HomeMy WebLinkAboutPermit Plumbing 1980-12-30
.:a... CITY Of SPRIIIGFIELO
. CmlBlllATlON APPLICATION/PERMIT
.? _: 'I ElIERGY SOURCES:
,........ . SP~ Heat 1911~ r.. 4.
II/ater Heater ~lP'L'"
Ranqe ~T
Ii.- 200 -- - --.. ~ ~\I k
Owner -r~ GtttLP LeJJm'l./M~t;;;;~,I'" 'f'IZo (;"0'0
Address ' BuiililntJ Permit Info: Oeser be Hork.li.e., Build Single
~1'l5 M.CiIZI..oU> eO Phone Familv nesidence 1.lith A,ttached Garaoel
u .
-ru"-lfr,,5 A-oc.-rl ~ -Co -r~tttt--l0 -HeM!":.
~SlctaJ<:f1AL- 'f="..~.OU-("" or"
-r1d1!. c.{.h/"-P ~
(lies. no.l lexniresl
IIIISPECTlOII LIIIE
726-3769
Job Address ~i 1 '5 ~
Legal Description 11- 0"2-. to
Construction lender
Db1-E
Address
DE::illirl TI:.AI"
(namel
Phone
(address)
Primary
f'WUP-L
Structura 1
Electrical
!1echanical
CONTRACTORS
(name)
(addrpss)
General
!'YLU U~ .
\J ~ M ':f"l.V M ~J "\G
c:A So, ~_LEL:(.e.t.L
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40 It:5
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Mt-., a..J 'SP I'...y., r=teLP q 14-11
~JJ~ 1W'..,~ 11401
Lu. Z~ 8Vt...el-Je; 17"bS
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S4+~ -n s (,
~'S '~1'lo
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I I I SSUANC, OF PFR!IIT
IS.C7D I TOTAL CHARGES
Electrical Contractor. the electrical portion of
Supervisor and returned to the Building Division
P1IJmhina
Electrical
/llechanical
PLUIIBIIIG
ELECTRICAL
Nil.
FF, C:H^Rt;F fIn
Residence of
Sco /0.00 sq. FT.
1..- New circuits alts.
or extensions
SERVICES
't.
Each single fixture
Relocated building
(new fix. additional)
S. F. Res i dence
() bath)
IOuplex (1 bath) each
jAdditional bath
I~Jater service
Sewer
Temporary Construction
Change in existing
r~<; j d.e.nce
multifamily, comm. or
!ndue:;trial
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amps.
Of
COW1./IND. FEEDERS
amps.
Storm Sewer
Install/alter/relocate
die:;trih. fppdere:;
Of
TOTAL CHARGES
WHEfiESTATE LAW REQUIRES
shall not be valii until the
10. CO TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
(l ice:;. no.
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rHAIH~1=" NO.
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INFORtIATION
726-3753
Sq. Ftg. f.1a i n
~q. Ftg. Access.
Sq Ftg. Other
~"iei.JAdd_Al ter -,Q.ep.
Fence Demo Change/Use
Other- -
50tp
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(ohone no. I
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(pxnirp<:;.-)
(ohane no.)
MECHANICAL
FFF
rHARr,1="
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
SD~CP hpatpr and vpnt
Appliance vent
seoarate
Stationarv evao.
e.ooler ~ .
Vent fan wi th
sinole duct
Vent system'apart
heatina or A.C.
Mechanical exhaust
hood and duct
3.00
from
Wood stove/heater
Exrs."'/j J)u~_;r :".vs.
-st~S"o
/tJ.c;~
17.S'O
thi s perlilit
I HAVE CAREFULLY EXM1INED the completed aprlication for nermit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that fm OCCUPA1KY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by Or-S 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
IWIE(please print)<?'1' ~ ~ J1'1J€. c.,,"L-O ~IGIIATURE
~~'^ -tbLU>.
