HomeMy WebLinkAboutPermit Plumbing 1981-09-23INSPECIION LINE
72&3759
Addrers
CIIY OF SPRlNGF'EI.D
coitEtNAilON Appt rcAiloN/pEnfl r INFOTA4ATION I.INE
726-37s3
H
\S
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Vqlue of Work:
SingleAddress
(phone no,)
Legol 1
Lender
Phone
(nome)(oddress)no.)re s)
Other
Describe Work (i.e., BuiPermit lnfo:
Resi
Address
DESIGN TEAM
ENERGY SOURCES:
Heot
Wofer Heoler ==-
Sq. Ftg. Moin
-New-Add-Alter_Rep.
-Fence-Demo-Chonge/
Use
Sq, Ftg. Access
Sq. Ftg. Orher
Structurol
Mechonicol
Generol
Electricq I
Plumbi
Mechqnicol
PTUMBING ETECTRICAT MECHANICAL
NO.rEE CHARGE NO.FEE CHARGE NO.FEE CHA,RGE
Eoch sinqle fixture
Residence of
-sq.
ft,
furnoce/burner to
-.-BTU'S
Relocoted building
(new fix. odditionol)
New circuits, olterotions
or extensions
Applionce vent
seporo le
S.F, Residence
(l both)SERVtCES
Stolionory evop
coo le r
Duplex (l both) eoch Temporory Construclion
Vent fqn with
single duct
Additionol borh Amps.
Vent syslem oport frm
heoting or A.C.
Woter service
Mechonicol exhousl
hood ond duct
Sewer Wood stove/ heoter
Storm Sewer FEEDERS Heot Pump
Amps.
Air hondler to
r0.000 cFM
Air hondler over
r0,000 cFM
ISSUANCE OF PERMIT
TOTAT CHARGES TOTAT CHARGES TOTAT CHARGES
WHERE STATE tAW REQUIRES lhot the Eledricql work be done by the Electricol Conlroctor, the elettricol portion of this permit iholl not be volid unril olobel hss been signed by on Electricol Contractor ond ottqched to the electricol ponel.
I HAVE CAREFULTY EXAMINED the compleled opplicotion for permil, ond do hereby certify thot oll informotion hereon is lrue ond correct, ond I further
sertify thqt ony ond oll work perform€d sholl be done in qccordonce with lhe Ordinonces of rhe City of Springfield ond the Lows of the Stote of Oregon
pertoining lo the work described herin, ond thot NO OCCUPANCY will be mode of sny structure without the permission of the Building Division. I further
certlfy thot my tegislrolion with the Builder's Boord is in full fore ond effect os required by ORS 701.055, thot if exempt the bosis for exemption is noted
heron, ond thot only subcontroctors ond employees who ore in omplionce wilh ORS 701.055 will be used on this proiect.
7-*-tDATESIGNATURE<#Bosis for Builder's Boord exemplion:
NAME (pleose print)Czerz /, O443a
FOR OFFICE USE ONI,Y
Fire Zone-Bedrooms occy Lood Sq, Ftg. Access
x
--Yolue
x
--Volue
x
-Volue
TOTAT YATUATION.
Sq. Ftg. lr{oinZone
-Type/Const. -Units
Sq. Ftg. Other-Flood Ploin lories-Occy Group
Plon Ck. Comm/lnd
65%/ Bldq Per Fee
Syslems Development
Choroe (1.5%)
BUITDING PERMIT
Chorges ond
Surchorges Plon Ck. Res
30%/Bldq Per Fee
Fe nce
Demo Totol Comb. Permit
PTUMBING PERMIT
Chorges ond
Surcho rges
Sidewolk
A/C Povinq
ELECTRICAL PERMIT
Chorges ond
Surchorges
Curb Cut TOTAT
MECHANICAT PERMIT
Chorges ond
Surchorges
Electrico I
CONTRACTORS (nome)(oddress)(lics. no.)(expires)(ohone no-)
coMBINATION APPLICATTON/PERMI] ---AP)
l. Applicont to f urnish
A. Job Address
B. Legol DescriPtion
I.-exomple-tox lot 100, Lone County Mop Reference I7 03 43
2. exfiiG-Lot l. Block 3,2nd Addition to Springfield Estotes
C. Norne, etc' of owner ond construction lender
D, Energy Sources
I. eiomple-heot./electricol ceiling/or forced oir gos' rr solor2. exomple-woler heoter ''eleclricol/ c
-E. Squore footoge or voluolion, elc,
l. exomple-1250 sq. {oot house, 500 sq' fool goroge
Z. exomiilE-if-new proiect, check nE-w-if oddition, check
odd, etc.
F. Building permit informotion:
i. .roilplu-construcl single fomily house with on ottoched
goroge
Z. exomple-remodel existing goroge into fomily room
3. exomple-convert single fomily residence into
6ltoulont (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Structu rol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or conslruction deloys, Building Division.
Stoff must be otrte lo conloct oppropriole Persons regording
design informotion or iob site corrections, etc'
ll. Abbrevioted Plumbing, Mechonicol & Electricol Sc'hedules
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 oppropriole
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
'I . To conserve sPoce on lhe permit form the schedules
hove been obbrevioted
2. lf rhe item(s) to be instolled ore not covered on the obbrevi-
oted schedules you should consult rhe 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 Sloff will
prepore o typewritten coPy ond return it to the opplicont ot
ihe'time the octuol permit is issued for his signolure.
lV. Fees ond Chorges
plon check fees ore due ond poyoble ot the lime of the_opplicotion,
ond no plons will be processed until lhese.fees ore poid' All .
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Proiect lnformotion:
PLANS REVIEWED BY:
nome signolure dote
-\ ----.\
I.-ERMIT VALIDATION
Permit Clerk