HomeMy WebLinkAboutPermit Plumbing 1981-7-22
INSPECTION UNE
726-3769
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CITY Of SPRINGfiELD
COMBINATION APPLICArlON/PEAMIT
.
INfORMATION LINE
72W753
Legal Description
-1 Q .20
tr? ,,3
fV\",- ~ '" sh
% <./'!-' 0 2.SQ 0
I ENERGY SOURCES:
Heat
I Water Heater
Ronqe
I Value of Work:
J/ I. (.,':.:?f':> "" t>
,
Building Permit Info: Describe Work (i.e.. Build Single
Forni/v R~~idt;nce With Attached Garone'
Sq. frg. Main
Sq. Ftg. Accen.
Sq. Fig. Olher
_New_Add_Alte,_Rep.
__Fence_Demo_Change I Us.
_Olher
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Job Addre"
Addren
N\ ,r- 5
.'205:
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N L L.-:1 S.,4= ' , '~hon.
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le.5<"~r_,_
00
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Owner
Add,."
Phon.
~c..U ?AHTa".",., W.,..., :r:> c:.fl4'~
.~........ "'" /M'" /' -" ~..... 'r
':;~oT/,~~_ /.../.6"',," ~4:&r"7.. J)J _,,_-._
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Construclion Lend.r
DESIGN TEAM
(name)
(addreu)
(li(l. no.)
{expires'
(phone no.)
Primary.
<:::pl~
Slructural
Electrical
Mechanical
CONTRACTORS
(name)
(addreu)
(Iics. no.)
Cell:piru)
(phone noJ
General
~,..l -F
Electrical
.:u \") V\.
CocK
bl (. c..t or! c-
~
Plumbinct
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
1/.-4 .
Each sjn~le fill:lure
Relocared building
(new fill:. odditionoO
S.F. Residence
(1 bolh)
i FEE CHARGE NO.
l:~<>/> ~-
8. fi.
FEE
CHARGE NO. I
FEE
CHARGE
NO.
.,
-
Residence of
furnace I burner to
I~TU's
Appliance vent
s.parote
Stationory eyap.
cooler
Vent fan with
single dud
Vent system oport from
. ht!otinq or A.C.
M.chonical exhaust
hood and duct
...:ft.
New circuits. olt.rations
or extensions
SERVICES
Duale.. (1 bath) each
Temporary Construction
A~dilional borh
Amps.
Wal.r s.rvice
Sewe,
Wood stove I heater
Stor,m Sewer
FEEDERS
"f.l..n.F~
h: ",-,,e,;:>.
I
I
I
I
Heat Puma
Air hondl.r to
10.000 CFM
Air handler 0....'
10,000 CFM
Amps.
I
I
I
r-
I TOTAL CHARGES
I
;a-
TOTAL CHARGES
ISSUANCE OF PERMIT
I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the EI.ctrical work b. dane by the Elet~rical Contractor, the .Iect,ical portion of this permit .haU not b. valid until a
lobel hal be.n si9ned by an Electrical Contractor and attached 10 the .Mdrical panel.
I HAVE CAREFULLy'EXAMINEO the completed application for permit, and doher.by certify that all information h.reon i. true and correct, ond I furth.,
certify thot o;;y C1nd all work performed sholl be done in occordonce with the Ordinances of the City of Springfield and the Laws of the Stote of Oregon
pertaining to the work described herin. and that NO OCCUPANCY will b. mode of any structure without the permiuion of the Building Division. I furth.r.
certIfy thot my re-gistTation with 1M Builder's Boord is in full force ond eff.ct a' required by ORS 701.0.55, thot if exempt the basis for exemption is noted
N::'f:,:.u~::::~~~~::;i ld ~P,'O'~~h~ ;in ~mPli:~~N~~:R~~'~i1Q jU:6 n~ DATE 1 n- ~ \
FOR OFFICE USE ONLY
Zone
fire Zone
Flood Plain
Typo/Canst
I\odrooms
c.tori.-
11nih
"''''y Load
I1ccy Group
Sq. Ftg. Main
Sq. Ftg. ACetlu
Sq. Ftg. Olh.r
'rolue
Value
Value
TOTAL VALUATION
x
x
BUilDING PERMIT
Charges and
Surchargu
Ii:>..
0<>
Pion Ck. Comm /Ind
6.5%{81da Per fee
Plan Ck. Res
30%/ BldCl Per Fee
6.5<>
System, Development
Charqe (1.5%)
PLUMBING PERMIT
Charge, (Ind
Surcharges
'1~
j<:!). .-.
-<to
fence
j Total Comb. Permit I
I
I 'I
I poJ~ oF r-qt;;"
I TOTAL
;zt:>. gc::>
Demo
ELECTRICAL PERMIT
Chorg., and
Surcharges
Sidewalk
A/C Pavina
MECHANICAL PERMIT
Charges and
Surchargu
Curb Cut
'-/B ./0
COMBINATION APPLICATION/PER" (CAP)
'I. Applicant to furnish
A. Jab Address
B. legal Descriptian
1. example.tax lot 100. lane County Map Reference 17 03 43
2. example.Lot 1. Block 3, 2nd Addition to Springfield Estates
C. Name. etc. of owner and construction lender
D.. Energy Sources
1. example-heat/electrical ceiling/or forced oir qas
2. example-wafer heater/electrical/or solar
E. Square footage or valuation, etc.
1. example.1250 sq. foot house. 500 sq. foot garage
2. example.jf new project, check new-if addition, chee'
odd. etc.
F. Building permit information:
1.. exam ole-construct single family house with on ottOI
garage
2. example-remodel existing garagb into faniily room
3. exampie-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 COt>iTRACTORS
To avoid design or construction delays, Building Oivisi
Stoff must be able to contact appropria~e persons regl
design information Oi' job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. E.xcept where blank :iraces occur in the description po
of the Mechanical and Electrical Schedules. the opplic
r.eed fill.in only the No. Boxes adjacent to the approF
item(s) to be inSlalled
B. Full Plumbing, Me<h~niwl. and Electrical Schedules
are cvailoble ot the Building Division .
1. To conserve space on the permit form the schedule
have been abbreviated
2. If the itern(s} to be installed'are not covered on the
ated schedules you should consult the full schedul,
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES A
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used a
worksheet only. Where possible, Building Division Staff
prepare a typewritten copy and return it to the applicar
the time the actual permit is issued for his signaturE..
IV. Fees and Charges
Plan check fees are due and payable at the time of the ..
and no plans will be processed until these fees are paid q!
other fees and charges ore due and payable when the Ij....
is issued.
V. FOR OFFICE USE ONLY
...
PROJECT CONDITIONS, to BE SATISFIED BEFORE OCCUPANCY:
Additional Project Infarmation:
f
PLANS REVIEWED BY,
nome ~'fJ~ ~.s::;. ~signalUr~
.
PERMIT VALIDATION
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CITY OF SPRINGFIELD
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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( 4\ . t f\{\ 9" ~O. B 56947 t1
Date ,,^\~l,. Nrl-, 19 Q lJ
Rec'd ro \~Cl D d \\OOU '1
Address S<6,() YW~~t
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Received
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For:
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(-. Amo".!'.t Received 4-'rS . "V
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1[\,10""1.0" .740' 5.."..
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Permit Clerk
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