HomeMy WebLinkAboutPermit Plumbing 1980-12-30
1 I~SPECTIOU l1NE
, 726-3769
I Job Address \O~/,l\-\ (LloCl.D~
!I:ega 1 Description
I
I Owne~ <E.ci. '~ '
.Address 3QU'l2 LC;C&.1au~~
, , ~W ~ ,~ 'lLt(o.QDt I
construc~7:n~ 'I
L~,~trTY OF SPRINGFIELD
CQI1BlrlATION APPLICATION/PERMIT
, EUERGY SOURCES:
Heat
\,1 a ter Hea ter
,..a
INFORf,1ATION tiN!: .,
726':3753
.so. F tq, f.la in.
':q. Ptg. Access. ~
Sq. Ftg. Othe
'New A Alter Rep.
Fe -_Demo_Change/Use'
er I
.~
~
Range
valu~
8<r11 (;'4 no Permit Info:
Familv Residence With
Describe \'Jork(Le., Build Single
/1.ttached Garaoe)
--
--
~
~
(name)
Phone
(address)
..[)Q.~. ~~ Q ~t
~
l"~._,
Address
DESIGN TEAn
(1 i cs. no.)
(exoi res '\
(ohone"" no. I
Primary
Struc'tura 1
"4 .-.,.
r
r
Electrical
11echanica 1
CONTRACTORS
(name)
(address)
(1 i cs .no. )
(expires)
(ohone no. )
General
~\..\\\~.l~X~c;)-,~ dn"
tu~-ZD/J
Plumbino' C\r0k)J\ ~~\L,~b
Electrical .~ '
I
-- -,. ~
i ~'ochanical
PLurm rriG
ELECTRICAL
r~ECHANIcAL
SQ. FT.
FFF I CHARGF NO:'"'="~-'
furnace/burner to'
BTlI's
FFI"
,~
r.HAR(;F
. :;;j: I
i Each single fixture
Fer
,t.
CHARGE
NO,
Residence of
Relocated buildina
(new fix. additio~al)
New circuits alts.
or extensions
Floor furnace
and vent
IS. F. P,esidence
(1 bath)
IDuPlex (1 bath)
IAdditional bath
Hater, service
SERVICES
,
I
1
I
I
Reces sed wa 11
Space 'heater and vent
,~
each
I
I
COMM,/IND. FEEDERS"
Install/alter/relocate
distrib. feeders '
amps.1
I
I
Appliance vent
sepa ra te
I Stationary evap.
cooler'
I Vent fan with
sinale duct, '
Veht system apart from
heatinq or A;C.
Mechanical exhaust
hood and duct
I \'Joodstove/heater
I
I
I
I.
Sewer
Istorm Sewer
Temporary Construction
IChange'in existing
residence
Imu.ltifamilY, comm. or
I ndustri a 1 '
Of
Of
amps.!
I
I
I
1
I
I
I
:<""h"; 1".
ISSUANCE OF PFm1IT
TOTAL CHARGES TOTAL CHARGES
I~HERE STATE LA1J REQUIRES that the Electhcalvlork be done by an
,shall not be vali.j until the label has, been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returnep to the Building Division
I HAVE CAREFULLY EXA~1INED 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 oerformed shall be done in accordance with the Ordinances of the City ~
ofSpringfie]~ and the Law~ of the State of Oregon oertaining to the work described herein, and that NO OCCUPANCY will be made
'of any structure without the permission of the Building Division. I further certify that my reqistration,\>lith the Builder's
Board is in full force and effect as required by ons 701.055"that if exempt the basis,for exemption is'noted hereon, and that
only subcontractors a'nd employees \1ho are in comoliance with ors 701.055 \1ill be used on this oroject. '
fW1E(please print)
AIAAfJ
(,t"'0t' SI~iJATURE-4~ (/ t?~4_
FOr; OFFICE USE o;~L Y /
Units So. Ftg. 11ain x
O(:cy Load - Sq. Ftg. Access x
Occy Group Sq, Ftg. Other ~
DATE l1..3:).ro,.
Value
Value
Value
Zone
Fire Zone
Flood Pla,in '
Tyoe/Const.
Bedrooms,
S tori es
TOTAL VALUATION
PLUMBING PERMIT'
Charges and
Surcharges,
,\0,0-0
------J1l)
Pl an Ck. Comm;-Ind
65%/Bldo Per Fee
Plan Ck. Res
'30%/81 dq Per Fee
Fence
I
Systems Development
Cha r.oe (1. 5%) ,
BUILDING PER~lIT
Charges and
Surcharges
ELECTRICAL PER~IT
Cha rges and'
Surcharges
Sidewalk
I
I
,I
, D~mo
, ,
-.--- ---'- - -_.-
. , . "
'A/C Paving,
Curb Cut
Total Comb; Permit"
TOTAL " '
fD.40
.
