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Home My WebLink AboutPermit Plumbing 1981-8-3 ~'--' INSPECTION LINE 726-3769 -, 9>00 3S" ~ , INFORMATION LINE 726-3753 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Address .0-2.5- /i'?/LL. ST~ Legal Description Owner .5:.#ooL 2)/:<; r .# / q Address S.25- H/.LL S/ ' Phone ":;;/2 /;';G F /,E LD Construction Lender Address DESIGN TEAM (name) Primary Structural Electrical Mechanical CONTRACTORS (name) General Plumbing /I/tJ / Electrical Mechanical PLUMBING NO. FEE Each single fixture Relocated building (new fix. additional) S.F. Residence (l bath) Duplex (1 bath) each Additional bath Water service Sewer Storm Sewer TOTAL CHARGES M Fe:; E" Phone (address) (address) CHARGE NO. Residence of ENERGY SOURCES: Heat Water Heater Ra nge Value of Work: Sq. Ftg. Main Sq. FIg. Access. Sq. fig. Other _New_Add_Alter_Rep. _Fence_Demo_Change/ Use _Other Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached Garaae) AJek../ ~h/Ce L/9rc-/2 He- h,o/A/G. (lies. no.) (phone no.) ~ ~ ~ ~ FEE CHARGE (expires) (lies. no.) (phone no.) (expires) ELECTRICAL MECHANICAL WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. FEE CHARGE NO. furnace / burner to I\TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct ..,. ft. New circuits, alterations or extensions 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 Laws of the State of Oregon pertaining 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 Board is in full force and effect a 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. i Basis for Builder's Board exemption: NAME (please print) 1- ---....., \::-'.... '" "\ \. Zono Fire Zone Flood Plain Type/ Const. Bedroom' Storio' BUILDING PERMIT Charges and Surcharges PLUMBING PERMIT Charges and Surcharges ELECTRICAL PERMIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges SERVICES Temporary Construction Amps. FEEDERS Amps. TOTAL CHARGES '" Wood stove/ heater Heat Pump Air handler to 10,000 CFM . Air handl~r over 10,000 CFM , ISSUANCE OF PERMIT TOT AL CHARGES SIGNATURE .\, DATE rr-~,..il .. ~~\ \. , , . " FOR OFFICE USE ONLY x Value Value Value Units 0ccy Load 0ccy Group Plan Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per Fee Fence Demo Sidewalk AI C Paving Curb Cut c;.,. Ftg. Main c;.,. Ftg. Access Sq. Ftg. Other x '( TOTAL VALUATION Systems Development Charge (1.5%) Total Comb. Permit TOTAL COMBINA nON APPLlCA nON/PEl (CAP) I. Applicant to furnish A. Job 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: AdditionClI Project Information: PLANS REVIEWED BY: namf' o;ignaturp ., , PERMIT VALIDATION Permit Clerlr r/atf' . ~:,;~<:,\':~" .~~~,~" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~. @ ~ ~ m Certificate 02 Occupant!' ~ I CITY OF SPRINGFIELD i ~ BUILDING DEPARTMENT ~ @ ~ ~ This Certificate issued pursuant to the requirements of Secft'on 306 of the Umform Building @ ~ Code certifying dzat at the time of issuance this ,rtructure was in compliance with the various @ ~ @ ~ ordinances of the City regulating buildhlg construction or use. For the following: @ ~ @ ~ .~ ~ Occ. GrouF' F .Type Constructi~n III I hr. Fire Zon" III Ilse Zonp . @ ~ @ ~ Owner of Buildinc School District 1f19 Addres~ 525 Mill Street @ ~ @ ~ 525 Ml"ll Str t 8608 )~ ~ ",;Iding Add,.,. ee "Idg. p:~m;, ~ dd- I ~ /f ~ '1 /J5[!Jd-- Date J ~ ~ ~ ~ ~ POST IN A CONSPICUOUS PLACE ~ ~~~~~~~~~~~~~~~~~~@~~~~~~~~~~~~~~~~~~~~~~~~~