HomeMy WebLinkAboutPermit Plumbing 1980-12-30 (2)
~.. I~;sPEcJroNL INE
:p26-3769, . '
; Job Address\'O~?JL\-\ Glo ClD~
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I Construction \:~ "/
Range
Valu~
awl1c;.:inq Permit Info:
Family Residence With
I NFORr1ATIO~j li'NE
726-3753
Sq. Ftg. r.1a i n
:oq. Ftg. Access. ./
Sq. Ftg. Othe
New A Alter Rep.
_Fe -_Demo_Change/Use
er
~.
Legal Description
CITY OF SPRINGFIELD
C0/1BI NATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
l'later Heater
Describe l'Jork(Le., Build Single
j.\,ttached Ga raqe)
--
---
~
L..-
L)o. ~,
'~9~t.
(Dhone- no. )
(exnires)
~
I
f. .
Address
DESIGN TEAr1
(name)
Phone
(address)
(1 ics. no.)
Primary
I Structural
I Electrical
1 r~echani ca I
! CONTRACTORS
'~
~,
J
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I
(name)
(address)
(I i cs . no. )
(exoires)
(ohone no. )
I
I Genera I
I Plumbinq LA~t)J\_~~~
J Electrical \j
?GUf\~~~\),Qo,ci.1\ .
- \ - -
LUlo-L'DI!
---.:--=--~~...:-'"
FEE
CHARGE f~- R" i d::' E:~:~~:'lHEJ~ No~i"m'''/b::::::;;A~: -EFF .
I
,~!
;
I ~'echanical
1-'
J
j
, >- t;6"T"~
PLUfmI tJG
Each single fixture
Relocated building
I (new fix. additional)
I S.F. Residence /,
, (I bath)
J Duplex (1 bath) each, I
I Additional bath I
! Hater service I
I I
I Sewer
I I Storm Sewer I,
I
I
I I
I
I
New circuits alts.
or extensions
'C~l
Floor furnace
and vent
SERVICES
Recessed wall
Soace heater nnd vent
ITempOrary Construction
IChange in existing
residence
ImultifamilY, comm. or
Industrial '
IOf amps.
ICOMM./IND. FEEDERS
!Install/alter/relocate
distrib. feeders
IOf amp~
I
I
I
Apoliance vent
separate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
hea t i n-q or A. C'.: '
Mechanical exhaust
hood and duct
I \'Iood stove/heater
I
I
I
,I
I
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I SSIJANCE OF PFRr1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l~HERE STATE LA\~ REQUIRES that the Electrical \'Jork be done by an :Electr;cal" Contractor, the electrical portion of this permit ro'
shall not be valid until the label has been signed by an Electrical Surervisor,and returned 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 \~ork oerformed shall be done in accordance ~Iith the Ordinances of the City
of Springfield and the Laws 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 registration with 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 and employees who are in compliance' with ORS 701.055 will be used on this rroject.
rJAr.1E(please printl-Akf ~ ~~
SIGr~,I\TURE--diAMA- 4 e':L
FOr. OFFICE USE ONLY /
DInE 1'2.,.3).12)
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms,
Stori es
Units
Occy Load
Occy Group
So. Ftg. f1ain
Sq. Ftg. Access
Sq. Ftg. Other
x
x
Value
Value
Value
x
TOT/l.L VALUATION
BUILDING PW1IT
Charges and
Surcharges
I Plan Ck.
65%/Blda
------------1 i~~/B~~~
\D 0-0 I Fence
------~~{) I Demo "
_ ___ _ _ ___ __J 'Sidewal k
A/C Paving
CommlInd
Per Fee
Res
Per Fee
I Systems, Development
Charge 0.5%)
PLW1BING PERMIT
Charges and
Surcha rges
ELECTRICJl.L PERf1IT
Cha rges and
Surcharges
Total Comb. Permit
MECHANICAL PERMIT
Charges and
t_~u:chargeS
Curb Cut
I
I TOTAL
_~D.4D J
r
,
J
COMBINATION APPLICATION/PERMIT (CAP)
1.
