HomeMy WebLinkAboutPermit Plumbing 1981-6-8
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CITY O' SPRINGfiELD
COM81NATION APPLICATION/PERMIT
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INfORMAtiON UNI
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ENERGY SOURCES: . - . ftg. oin
Heat pll=lrtr1r 'S f ..
_./ q. Ig. ccen.
Water Heater-elec.t.r--i~ Sq. Ftg. Other
Range .JLNew_Add_Altor_Rep,
Value of Work: _Fe"clIl_DlIlmo_Chong./U,.
$4,292.00 _Olh., comple.tc
. , leas!' ~ P"CP
Building Permit Info: Describe 'WorK (I.e., Build Singl.
Family Residence With Attached Garone'
Ice Cream Parlor
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.... ..dd..... _ ._,__4350-B Ma in Street
a..gal Oelcription _2 ~rJCJ
/'1073231
Own.' Gene & Bernard Hiatt & Robert Cochran
"dd,... 663 West Centennial phon. 741-1420,
SadJl.gfield. OrpgQll Q7/177
Construction Lender PFF ~ <:;nri n.gfi p 1 rt
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Address
Phone
DESIGN TEAM
(name)
(address)
(lies. no.)
(expire.) (phone no.)
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Primary
Hiatt Brothers
663 W. Centennial
Structural
Electrical
M.,honkol Harvey & Price
CONTRACTORS
(nome)
Sarinafie1c1
(address)
<lies. no.)
(expires)
(phone no.)
PlumbinQ
~i"tt Rrothpr~, InvP5tm~ntc
Twin Rivers PlumbinQ
Penselin El~trir
Harvev & Pri ce
741-1470
General
Electrical
Euaene
'rringfipln
Sl)rinnfip1n
?O-Q/;
?na4l1C
~Q~_1A 1A
Mechanical
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PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE
CHARGE
NO.
, fEE
. CHARGE NO.
/
fEE . CHARGE
Duplex (1 both) each
Temporary Construction
2.
furnace/burner to
~TU's
Applionce vent
separa'e
Stationary ."op.
cooler
Vent fon with
jin~le duct
Vent system apart from
h.otin~ or A.C.
Mechanical exhoull
hood and duct
3,00 6.00'
Eoen sin~l. fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
5.00 35.00
Residence of
";I' ft.
New circuits, alterations
or extensions
SERVICES
Additional both
1
"mp., 100
15.00
Water service
1
Se.....er
10.00
Wood sto"./heater
Storm Se.....e,
FEEDERS
1
Heat Pump
Air handler to
10.000 CFM
Air hondlor over
10,000 CFM
6,00
1
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I TOTAL CHARGES
I
Amps.
ISSUANCE OF PERMIT
10.00
22.00
45.00
TOT At CHARGES
15.00
TOT At CHARGES
WHERE STAte LAW REQUIRES that the Electrical work b. done by the Electrical Contractor, the electrical portion of this permit &hall not be valid until a
label has b..n signed by an ElectTical Contractor and attached to the _'-drieal panel.
. 'I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further
. certify that any ond 011 work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to the work described herin. and that NO OCCUPANCY will b. mad. of any structure without the permission of the BuildIng Division. I further
certify thot my reghtrotion with the Build.,', Boord h in full force and effect as required by ORS 701.055, that if exempt the basis for exemption Is nohld
heron, and that only subcontractars and employees who are in compliance with ORS 701.055 will be used on this project. ~._
NAME (please print)
f) E/.J A/ I S
c:;. Lo (./ e /2
<IGN"TU'-J1.av'W'; 1/ ~~
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"~D:TEb-16-''l" /
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Basis for Builder's Board exemption.
FOR OFFICE USE ONLY
. Ipno
fire lone
C-4
Type/Const.
ledrooms
Ctorior
v- 1 HR
1
Sq. ftg. Main
Sq. ftg. Access
Sq. Ftg. Other
lORn
x Value -4-,..2.92...-0
x Value I
Value
TOT..LV"LU"TION 4.292.00
flood Plain
1
Units
n.cy Lood -1~
Occy Group B -?
