HomeMy WebLinkAboutPermit Plumbing 1980-11-25
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INSPECTION LiNE
72f>-3769
CITY OF SPRINGFIelD
COMBINATION APPLICATiON / PERMIT
INFORMATION LINE
nf>-3753
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Owner.em~T LA;e~
Address L3L7 A.,{O. ~
q . ;-?';'~d
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I ENERGY SOURCES: / / ~! Sq, ftg. Main
Heat.$L~(o- n.-e,l ~a. Ftg, Acc'ess,
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I Water Heater ~-r. _ i Sq. Ftg. Other
: Range i_New ___Add __Alter _R~P_
I Value of_ Work: 1- _Fence ___Demo_~_Changel Use
t Jf 8. tJ-O i - _Other
h.LU1~.() ~~-L I_~_ __ _____n'
A. I [)u;l~ing Permit Into: De,"iCribe Wo, rk. (i.,~" Build Singie
Phone 7,~-4SB/ I Famdv Residence With Attoched Gar~eJ
-- - !~e.d~~'--~~ LeAS~
I S-jDA .tA>. ~ '
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Phone
Job Addrm z'j 7 @ 5 +' lZe<",- r
LegaIDemiPtion7jj]~~320 3/
Construction Lender
/i' " 6/1. er
Address
DESIGN TEAM
rnomp.)
(address)
(lies. no.)
(expires;
(phone no,)
Primary
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-<lI~:",~oi
::-:~lTJ~ACTORS
(nome)
, cc::ires5;
i:C_ no.,
(expire,,;
;:'~or.~ ...~.)
:-:~;"":~rOI
~.r#f /./Z/.7
;:It.:moinq
~:ec:ricai Ad ~ ~" :7. ;" e ,c:=~-e.c
,........"!(na!'l:~al ~ ~ /1, ~ --' L -h / "" ,. ~
( ---t' J.r /.'-06 n r ::":'~c.-<j,
?LUM5ING I
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:LEC7R1CAl
.~,"\ECH ANfCAt
-'~
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C-..:,:.RGE I NO,
CHARGE N."
CH.ARGE i
..:.-
:.ccn sinqie fiXTure
!~ ~.elo'ored buiiding
(new fix. ociditioncH
__~_~a. ..-
furnacel Durner to
_____ BTU',
Residence of
v
New ClfCViTS. c.uercl1orn
or eXTens.ions 2~1''''~~
Appilon:::e venT
S2Porar~
S.F. ReSidence
(1 ba,h;
SERVICES
Stationary evop.
cooler
WatC!r ..en-ice
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Vent fen with
single duct
Vent SYSTem open from
heatinq or A.C.
Mecnanico! exhausT
hood and duct
-'.....c.~,
'::~;- ~C""!
Temoorcry Cons~;uC!ion
I Adciirionci beth
Amps,
Storm 3~we!"
FEEDERS
I
t. 'Nood stove/heeter
I
I Heat Pump
! Air handier to
I 10,000 CFM
Air handler over
10,000 CFM
jewer
, , '
//e>l--c.:' A~---~^ /....... ___ --r"f'''t..t::
Amps.
i~.~./ -;< "' -- - .p. . ----- -:/-Q-~:"
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TOTAL CHARGES
TOTAL CHARGES
ISSUANCE OF PERMIT
I TOTAL CHARGES
WHERE STATE LAW REQUIRES Ihat thl> Electricai work be done by the Electrical Contractor, the electrical portion of ihis permit shall nol be valid until a
label has been signed oy an Electrical Conlractor and altached to the electrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and, correc" and I funher
certify that any and oil work. performed shoil be done in accordance with the Ordinances of the City of Springfield and the laws of the'State or Oregon
pertaining 10 ,he work deSCribed herin, and that NO OCCUPANCY will be made of any structure without the permIssion of the Building Division, I further
certify that my registration with the Builder's Boord is in full force and ..ffee! 0 s required by ORS 701.055, thot 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 printLVf'"JU5)' h/J/Jtt; // <;IGNATURE 'X ~--
-, r _ '"
FOR OFFICE USE ONLY ~
DATE//-Z S:E!~
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Zono Type! Const, Units
Fire Zone Bedrooms nccy Load
Flood Plain Storir'" ()ccy Group
BUILDING PERMIT 0l\ .00 Plan Ck. Comml Jnd
Charges and 65%/ Bldg Per Fee
Surcharges 1,1(0 Plan Ck. Res
30%/ Bldg Per Fee
PLUMBING PERMIT j().O'Q
Charges and Fence
Surcharges t[()
Demo
ELECTR leAL PERMIT l'3.0D
Charges ond Sidewolk
Surcnorges LDCJ
. AI C Pavi"q
MECHANICAL PERMIT UP. 00
Charges and Curb CuI
Surcharges -----:(0 Lf -
Sq. Ftg. Main
"q. ftg. Access
Sq. fig. Other
Value
Value
Value
TOTAL VALUATION
x
Systems Development
Charqe (1.5%)
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I TotaJ Comb. Permit
1 TOTAL
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~~.40
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COMBINATION APPllCATIO,:-</PERMIT (CA?)
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I. Applican".lV furnish
A. JOD Address
B. Legal Description
i. exampie-tax lot 100, lane County Map Reference 17
2. exampie-Lot I. Slock 3. 2nd Addition to SpringfieldE!
C. Name. etc. of ownercnd construction lender
D.' Energy Sources . .
L examole-neat/eleCtrical ceilina 'or forced .air oas
2. example-water heater:- electric-a! lor sOiar '
., E. Square rOOTage or valuation, etc.
I. exo';'cle-12505q. foot house. 500 sq. foot garage
2. ~xamPte.ir new project. check new-iracidition, check
acid, etc_ '
F. Building permit informaTion:
1. examPle-construct single family house with an cttor-
-=::r::Ge
~.'('.r:rr:OJe~(e~Gce'i t;Xi5:~-~ ;=:-cge.'ihTo fCrr',ii~J i~":ti';'
.... excrn~re-cc!1verr'5in~i.c TC:iljiy residence_ i,nto
:-cs:cur.::nr t:::-:cnce':;~ -...:::.e.::
G~ Vc:ua or. 'J'/C~K as .cerine!:.......-: .:;~icn 303 (c)."oi .~he
.S~rUCTurcj Speclchy Cod~
H: DE5!G,~TEA!.\ AND CONE/ACTORS
To ':Ivcici design or'COn$in..:~;=:: delay'sf Building ,O!visi.
Sttc~f m~s,! _ be a~!..~ _fo~~~r~s: =:Jprop.~:.ate p~rscn3 re,g-
ceStgn InroqnC!ion or JO~ SUi::- corre':rIC;~"Sf e7C_.
hborevi~ted P(umbing. ^\F.:cnc.:":.~cct '& Electr:cai Sc~~'~:.;;e~
,~.' Except ",'nere bicnk ~:Jcte5 c.::ur in _die descri~:icn :=!:
of tne Mecno:licai_ d::o ~Ie:=::-:::::l Scnecuies. .rhe_;:::;::::-!': t
heea 7iil~in or:iv tne No~,"S::..x~ aoiccent to tk~ c::::;;".~..
,;:;:":!rSi to 6e !n'S:c~ied
.Fun PJuTnoi'ng, :\\e<:nanTcci: .::~~ =!ectricc! ~c~eClJtes
are cvcilable c: t;,c 5ui:d~:-i~ ::ivision
i ... To con~erve space an r~-? ~ermit form the sch~~;iu!
have oeen ccoreviatec'
2.. !f the tteml.s) TO be j~s;G:ied are not'covered on'ri- ~~~:f
'::~ed !:cnecuies You snc!..:ici consult The fuH .5cneau
L. ;:ujlDf!'~G c:vlsrc:-.J STArr WILL Fill OUT ALL FEES.
CHA~GESON THE SCHEDULES
!IL
:\'ppiicanr to sign cr1cidote ,
Wheno;ver cossioie. rne initio! oopUcation will be usee
wori-:sneet ~nlv. Whe~e possiD!e~ Building Division Stof
prepare 0 rype'Nrittencooy cind return it to the app'iicc
~:-:e lime the acruoi permit is issued for his.signature. . .
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;Y. fees and C~c'rges'
i'
nCl1c~ec)( fees c;~ ::ue and payable at the time of thf--_:- ,.
and no Cld~s w;li ce ::rccessec until these fees are paid. All
:l~her. ~~::~:::: c;.,~~ ,.,.esore due cnd poycble when the permit
'S jS5~ec_
V_ FOR GFfiC= US::, OM Y
;. PROJECT CONDITioNS 10. BE SATISFiED BEFORE OCCUPANCY:
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Additional Project Information:
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PLANS, REVIEWED BY:
, name
~ignaturf'
caTV 0
I o. ifF S P R J ~J G f I E"t D
City Hall
'. Springfield, Oreaon
Oeport~ent ,of Pub Ii; Works
. 0 F rI C I A t R E C:: I P T
Nn p
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19-80
R ,. F '. 1~.1'I" .,/1'
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~mOlJnt Received ~Cj 4. /'\
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BY
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S:I<IEl T"~'TU!"48~:lJTHORllEC SIC:;N_. TURE
, . 1. ;>"''''''''~RS . EUGE~E, OR 97.&0.1
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Permit Clerk-
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