HomeMy WebLinkAboutPermit Plumbing 1981-09-10INSPECTION tINE
726.3769
CITY OF SPRINGFIETD
CONTBINATION APPTICATION / PERMII
INFORIAAIION TINE
726.3753
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ENERGY SOURCES:
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Wqter Heoler ------ 3z'52-Legol De >k)
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/--Fence-Demo-Chonge/
Use
A.{.{
-New
-Other
A l+o'
-Rep.
Sq. Ftg. Moin
Sq. Ftg. Access.
Sq. Frg. Other
Volue of Workr
Fomily Residence [!$Attoched Goroqe)
ing Permil lnfo: Describe Wor k (i.e., Build Single
v//azrfr.,srrz, il iz.
l-/ouction
lc\
sol
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PhoneAddress (phone no
DESIGN TEAM
rlno.)(oddress)(nome)
Primo
nicol
Electrico I
Mechonicol
MECHANICAL
FEE CHARGE
ETECTRICATPTUMBING
FEE CHARGE NOCHARGENO.FEENO.furnoce/burner to
-BTU'S
Residence of
--=_=-sq. ft.Eoch single fixture
Applionce vent
sepo role
New circuits, olterotions
or exlensions
Relocoted building
(new fix. odditionol)
Stotionory evop.
oolerSERVICES
S.F. Residence
(l borh)Vent fon with
sinqle ductTemporory ConslruclionDuplex (l both) eoch
Vent syslem oporl from
heoling or A.C.Amps.Additionol both
Mechqnicol exhousl
hood ond ductWoter service
Wood stove/heoterSewer
Heot PumpFEEDERSStorm Sewer Air hondler to
I0.000 cFMAmpr.
Air hondler over
r0,000 crM
ISSUANCE OF PERMIT
TOTAT CHARGESTOTAT CHARGESTOTAT CHARGES
DATEt
,TURE
benot untilvqlidthisofrhallElectrirheConlroclor,col the permitbeworkportiondonelhethotElectricolbySTA'WHERE rAwIE REOUIRES
the eleclricollo ponel.ottqchedqndConlroclolElectricolhoslobelbensignedby
CAREFUttY EXAMINED the completed
otl work performed sholl City of
wilhout
Springfield ond
lhe permission'ony
to the be mode of ony
effect os required
tshereon true nd ndq furtherInformotioncorrect,qll Ilhotonddoforcertifyherebyopplicotionpermil,YEHA'the ofStotetheofLowslhelhewithofOrdinoncesdoneoccordoncebendthotcertify Oregon
furlheroftheBuildDivision.IstruclurengwillthotondOCCUPANCYNOdescribedherin,worknrngpertoi
I notedthotbosilheforss70r.055,exemplionoRsexemptbyfuforceIndoBuilder'r IBoord tnswithi slrotion thethotcertlfyrsgmy .055 be onusd thiswirhnce701 proiect,ORSorewhotnqsubconlroctorscompliondhethotondemployeesr0n,only
Bosis for Builder's Boord exemplion:
NAME (pleose
FOR OFFICE UsE ON1Y
Zone
-Type/Conrt, -Units
-.....--Sq'
Ftg. Moin x Vo lue
x Yolue
x
-Volue
TOTAT VATUATION
Fire Zone-Bedrooms occy lood Sq' Flg' Access
Flood Ploin Storiet OccY Sq. Ftg. Other=....--
Syslems Development
Choroe ('I.5%)Plon Ck. Comm/lnd
65%/Blds Per Fee
Plon Ck. Res
3O%/Blds Per Fee
Fente
Tolol Comb. PermitDemo
PTUMBING PERMIT
Chorges ond
Surchorges
Sidewolk
A/C Pqving
ELECTRICAI PERMIT
Chorges ond
5urchorges
Curb Cut
TOTAT
MECHANICAT PERMIT
Chorges ond
Surchorges
oeleclricol
on
BUIIDING PERMIT
Chorges ond
Surchorges
COMBINATION APPLICATION/PERM. (CAP)
l. A,pplicont to furnish
A. Job Address
B. Legol Descriptionl. exomple-tox lot I00, Lone County Mop Reference l7 03 432. exomple-Lot I. Block 3,2nd Addition to Springfield EstotesC. Nome, etc. of owner ond construction lender
D. Energy SourcesI. exomple-heot/qlgqlllgl ceiling/or forced oir gos
2. exEmFlE-woterTEoGTel-ecrri co I / ", Wl ---
E. Squore footoge or voluotion, etc.
I
2
exomple-l 250 sq. foot house, 500 sq. foot goroge
exomple-if new proiect, check new-if oddition, check
odd, etc.
F. Building permit informotionrI. exomple-conslruct single fomily house with qn ottoched
goroge
2. exomple-remodel existing goroge into fomily room
3. examFl-e-convert single fomily residence into
i6Stouront (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 construction deloys, Building Division
Stoff must be oble to conloct oppropriote persons regording
design informotion or iob site correclions, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in lhe description portion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in only the No. Boxes odiocent to the oppropriote
item(s) to be insrolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building DivisionI. To conserve spoce on the permil form the schedules
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the obbrevi-
oted sc,hedules you should consult 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 initiol opplicotion will be used os o
worksheet only. Where possible, Building Division Sroff will
prepore o typewritten copy ond return it to the opplicont ot
the time the octuol permit is issued for his signoture.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicotion,
ond no plons will be processed until these fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
/ERMIT VATIDATION
Permit Clerk
PROJECT CONDITIONS IO BE SATISFIED BEFORE OCCUPANCY,
Additional Proiect lnformotion
nqme signoture dote
PLANS REVIEWED BY: