HomeMy WebLinkAboutPermit Plumbing 1981-03-05tNSPECItOi'
726,59
TINE CIIY OT SPRINGTIEID
COMBINATION APPTICAIION / PERi,TII
INFONMATION tINE
726.3753nn
legol De t z
o*n., ts)l
Sq. Ftg. Olher
-
New-Add-Alter-ReP'
Sq
Ftg. Accers.
ENERGY SOURCES:
Heo t
Woter Heoter
Ro
Volue of Demo-Chonge/ Use
Address (Phone Fomily Residence With Aloched Goroge)
@"w"iN'.#iJs;ai;
or)7bit,ffi-tr n{. , Q,\s.-
con.*,i.rioI-Lr f
Addre ss Phone
a9
)
7v
DESIGN TEAM (nome)(oddress)(lics. no.)(expi res)(phone no.)
Prim o ry
Slruclurol
Mechonicol
CONTRACTORS (nome)(oddress)(lics. no.)(expires)(phone no.)
Generol
Plu
Electricol
l,{echonicol
ETECTRICATPTUMBING MECHANICAL
No. I FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE
I
I Eoch single fixture
Residence of
-sq.
ft.
furnoce/burner to
-BTU'S
Relocoted building
(new {ix. odditionol)
New circuits, ollerotions
or exlensions
Applionce vent
5epora le
S.F. Reridence
(l borh)SERVICES
Slolionory evop.
cooler
Duplex (l boih) eoch Temporsry Consiruciion
Vent fon with
sinqle duct
Additionol both Amps.
Vent sy5rem oport from
heoting or A.C.
Mechonicol exhousl
hood ond ductWoter rervice
Wood stove/heoter/Sewer lo.a )
Heol PumpSlorm Sewer FEEDERS
Ampr.
Air hondler to
I0,000 cFM
Air hondler over
r0,000 crM
ISSUANCE OT PERA{IT
TOTAT CHARGESlO LoIOTAT CHARGES
WHERE STATE fAW REQUIRES thot thc Electricol work be donr by the Elecrricol Conlroctor, the clcctricol portion of thir pcrmit sholl not be volid until o
lobel hos brn signed by on Elcctriol Contraclor ond ottoched to lhe cleclricol ponel.
TOTAT CHARGES
I HAVE CAREFULLY EXAMINED the completed opplicotion for permit, ond do hereby certify thot oll informqtion hereon is true ond correct, ond I further
certify thot ony ond oll work performed sholl be done in qccordonce with the Ordinonces of the Ciry of Springfield ond the Lows of the Stote of Oregon
pertoining to the work described herin, ond thot NO OCCUPANCY will be mode of ony 3tructure wiihout the permission of ihe Building Division. I further
errlfy thot my regi.trolion with the Builder's Boord is in full force ond effect os required by ORS 701.055, thot if exempt the bosis for exemption is noted
heron, ond thot only subcontrqstors onci employees who ore in complione wirh ORS 7O1.055 will be used on this proiect.
DATESIGNATURE ,-q5g\
Bosir for Builder'r Boord exemption:
NAME (pleose print)
/FOR OFFICE UsE ONIY
FireZone-Bcdroom:occyIoodSq.Ftg'AccessxVolue
floodPloinSlorie.OccyGroup-Sq.Ft9.other-1-{q|gg
TOTAT VATUATION
x ueSq. Ftg. MoinZoneConsi.
-Unils
Systems Development
Choroe ( I .59lo)
BUITDING PERMIT Plon Ck. Comm/lnd
Fee
Plon Ck. Res
Per Fee
Chorger ond
Surchorges .S,o,rl.fA-/rfr.d
Totol Comb. Permit
-T
PTUMBING PERMIT
Demo
Chorger ond
S urcho rges
Chorges ond
Surcho rges
c
Sidewolk
MECHANICAT PERMIT
Chorges ond
Surcho rger
Curb Cut
TOTAI.//0{)
-
oQt
a
Electrico I
COMBINATION APPLICATION/PERMIT (CAP)
l. A,ppliconl. to furnish
A. Job Address
B. Legol DescriptionI. exomple-tox lot I00, Lone County Mop Reference l7 03 43
2. exomple-Lot l. Block 3, 2nd Addition to Springfield Estores
C. Nome, etc. of owner ond construction lender
D. Energy Sources
PERMIT VALIDATIOiI
B6rtt
dl.s €6 I'I
1 elcgp!s-heot,/elect.i.o ; cei I i n g,/or f orced o i r gos
e x6frFlE- w o te rT-e-6G7/ el6it frio I i o i! oiE .2.
E. Squore footoge or voluotion, etc.l. exomple-1 250 sq. foot house, 500 sq. foot goroge
2. exomple-if new proiect, check-new-if oddition, check
odd, etc.
F. Building permit informotion:
1. exomple-construct single fomily house with on olloched
goroge
2. exomple-remodel exisiing goroge into fomily room
3. @-convert single fomily residence into
restouront (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Structurol Speciolry Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Division
Stoff must be oble to contoct oppropriote persons regording
design informotion or iob site correclions, etc.
ll. Abbrevioted Plumbing, Mechonical & Electricol Schedules
A. Except where blonk spoces occur in the description poriion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in only the No. Boxes odiocent to the oppropriote
item(s) to be instoiled
B" Full Plumbing, Mechonicol, ond Electr.icol Schedules
ore ovoiloble ot the Building Division
I. To conserve spoce on the permit form the schedules :
hove been obbrevioted
- 2. lf the item(s) to be instolled ore not covered on the obbrevi-. oted schedules you should consult rhe full schedules
C. BUILDING DIVISION ST,AFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dofe
Whenever possible, the initiol oppliqotion will be used os o
worksheet only. Where possible, Building Division Sroff will
prepore o typewritten copy ond return it to.lhe 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. AII
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OTFICE USE ONLY Permit Clerk
PROJECT CONDIIIONS TO 8E SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
nome signoture dote
PLANS REVIEWED BY: