HomeMy WebLinkAboutPermit Plumbing 1981-11-4
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.TY OF SPRINGFIELD
CO TlON APPLICATION/PERMIT
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INFORMATION LINE
726-3753
Addreu Q40 S. 4:1rd Strp.pt
JOO: l'Ib-l'lJl
I-!m Phon. 74f'-"l?1n
~!l71f\. nn
Building Permit Info: Describe Work {i.e., Build Single
Family Residence With Attached Goraae\
Sq. Frg. Main ~'JLU ex 1 S"(;. ex>
Sq. Fig. Accen. 0
Sq. ftg. Other e
_New_Add_Alter_Rep. ~
_Fence_Dema_Changel Use
. --"':""Other-CompJetg ; ntpY'
or
4157 Main Street
L.goIOmdpt;on 1[-02-32-3? L I
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ENERGY SOURCES,
H.ot bil~ FA Ilni t I-!tr
Water Heater Fl PC':t.
ROnl=lB
Value of Work:
Own" Sherman Ruttpncuttpr
--5rr;n3~~oln. QR 97~7
Construction lender Ppnn 1 PC:: R;l nit
Plumbino. Electrical. Mechanical & TJlteriu'
for Shell built under Job #810416. 6-29-81
Address
Phone
DESIGN TEAM
(name)
(address)
(liCl. no.)
(expires)
(phone no.)
Structural
"
"
~tl 726-2250
J0i7Z; "
4;
Primary
bPnrop I. (;ri fJi n
?Rfifi Milnnr nrivp
Electrical
Tpn Fc::c::npr Tnr r,pnrgp ~r;ff;n
"
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(exoires)
(Dhone no.)
Gon"o' Mp~lilrl Rlrlr~
Plumh;no Twi n Ri vers Pl bQ
44 I}reg.cln <;t. CJ:es1"o11 ~1l~7h
2040 W. Broadwav
344-1832
fiR"l-1414
741-]18fi
Electrical Hp.nrv ppn~p 1; n
~R~ w. rpntpnni.l Rlvrl
Mechanical
PLUMBING ELECTRtCAL MECHANICAL
NO. FEE I CHARGE NO. FEE CHARGE NO. I FEE CHARGE
Residence of 12 furnace/burner to 6:88
1 Each sinQle fixture 5.00 ".,. ft. D.TU's 19.50
Relocated building New circuits, alterations Appliance vent
(new fix. additional) X or extensions 2 or mOl e 15.0( separate
S.F. Residence Stationary evap.
(1 bath) SERVICES cooler
Vent fan with
Duolex (I both) each Temporary Construction 2 sin!:!le duct 3.00 fi.nQ
1 Vent system aport from 4.50
Additional both Amps. heatinr or A.e.
Mechanical exhaust
Water service hood and duct
Sewer Wood stove/heater
Storm Sewer FEEDERS Heat Pump
NOl E: 5 plumbing fi xture s 2 100 10.0020.00 Air handler to
Amps. 10.000 CFM
we~e , Air handler over
charged to the firsi 10.000 CFM
per mit. 1 Gas Pioino 2.00
ISSUANCE OF PERMIT
In 'In
TOTAL CHARGES
5.00 TOTAL CHARGES
"l<;. (In. TOTAL CHARGES
47 nn
WHERE STATE LAW REQUIRES that the Electrical work be done by the Eledrical Contrador, the electrical portion of this permit shall not be valid until a
label has boen signed by an Electrical Contradar and attached to the eledrieal panel.
I HAVE 'CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further
certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the Stole of Oregon
pertoining to the work described herin, and that NO OCCUPANCY will be mode 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 os required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
Rasis for Builder's Boord exemption-
NAME (please print~~~#4/
/7 #' ~-
tfLLJ,JA/tf.!LI rE,pSIGNATURF,J..ku';"n(r;../.4',t"~ OATE/r ~-?/ I
FOR OFFICE USE ONLY
Zone r 4
Fire Zone
Flood Plain no
Type/ eonst.
Bedrooms
<; N
Units
n,.cy Load --9.6
Occy Group---R?
i~~"p<iJnr ~,
Plan Ck. Comm/lnd
65%/ Bldq Per Fee
Plan Ck. Res I
30%/ Bid!:! Per Fee
Sq. Ftg's!};n ~R 1 ptp
Sq. Fig. ,.. (l
Sq. Ftg. art ore 70.2(1
only $Bl,Q88 Q\
; nterin.... Yalue
x . RO Volue -2...400..ll0
x . RO Votu. ?3"lfi 00
TOTAL VALUATtON $4736 on
"'forie.'
1
NOTE: Prior Rui)dirlO pprmjj,jl.~.
BUILDING PERMIT
Charges arid
Surcharges
.____~2.., 00
1. ?R
?n..B(l
Systems Development
Choroe 0.5%)
7-1~.oA
PLUMBING PERMIT
Chorges and 'i. nn Fence
Surcharges
7n Demo
ELECTRICAL PERMIT
Charges and ~~ nn Sidewalk
Surcharges
'1.40 Ale Pavinq
MECHANICAL PERMIT
Charges and _____..J0.00 Curb Cut
Surcharges
1 f'R
Total Comb. Permit
118.56
TOTAL
$710 qO
COMBINATION
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A~~U.ON!PER' {CAP}
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..PERMIT VALIDATION
. ,
L Applicant to furnish
A. Job Address .'.",
~;r~. Legal Description .., ...
, . .'.', 1. example-tax lot 100, Lane County Mop Reference 17 03 43
'j ; i":' ,2: :example-Lot 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and constructionl.len'pe~\ ,',
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
. : -2. example.wafer heater!electriccil/o~- solar .;;. " . '.: :
E. ,Square footage or valuation, et.c. .: ~ \ ,,:. -'. ,..-:
, 1.' example.1250 sq, foot house, 500' sq. foot garage'
2. example-if new project, check new-if addition, check
add, etc.
F. .Buil~ing permit information: .: .
1. e'xample-construct single family house with an 'attached '.
garage
2. example.remodel existing goroge into family room
3. example.convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
.Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS' .",
,To avoid design or construction delays, Building Division,..
Staff must be able to contact appropriate persons regarding .
, design information or job site corrections, et,c.' ~.: ... ~ I .
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill.in only the No. Boxes adjacent to the appropriate
" item{s} to be installed
'B: Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit.form the schedules" ,.
have been abbreviated
2. If the item(s) to be instailed are not covered on the abbrevi-
.". ated schedules you should cansull the full schedules
C: BUILDING DIVISION STAFF WilL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES:
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III. Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, Building Division Stoff will
prepare a typewritten copy and return it to the applicant at
the time the actual permit is issued for his signature.
IV. Fees ond Charges . ,
Plan check fees are due ond payable at the time af the applicatian,
and no plans will be processed until these fees are paid. All
other fees and charges ar.e due abd payable when the permit
is issued.
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V. FOR OFFICE USE ONLY
Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
"r";; The,'oriainal olans & oennits were for thE' strt,,~ttlrill shpll.~.
restrooms onlv.
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These olans.& oennft\;.arE' for thp comolptin~f thp int..rin.. ir:u:lt.tlin,:, nn..
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plumbinq fixture not covered initially arid electttcal and mechanical systems.
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PLANS REVIEWED BY,
nom- Lorne Pleger
,ignatur- ~~ ~:<r...r->
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9-28-81. f)'
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