MECHANICAL PERMIT,
'Charges and,
Surcharges,
"... . I.. ...,,. ,.. "~.," . ":'" . .
:J
1
j
J
j
]
f....._.~';JE.~~.~~~~.I';;~~;' ~;.7;'~;;~;;;~-;~;~~;-;~;;;;~~....~'~~~"'-'.,L ..,., .0
I
Iii
J
J
9
~'
~
~
(:l
~
~.~.
~
I
~j
'u'
::!-1
:il
~
'~
;;;
I
I
i
g
I
, ,~~',\~~":_I:~:,,
.l.
.
'.
COMBINATION APPLICATION/PERMIT (CAP)
1.
1
t
CITY
(
PERMIT VALIDATION
OF SPRING FIE lO
City Hal\
'Springfield, . Oregon
t of Public Works
Departmen ,
OffiCIAL R~C~IPT
No.' 855487 (
Date o.O{'. .. W~~ .r
c Rec'd From~~- ' QttxW ~
Add,e"~~Z-~ \~, Orl r' (,
II.
Appl icant to furnish,
A. Job Address
8. Legal Description
1. examole- Tax Lot 100, Lane County Map
'17 03 43
2. examole- Lot 1. Block 3, 2nd Addition 1
Springfield Estates ~
C. Name. etc. o~ owner and construction lender, (
D. Energy Sources
1. examole- heat/electrical ceiling/or for
2. examole- waterheater/electricalior sili: (
E. Square rootage, or valuation, etc.
1. 'examole- 1250 sq. foot house. 500 sq. fc
2. examole- if new project. check-new - if
check add. etc.
F. Building permit information:
1. examole - constru.:t single family house \
dttacned garage
2. exaiT,ole - remodel existing garage lrlto f, 11
3. exar;;ole- convert single family residenCE \tr
restaurant (change of use) Recet!.ed For:
G. Value of work as defined in Section 303 (a) 6
Structural Specialty Code
H. DES I GN TEN! AND CONTRACTORS
To a~oid design or construction delays, Build:
Divi'sion Staff must be able to contact aporopr
persons regarding design information or job si (
corrections, etc. ,
Abbreviated Plu~bing, Mechanical, & Electrical Sch
A.. ::xceDt,,\<ihereblank soaces occur in the descrip
:crtion of t,~e ~'~echanical and Electrical Schedl b r.
the apolic~nt need fill-in only the No. Boxes, ~r
to the aoorooriate item(s) t6 be in~tarled
3. Full Plumbing. Mechanical, and ElEctrical S~hed
~re available at the ,Building,Divisioh ~.
... ;0 conserve sp.Jce on the permit form the SCi ~l'
liavebeen abbreviated' ,
2. If the item(s)to be installed are not 'cover
the abb.'eviated schedules you shguld consult C"
full schedules " .
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES O~ THE SCHEDULES '
D. As note'd on the CAP, the 1 abe 1 must
electrical contractor for signature
supervisor. The general' contracto~
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial 'applicaticinwill be, us'
a worksheet only., Where possible, Building Division ~
will prepare a type written copy and return it to the
applican~ at the time the actual permit is ~ssued for
signature.
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 ari'due and
, payab 1 e when the permi tis issued.
~ -. . .."..... - .-
,
c
(
l
l
(
c
~.1'f\'iJ
LlC70
- (~
\ f)fP -
'~U() <]
000
,t .' \ "-
, ,tJO
~.
. C1 N\b'
l ,'~
~/
L{Cfb
f
(1-2 '(
be delivered
by his electr
is not author
(i Amount R~'eived-Nbr{,Q
f1y'~,)
AUTHORIZ.e:.O SIGNATURE, 40\ !!l851!.e
". EUGENE. OR 97
SHEL TONoT\jRNBULL PRINTERS
, C,
(
I I 1.
('
{,~, (
(
V.
FOR OFFICE USE ONLY
Permi t Clerk
10, .11.1 ~ ~',"'I, ,ICJ. ~ ,1"'1I1~ I I. ~1I11it..~. ,
Permit applicant exempt from registration with the Builder's Board b~cause:
~
Additional Project Information:
- PLANS REVIEWED BY:
name
signature
date
,
..