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Home My WebLink AboutPermit Plumbing 1981-11-4 INSPECTION LINE 726-3769 .- CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 Job Address 279'7 - elL. Y/"'7..o /~ /7_!'.... 7<"'-_11./ ~..,:}- - ~, S7: ~)c&O ENERGY SOURCES: Heat Water Heater RanQe Value of Work: Sq. Ftg. Main Sq. Fig. Access. Sq. Ftg. Othe" _New_Add_Alter_Rep. _Fence_Demo_Chonge/Ule _Other ~ I' ~ ~ C\; ~al Description Add",,/~65- /-#GH ST. E':#::;-~A/ E /Je. q 7.t;i-c; / / PlGMr .t1F'oPEL!r y Phoo4'.f's--F.zs ~ Own,,?;Ucdh7& Address Phone Building Permit Info: Describe Work (i.e., Build Single Famil., Residence With Attached Goraae\ ~~L-"tC.6 /l/'::QNOt>/"7'" H/VD P.edpl/IU'5 ,.t::7.et?7'c:::'"CT~.<J.ItJ A'A.lD ~C.€5S -;a,y ,. /lJo kc- r:nnstrudion Lender DESIGN TEAM (name) (address) (Iics. no.) (expires) (phone no.) Primary Structural EIMtritnl Mechanical CONlRACTORS (name) (address) (Iics. no.) (exaires) (phone no,) General PlumbinQ #/0 I Electrical Mechanical PLUMBING ElECTRICAL MECHANICAL NO. I FEE ~ CHARGE NO. I FEE I CHARGE NO. I Relidence of furnace/burner to D,TU's Appliance vent separate Stationary evap. cooler Vent fan with single dud Vent system aport from heating or A.C. Mechanical exhaust hood and duct FEE l CHARGE I I Each sin!:de fixture Relocated building (new fix. additional) S.F. Residence (1 bath) 'Q. ft. New circuits, alterationl or extensions SERVICES Duplex (1 both) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10,000 CFM AmDs. ISSUANCE OF PERMIT I TOTAL CHARGES ~ Me- TOTAL CHARGES TOTAL CHARGES I WHERE STATE LAW REQUIRES that the Eledrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has b..n signed by an Elemical Contractor and attached to the eledricol 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 and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the lows of the State of Oregon pertoining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further cert1fy that my registration with the Builder's Boord is in full force and effect Q s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption. NAME (please print) f(\ A-R:rf -S cA1UL - ~A . -1L " <;.IGNATURE II r~ ~ FOR OFFICE USE ONLY DATE dt( 91 Zone Type/Canst. Units Sq. Ftg. Main Fire Zone ~drooms "ccy load Sq. Ftg. Access Flood Plain C:1orie. nccy Group Sq. Ftg. Other BUILDING PERMIT Plan Ck. Comm/lnd Chenges and 65%/Blda Per Fee Surcharges Plan Ck. Res 30%/ BldQ Per Fee PLUMBING PERMIT Charge I and Fence Surcharges Demo ELECTRICAL PERMIT Charges and Sidewalk Surcharges AIC PaviM MECHANICAL PERMIT Charges and Curb Cut Surcharges -------- x Value "clue Value x x TOTAL VALUATION Systems Development Charae (1.5%' Total Comb. Permit TOTAL . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Jab Address B. Legal Description 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 air gas 2. example-water heater/electrical/or 'solar E. Square footage or valuation, etc. 1. example-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, check add, etc. F. Building permit information: 1. example-construct single family house with an attached garage 2. example-remodel existing garage 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, etc. 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 installed are not covered on the abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten copy and return it to the applicant at 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 application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: nam'" coignatur,o PElm V ALIDA liON I Permit Clery ~ate