PLUMBING PERMIT
Charges and
Surcharges
32.00
1.28
45.00
1.80
15.00
I;f\
Plan Ck. Comm/lnd
65%/ Bldq Per Fee
Pion Ck. Res
30%/ Bldp Per Fee
?f\ An
Systems DeYIIlopment
Chorae n.5%1
64.38
BUilDING PERMIT
Chargos and
Surcharges
fence
Plan Check Due
20.80
-,118.56
Demo
Total Comb. Permit
ELECTRICAL PERMIT
Chorglls and
Surcharges
Sidewalk
..~. , Y'
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Alc Povinn
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TOTAL
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;::. cfo\,:;:'rtt.
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';~~:$203. 74. ':-1
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MeeHAN ICAl PERMIT
Charges and.
Surcharges ~t
,
___..1~ 00___
Curb Cut
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'.COMBINATlON APPLICATION/PERMIT (CAP)
. ,~. '.of"':".'
i. Applic~~;-to f~rnish .
" A. Job Address
.~2c-'B. Legal Description
: ~- ,. ~(.1. example.tax lot 100 Lane County Map ReferenCE
......... ~ .>\;. ,
':,~,,?(:.;2., example-La! I. Block 3. 2nd Addition to Springfiel
. ~>:'~, Name, .~'.c...of ow!'er and construction lender
":,~'D. Energy Sources
.....:~t.;.:-; 1. example.heat/electrical ceiling/or forced air gas
,~. ~ 2, example.water heater/electrical/or solar . .. .'.
~ .,E. Square footage or valuation, etc. . \ -...,.
.: I. example-I 250 sq, foot house. 500 sq, foot. gorage
. -. 2. example-if new project, check new-if additionf chI
---. ...... -
~.:..:~' ;.~..) add, etc.
. "t'F'" Building permit information:
, 1. example-construct single family house with an aft
. .{.... . . " garage ~ \ .
... 2, example-remodel existing garage into family'roo,
3. example-convert single family residence into .
restaurant (change of use)
G. Value of work as defined in Section 303 {oj of the
Structural Specialty Code
H, ..DESJGN TEAM AND CONTRACTORS
:To.avoid design or construction delays, Building Divi
" 'Staff must be able to contact appropriate' persons rei
.; ..~~si~n i~formation or job site corr~c~io~~~ etc.
II. Abb~eviated Plumbing, Mechanicol & Electrical'Schedul.
A. Except where blank spaces occur in the description F
of the Mechonical and Electrical Schedules. the oppli
need fill.in only the Na, Boxes adjacent ta the apprc
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 schedul
have been abbreviated
2, If the item(s) to be installed are not covered on tl
..,ated schedules you should' co;,sulti,he full ;chedu
C, 'IiUILDING DIVISION STAFF WILL FILL OUT ALL FEES J
CHARGES ON THE SCHEDULES oj';-
...' :
III.' Applicant to sign and date _ : '
\, "
,Whenever possible, the initial application will be used I
, . worksheet only, "':'here ~ssible,,~uildi~g. Divisia~ St~ff C.... ,
." . prepare a typewnttenj'copy and return. It to the appilca
.. ,~' the ,time the actual perr:nit Is is~ued for his signature. ~..
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IV, Fees and Chorges I' .".
Plan check fees are due and pay;'ble.at the time of the application,
and na plans will be processed until th~~e fees ore paid. All
other fees and charges are due and payable when the permit
is issued. 1:../ .
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional. Project Information:
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PLANS REVIEWED BY:
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. ;,c' cit.fj'.:Oan Smi th "...{'
name." '- .. . .
...,ignatur....
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City Hall
. Springfield. Oregan
D"'~artment af Public Works
O'FFICIAL RECEIPT
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Rec'd Fram Jdiatt frNhiJNJ
Address l~h?J. U), (Q.mo fIJ1/a ~
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6/3/81
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