FO~ OFFICE USE OIIL Y
Zone M-~ Tyoe/Const. .\L -.if Units I Sf1. Ftg. Hain
Fire Zone Bed rooms Occy Load 8 SQ. Ftg. Access I-/.r.;n
Flood Plain Nn Stories ! Occy Group T - A... Sq. Ftg. Other
DATE
LIt (,,/go
x
x
Value
Value /2. !:_"'V1'?&'
Value
x
TOTAL VALUATION !r?. ('..,,,..,,,,..,CO
BUILDIrIG PERflIT
Cha rges and
Surcharges
.YLJ~' ')_ ~y~...~Oevelopment I
" . ha~~e 11.5'-)
Pe(;#:PjF)1 I ~ . .
;<3q.oo
PLUl1BING PERMIT
Charges and
Surcha rges
I I Plan n. COlTlll/lnd
_______{,;,.l,QQ:l 65%1Rlda Ppr Fpp
Plan Ck. Res
~, </'1 30%/Blda Per Fee
_______l{}~yJ Fence
1"'10 D~mo
ELECTRICAL PERI~IT
Cha rges and
Surcharges
_______L~...c:.::L Sidewalk
,(:;0 A/CPavin9
_ _ _ _ _ _ _C7J~!)_ Curb Cut
/Ii?
11ECHAN I CAL PERI1IT
Charges and
Surcharges
ITotal Comb. .Permit
!tJ0.{.?{)
>9f';;'9.5.00 ,
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I TOTAL'
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
!
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I: Applicant to furnish
A. Job Address
8. legal Description
1. examole- Tax lot 100. Lane County Map ~ (L
II 03 43
2. examole- Lot 1. Block 3. 2nd Addition t
~prlngtield Estates
C. Name. etc. of owner and construction lender (
D. Energy Sources
1. examole. heat/electrical ceilimy'or for-
2. exaw.ple- waterheater/electr;cal/or s~
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 sq. f(
2. examole- if new project. check-new - if
cheCK add. etc.
F. Building permit information:
1. example - construct single family house
attached garage
2. examole - remodel existing garage into f
3. examole - convert single family residenc
restaurant (change of use)
G.. Value of work as defined. in Section 303 (a) ,.
Structural Specialty Code
H. OESIGN Tf.I\H Aim CONTRACTORS
To avoid design or construction delays. Bull( (
Division Staff must be able to contact appro~
persons regarding design information or job ~
corrections. etc.
II. Abbreviated Plun:bing. r-lechanfcal. & Electrical Sc '1
A. Except where blank spaces occur in the descri
portion of the Mechanical and Electrical 5che
the applicant need fill-in only the No. Boxes (
to. the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical 5ch,
are available at the Building Division
1. To conserve space on the permit form the ~ (
have been abbreviated
'2. If the item(s) to be installed are not co,
the abbreviated schedules you should canSt
full schedules
C. BUILDIiiG OIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEOULES
D. As noted on the CAP. the label must be deliver
electrical contractor for signature by his ele
supervisor. The general contractor is.not aut
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial application will be
a worksheet only. Where possible. Building Divish (ca
will prepare a type written copy and return it to 1 .'1'
applicant at the time the actual permit is issued 1
signature.
IV. Fees and Charges C
Plan check fees are due and payable at the time of
application. and no plans will be processed until t+-o . .
fees are paid. All other fees and charges are due and
payable when the permit is issued.
Cl
"U.,.',OIlIZItD SIG,..".,.UO:It...o,
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CITY
OF
SPRINGFIELD
City Hall
Springfield. Oregan (;
Department of Public Works
OFFICIAL RECEIPT ,
No.8 S5310(
(" DaIJ1:.~ 19m . :
<h' Rec'd Fram,S;tnn-hJ~ f:j;D r
Address ~q 5 M. i.Ma..:.,. '\ '
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Amou~t Received
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V. FOR OFFICE USE ONLY.
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signa ture
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