HomeMy WebLinkAboutPermit Plumbing 1981-7-30
INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
.
INFORMATION LINE
726-3753
Job Address
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legol Description \! (') ~ -S V:; ;). d. _
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OwnerNLt~A/.z"/E A/es~ 6~blP
/ / J./ 7"' C"--r- -7,; / 0/1'2 tBuilding Permit Info: Describe Work (i.e., Build Single
Address / -"7YL'.2 - L- ...,.)./ , PhonEII' 7 7"C:J e..r:;), Fomily Residence With Attached Garage)
52:7//?/A.JGF/272.,D 1J/;-G~A/A/E'Qr 7)4@A/S'Pc:Jh/T
ENERGY SOURCES:
Sq. Ftg. Main
Sq. Ftg. Access.
Sq. Ftg. Other
_New_Add_Alter_Rep.
_Fence_Demo_Change/ Use
--,--Other
~
~
~
~
,
Heat
Water Heater
Range
Value of Worb
Construction lender
Address
Phone
DESIGN TEAM
(name)
(address)
(Iics. no.)
(expires)
(phone no,)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(Iics. no.)
(expires)
(phone no.)
Plumbinq
I
.~
General
Electrical
Mechanical
PLUMBING
ELECTRICAL
: MECHANICAL
NO.
FEE
CHARGE NO.
FEE
CHARGE NO.
FEE I CHARGE
SERVICES
furnace/ burner to
BTU's
Appliance vent
separate,
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or,A.C.
Mechanical exhaust
hood a nd duct
I Residence of
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
sq. ft.
New circuits, alterations
or extensions
Duplex (1 bath) 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
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
. I I
Akke
TOT AL CHARGES
TOTAL CHARGES
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.
I HAVE CAREFULLY EXAMINE'D 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 mode of any structure without the permission of the Building ,Division. I further
eertify 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.
Basis for Builder's Board exemption:
Ilnit.
('\ccy Load
(")ccy Group
<;IGNATUR~...cs.H
FOR OFFICE US-E' ;;:;;;----;;- ,
Sq. Ftg. Main
Sq. Ftg. Access
Sq. fig. Other
DATE
7 -.:hJ -J=' I
.-
-fo'/:
NAME (please print)~ h I I- 'e.y
Zon..
Fire Zone
Flood Plain
Typel Const
Bedrooms
c;,torip.~
Value
Value
Value
TOTAL VALUATION
'(
x
BUILDING PERMIT
Cha~ges and
Surcharges
Plan Ck. Comm/lnd
65%1 Bldg Per Fee
Plan Ck. Res
30%1 Bldg Per Fee
Systems Development
Charqe (1.5%)
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
Total Comb. Permit
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
AI C Pavin!,
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
COMBINATION APPLlCA T10N/PERI(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 informa,tion:
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 (0) 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 ~s;d--~s 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:
AdditionQI Project Information:
PLANS REVIEWED BY:
namp
<;ignaturf'
.ERMIT VALIDATION
Permit Clerk
rI"te