HomeMy WebLinkAboutPermit Plumbing 1981-09-14CITY OF SPRINGFIETD
COIIBINATION APPUCATION / PERMII
INFOR'SAT]ON I.INE
7283753IN'PECTION LINE
7263759
.sr
Woter Heoter
ENERGY SOURCES:
l{ect
legol n
-New-Add-Alter-ReP.
-Fence-Demo-Chonge/
Use
Other
-
-
Sq. Ftg. Moin
Sq. Flg. Acces:.
Sq. Ftg. other
Volue of Work:
Building Permit lnfo: Describe
Fomily Residence With Attoched
Work (i.e., Build Single
Gorooe)Ph.6F7.-lddr.rr J
///astr tVaaz AC1
N
N")
\
$
Address Phone
(lics. no (expires)
DESIGN IEAM (nome)no.)(qddress)
Electricol
Electricql
Mechonicol
MECHANICALETECTRICALPTUMBING
FEE CHARGENO.FEE CHARGErEECHARGENO,NO.furnoce/burner lo
-8TU'S
Residence of
fr.Eoch single fixture
Applionce vent
seporole
New circuits, olterotions
or extensions
Relocoted building
(new {ix. odditionol)
Slotionory evop.
coo lerSERVTCES
S.F. Residence
(l borh)
Vent fqn with
sinqle ductTemporory ConslruclionDuplex (l borh) eoch
Vent system oport from
heotinq or A.C.Amps.Additionol both
Mechqnicol exhqusl
hood ond ductWoler service
Wood stove/ heoterSewer
Heot PumpFEEDERSStorm Sewer
Air hondler to
10.000 crMAmpr.
Air hondler over
r0,000 crM
ISSUANCE OF PERMIT
TOTAI, CHARGESIOTAT CHARGESTOTAI. CHARGES
work bc done by thc Elcctricol Conlroclor. thc clc<lricol porlion of this permit rhall not ba vcrlid until o
ond ottoched to lho .loctricol Psnsl.
I HAVE CAREfULty EXAMINED the completed opplicotion for permit, ond do hereby certify thot. oll infomotion hereon is lrue ond correct. ond I furlher
sertify thot ony ond oll work performej sholl be' done in ocordonce with the Ordinonces of the city of Springfield ond the Lows of the stote of Oregon
p"".i^l.g to tie work described herin, ond rhot No occUPANcY will be mode of ony structure wilhout lhe permission of the Building Division. I furlher
ertlfy rhot my,egislrorion wirh the auitder,s Boord is in full fore qnd e{fect os required by OR! 701.055., thot if exempt the bosis for exemplion is noted
h.ron. ond thot o=nly subcontroctors ond employees who qre in omplionce wirh ORS 701.055 will be usd on lhis proiect'
DATESIGNATURE
WHERE STATE tAW REQUIRES thot the Eleclricol
lqbel hss bean signed by on Electricol Controctor
Bqsis for Builder's Boord exemption:
NAME (pleose print)
FOR OFFICE USE ONLY
Zone
-Type/Conrt.-Units
--Sq.
Ftg. Moin x Volue
x Yolue
1-fslg6Flood ploin Storict-Occy Group-Sq. Ftg. Other-
Ftg, AccessFire Zone Bedrooms Lood
TOTAT YATUATION
Systems Development
Choroe (1.5%)
Plon Ck. Comm/lnd
65%/Blds Per fee
Plon Ck. Res
3oo/"/Bldg Per Fee
Fence
Toiol Comb. PermitDemo
Sidewolk
A/C Povino
Curb Cut
BUILDING PERMIT
Chorges ond
Surchorges
PTUMBING PERMIT
Chorges ond
Surchorges
ETECTRICAT PERMIT
Ihorges ond
iurchorges
\ECHANICAT PER,MIT
rorges ond
,rchorges TOTAI.
/r4DJob Address
=r-E
coMBTNATTON AppLtCATtON/pERM|T (CAp)
L Applicont to furnish
A. Job Address
B. Legol Description
I. exomple-tox lot 100, Lone County Mop Reference I7 03 43
2. exomple-Lot I. Block 3,2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construction lender
D. Energy Sources
l. exomple-h"otl.lgg11lgkglgglor forced oir gos
2. exo mFlE-w o te r TEEIErlEl-ect ri co I / o r IJA
E. Squore footoge or voluotion, elc.l. exomple-I250 sq. foot house, 500 sq. foot goroge
2. exomple-if new proiect, check new-if oddition, check
odd, elc.
F. Building permit informotion:I. exomple-construct single fomily house with on otloched
goroge
2. exomple-remodel existing goroge into fomily room
3. @-convert single fomily residence inlo
restouront (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 contocl oppropriote persons regording
design informotion or iob site correclions, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description porlion
of the Mechonicol ond Electricol Schedules, the opplicont
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 DivisionI. To conserve spoce on the permit form the schedules
hove been qbbrevioted
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 FItL 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 lypewritten copy ond rerurn it to the opplicont ot
the time the ocluol permit is issued for his signoture.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicotion,
qnd 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
PTANS REVIEWED BY:
PERMIT VATIDATION
Permit Clerk
PROJECT CONDITIONS IO BE SATISFIED BEFORE OCCUPANCY:
Additional Proiect lnformolion:
nome signolure dole