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HomeMy WebLinkAboutPermit Plumbing 1980-01-26lusprcircl iEt,D-_. -_726-37 69 --..- COIIBI',{ATIOI'I APPLICATIOi{IPERMIT iNFORIIATION LiNE itb-Jt5l --{ \, Yl/nUI Job Address iiIERGY SOURCES Hea t l,later Heater Ranqe Sq. Fto. l'lain_ Sq. Ftg. Access._ So. Ftg. 0ther-- Jlew_=.AddJl te r_Pep . _Fence_Demo Change,/Use 0ther l-ega1 Description \ Val ue of l'lork: 0wner Address Phone DU I Fan 'I dinilv o Pernri t I nfo: Descri be l'lork ( llesidence l'Jith Attached Garage :e., Build Sin_qie ? ),La{-na ,isl zx+s C";t"*t,il Lender Addres s Phone DESIGN TEAII name address (lics. no.exDl res no Primary Struc*,ura I El ec tri ca'l l''lechanicai CCIIiRACTCRS naiire address i I ics. no.pYnt rPs i (nhone no- ) Cener^a i ?l unbinq 8t trn cf- ilectrical Iechanical PLUIIB I iiG ILECTR I CAL I.,IECIiAN I CAL i tJO -I FFE i CHAPGE l:0.FFF I C}lARG: ii::ci srn0le |rxiure irii! Residence cf in E- furnacelburner to BTLI' s I Reiocaterj bui id ing (new fix. additjonal ) New ci rcui ts al ts or extensions Fl oor furnace and vent l I S-i. iesrdence(l oatn)S ERV I CES Recessed r*al i Soat:e heater and vent 0up1ex (1 bath) each Addi tional bath Tempora ry Constructi on Apoi iance vent seDarate j I irJater:ervice Change i n exi sti ng rps.i darrce Stationary evap cooi er Sewer multifamily, comnn. or Tndrrst-rial Vent fan with sinole ciuct Storn Sewer 0f Vent system epart from heatino or A.C. I COi4I'I./IND. FEEDERS iilechanical exhaust hnod and duct- Instal I /a I ter/re i ocate I I Idistrih. fFcders l'Jood stove/heater 0f amps -T I i I I I ISSUANCT OF PFRIlIT TOTAL CI{ARGES TOTAL CHARGES TOTAL CI]ARGES x"HEilE STATE L{,.1 REQUIRSS that the Electrical r.rork shall not be valil until the label has been signed by be do an El ne by an Electrical Contractor, the e.lectrical portion-of this perriit ectrlcal Supervisor and returned to the Building Di.vision the com0 I e a pp C dL i n for Derm t an o d 0 he reb.y rt i fy tha f a I I j nfo rna a i on h e i S rue a nd co rrec t o nd fu rt he r cert '1 fy tha t a ny a n0 a I I l^rO r k oe rfro rmed ha I I be d one I n acc0r da nc wi th the 0rd i na es of the ci ty r'l bed here i nd th t t'l c OCC UPANC Y W1 1 I be madefSor'i ngil e I d a nd the Laws of the 5 ta te of 0re g on DE rta 'l n 1 ng to the wo rK d e s C n a a of any re w'i thou t the perm s1 o n of th e u.i I d 'I ng D 1 vr on i fu rt he r cer ri fy th d t rn.y reg I tra t I on vn th the Bu '|I der S Eoard S i n rU I 1I fo rce and e ffec t as req u i red by ORS 7 U3 5 tha t 'I I exemp t t he ud5 i fo r exemD t i on 'I s not ed he reon a nd tha t on I -v subco ntr'acto rs and emD I oyee s who a re I n c0m I ,i a nc e wl +k 0i?s 7 n 05 5 be U sed o n rh .I S pro.j CC I iC rcr /-26- fAl.lAl,1E(please orint R IGiiATU FF Zone T'Yoer'Con s t Uni ts 5q 5q . Ftq . Ftg . Ftg l'la i n x Value Fi re Zone Bed rooms Load . Access .0ther al Flood Plain Stories Group 5q X Value TOTAL VALUATION BUILDING PERI.IIT Charges and Surcharges P.l an Ck. Comm/ Ind 65%/81dq Per Fee Svsteiis Develocment clarqe (1.51) Plan Ck. Res 30iilBldg Per Fee PLUI4BING PERMiT Charges and Surcha rges tn Fence Demo ELECTRICA,L PERI|IT Charges and Surcha rges Sidewalk A/C Pav i ng Curb Cut TotaI Comb. Permit iIECHANICAL PERI,IiT Charges and Surc ha rges TC|TAL !t 1r rtl (1{'l )A ( nI S I /n 4r+/ e/- lel COMBINATION APPLICATION/PEPJ4IT (CAP) I. Applicant to furn.ishA. Job AddressB. Legal Descrjption1. exarnole- Tax Lot 100, Lane County Map ReferenceITTT": PERMIT VALIDATION CITY OF SPRINGFIELD 2. elslple- Lot 1. Block 3, Znd Addition toSEFI;!--rr'etd Estates 9. Name, etc. of owner and construction lender,D. Energy Sources I. examole- heat/electrical c!iling/or for (u E. SquaiE-?6oTage or valuati;rffi I gx?ry]L i?s0 sq. foot house, 500 sq. fcz. examoie- if new project, check-riew _ if iitEIEEI'-i-acJ, etc.F. Suilding perrnit irrformation:l. examp.le - cons t.ruct single fami l,v i16u56dttached qaraae2- exarnole --"e,,-,6del existing -oarage into fi3. efimtia - convert single iaiiiy'res.iOencerescaurant (change of use)(:- Vaiue of work as defineo .in Section 303 (a) o theSt!.uctural Specialty CodeH. DESIG;,i TEAiI AIID CCII1RACTORS To avoid design or conslruction delays, BuildDivision St.aff n:ust be able to contali'apprcor tepersons.reoaroing design information or jtl iicorrections, etc. Abbrevia."eo plunbing, i.iechanica.l , & Elect!^ical SchA. :xceoE il,here blank sDaces occur in the descriopor-:ion of the |lecnanicai and Electrical Schedrihe appiicant neei fiil_in only rhe No. Bcxes i ^ :o_rhe-aooropriate iren(s) to 6e installeetr. ruil ptumbtng. l,iechantcal, and Electr.ica j Scheoare availabie at the Buildinq Division1. To conserve space on the permit iorm the schave been abbreviated2. If the rtem(s) to be installed are not coverthe abbreviatecj schedujes you should consultfull scnedulesC. tsUILOIiiG OIVISIOiI ST;FF I^JILL FILI OUI ALL FEES AC!{ARGES Oil THE SCHEDULESD- As nored on the CAp, the label must be deliveredelectricai contractor for signature Oy tris etectrsuoervisor- The general coniractor ii not author- to sign the electricaI iabelApplicant to sign and date l,{henever oossible, the initial appjication wilj be usa..!.rorksneet only. l.Jhere possible, Building Oivision .wl il.prepare a type written copy ano rerurn it to cheapplicenc aE, the time rhe actual permit .is .issueo forsi gnature. Fees and Charges Plan_cneck iees are due and payable at the t.ime of theappiication. .and_19 plans r.ritt-Oe proceiiJo untit thesrees a!-e oaid. All other fees and charges are due andpayab l e when the pemi t i s .i ssuerj - FOR OFF:CE USE C:,ILY CirY Holl SPringfield' Oregon o"ooi-"ir of Public works--'orFtclAL REcEiPT t{0. B 552Btc Do 4 (t fr F s (! (B iH 6 Recei ved For:TI n (S (on { III IV \ Amounl Received sFELloi turiluLL I BY( fV SIGNAlURE €u6fxa or t7'ol .TH PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY: nTtPe t't a I ci na tp e X ft romnY ci tremp a t no iW h!L tneg he uB I.I d e r S Bo a becrd t u eS Additional Project Information : PLANS REVIEI{ED BY: name da teSignatu re ! ( i