Appli~ant 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. examole- heat/electrical ceil inq/D'r forced air qas
2. example- waterheater/electricalior solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot 'house, 500 sq. foot garage
2. example- if ne':/ project, checkr;ew - if addition,
,check add, etc. '
F. Building permit information:
'1. example - construct single family house w1th an
attached garage .:' ~ ".:
2. examole - remodel existing'garage into family room
3. examole - convert single family re~{dencefinto
res taurant (change of use) ! ' ' ' .\
G. ,Value' of work as defined in Section 39~,(a!' ot,;,' t"h~_
Structura 1 Speci a lty Code "
H.: DESIGN TEAM AND CONTRACTORS ,
To avoid design or construction delays, Buildinq'
Division' Staff must be able to contact ap'propri~te '
pel~sons regarding des'ign informatiori or !iopsite '
corrections, etc: ' .J. -) t' ~.'"
Abbrevjqted Piumbing, Mechanical, & Electrica'l Schedu-les
-Ai Exceptv/here blank spaces'occur_'inthe'd~scri.pti6n,
portion of the Mechanical and Electrical~Sthedules,
the appl i cant need fi H..i nonly the No.: Boxes'. adJacent
to the appropriate item(S) to be' instailed' ;i,;,'" "
B. ' Fun Plumbing, Mechanical, and Electrlcal>Schedules
are avai lable 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 abbreviated schedules you should consult the
full schedules' '
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
'CHARGES ON THE SCHEDULES , : ' :
D.' As noted-on the CAP, the label must be deliv~~ed to the
electrical contractor for signature by his electrical
supervisor. The' general contractor i snot authorized
to sign the electrical label. - '
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' type written copy and return it to ,the
appl icantat the time the actual permit is issued.for his
s,ignature. ,
Fees and Cha rges
Plan check,feesare 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 ~re du~and
payabl e when the permit is issued. .',
c:-- '
. . ",' t ,'"
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANqV:
II.
III.
IV.
V. FOR OFFICE USE ONLY
'"
PERMIT VALIDATION
'~
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l
Permit: Clerk
"T
Permit appl i cant exempt': from regi~'trati on ~ith the Buil der"~ ,Boq.rd ,b,ecaus'e:
~ ' ,.'
'Additional Project Information~
PLANS"J~EVI EWED BY:
I"
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name
signatu(e
'.)
.'Z;
date,
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INFORf1ATION UNi:
726-3753
Sq. Ftq. f,lain
:q. Ftg. Access. /
Sq. Ftg. Othe
, New A Alter Rep.
Fe' _Demo_Change/Use
~
'.1' HlSPECTIOi'! LINE
i .726-3769 "
Job Address \. O~?l\ -\ fLlo ClD~
Legal Description
, CITY OF SPRINGFIELD
C0/1BIrlATION APPLICATION/PERMIT
ENERGY SOURCES: '
Heat
'\'Jater Heater
"
Range ' .
,valu~.
6.lrllc;'~nq Permit Info: Describe \'Jork( Le., Build Single
Familv Residence' With Attached Garaqe)
g
I' 0\1ner €Ci Q~
I Address, 3qUf)'r L.-Ca ()-tU u ( 0 fF'r.'~
I' '~~~/'~ lLHch~D(1
Construction ~ . ,
--
--
~
(name)
, Phone
(address)
t--,'\~' ~. ,~~{\ ~ ~ t ~
~ -\-' --, ---~)
, (lies. no.) (exnires) (phone no.)
~
,'Address
DESIGN TEAr 1
'''".''
'.~
Primary
( ,
~ ;:: ", ,'.'
F
I
(ohoo, 00.) "r .".
IUlo-ZDIL: .~.:
Structura 1
El ectri ca 1.
!1echani ca 1
CONTRACTORS
(n ame )
(address)
(1 i cs . no: )
(expires)
General
?lumbina
a~~ )\~ ~St~t),
t \. . \.) , "
, '\,j ,
?G Uf\~~~\\C)Cl~ dn
- \
Electrical
J
:""
i ~'",chan;cal
PLur~B rr:G '
ELECTRICAL
t1ECHAN I CAL
" ~.:.
Res,i,qe,0ce, of.
'SQ. FT.
~FF frHARGF NO.
,;,c."
F-Fl rHARGF'"j
:"~~.
.,~-~
'-
I' FEE CHARGE ~JO,
Each single fixture
furnace/burner to
BTU's
;.;.'
Relocated buildina
(new fix., additional)
'I'S' F . Residence
(l ba th)
D~plex (1' bath) each
New circuits alts:
or exten.s~i.gQ?4;g~~!;;?((:y~~; ~,t}.
