractor ii not authorized. .to sign the electrica.l IabelAppttcant to sign and dateHhenever possible, the initial appJication will be used asa.urorksheet only. l,Jhere possibl;', Buiidi;g D.ivision staffwil'l.preoare a type rvritten .opy-.rJ-..lrm it to theapplicant at the time the actrli pe"mii-is'isrr.o for hiss i gna ture. Fees and Charqes Plan.check feis are due and payable at the time of theapplication, and no prans wiit"b; ;.;;e;;Ja untit thesefees are paid. All other fees and .;;;;;;"u." due andPayable when the perm.it is issued. FOR OFFICE USE ONLY I . III. IV V PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: P e trmr a 'i c na EX+upp t r0mf re S'l rat Itemp Won tI hg t ch uB i ed r S rdBoa beca u eS Additional Project Information: PLANS REVIEWED BY: name da tes'l gna tu re PERMIT VALIDATION :ITY OF SPRINGFIETD Ciry Ho[ _ Springfield. Oregon Deportment of pubtic WorksOFFICIAT RECEIPT No. B S37U5 9 ved For: rnl Receiv ed AUTHORIZEO SHELTON.TU'N!U!! PRINTERS Permit Clerk SIGNATURE EUGEIE OR 974OI ( I I ( ( (