Floor furnace
,and vent-'
Additional bath
I ~!a tel", serv ice'
"jsewer
, ., Storm Sewer
,lTempOrary Construction
IChange,in existing
residence
ImultifamilY, comm. or ,I
Industrial
10f amps~ I
ICOMM./IND. FEEDERS I I
I Install/alter/relocate I I
distrib. fpeders
10f . amps.
1
Recessed wall
Space heater and vent
I
Appliance vent 'I'
sepa ra te
Stationary evap.
cooler
Ven t fan with
sinale duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
~
SERVICES
....:.';
:;'~
.~: l"
.;:..
ISSUANCE OF PF.Rr1IT
, TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES,
I~HERE STATE U\1 REQUIRES that the Electrical work be done by an .Electrical Contractor, the electrical portion of this permit
shall not be val i'J until the label has been signed bY' an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXNllNED thecomp leted app 1 i cati on for permi t, and do hereby certify that all i nformati on hereon is true
and correct, and I further certify, that any and all \1ork performed shall be done in accordance with the Ordi,nances of the Ci ty
of Springfield and the Laws 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 registrationvlith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors a'nd employees I'lhoare in comoliance with ORS 701.055 \1ill be used on this project.
~.
NAt.1E(please print) AIA~f J"" C..M~
SIGiUITURE '/~ i r?:L
FOR OFFICE USE Oi~LY . / '
DATE 11-.;,=?l).PI). '
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stori es
Units
Occy Load .'
Occy.Group
Sa. Ftg. r1ain
Sq. Ftg: Access
Sq. Ftg. Other
x
x
Va 1 ue '
Value
Value
'-"\..,
'.\~ .'
\
x
TOTAL VALUATION
BUILDING PER~1IT
Charges .and,
Surcharges
I
Plan Ck. Comm/Ind
fi5%/Bld'a Per Fee
Plan Ck. Res
30%/BldQ. Per Fee
\ D OD Fence
------~~{) D~mo
_ ___ _ _ ___...:..._J 'Sidewalk',
I A/C p'avi ng
I Curb Cut
~--- -:~,-- ----I
Sys tems, Deve 1 opment
Cha rqe (1.5%)
PLUMBING PERMIT"
Charges and
Surcharges
ELECTRICAL PE~~IT
Cha roes and
S'urcharges
v'}"
t
IT~tal Comb.' Permi t ,
MECHANICAL PERMIT
Charges, and' '
Surcharges'
. TOTAL
J
CD .40
~~..._,-~
f:
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COMBINATION A~PLICATION/PERMIT (CAP)
1.
7-1
t
i
CITY
(
I
I
PERMIT VALIDATION
OF SPRINGFIELD
City Hall
Springfield. Oregon
Department of Public Works
OffiCIAL RECEIPT
No. B 5 5 4 87 (
ao\", ~ ?f)19f:D
Dote ~- ~~ .'f\
( Rec'd From -en~) V~
Add,." "" L' - ~ t~(
II..
Applicant to furni~h
A. Job Address
B. Legal Desc~iption ,
1. examole- Tax Lot 100, Larie Countyr'lap
17 03 43
'~,2. examD1e- Lot 1. Block 3, 2nd Addition 1
Springfield Estates ,r'
C:- Name. etc. of owner and constructiori lender ~
D. ,Energy Sources '
1. examole7 heat/electrical ceiling/or for
2. examole- \~aterheater/electrica1io~ sora (,'
E. ,Square, footage or valuation, etc.
1. 'examole- 1250 sq. foot house. 500 sq. fc
2. examole- if new project, checknew -if
check add. etc.
F. Building pemit i,nformation: ,
1. exarlD 1 e - cons tru.:t, s i ngl e family house \
attacned garage ,
2. e~amole - remodel existing garage into ff
3., examole ~ convert single family 'residencE
restaurant (change oJ use)
G. Value of work as defined in Section 303 (a) 0
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid ,design or constru~tion delays, Build'
Division Staff must be able to contact appropi
persons regarding design information or job si (
corrections. etc.
Abbreviat~d Plumbing, Mechanical, & Electrical Sch
A. ~xceot where blank spaces occur in 'the descrip
:ortion of t~e Mechanical and Electrical Schedl ~"
tne aoolicant need fill-in only the No. Boxes c ~.
'to the dporooriate item(s) t6 be'insta11ed
B. ~ull Plumbing. Mechanical, and Electrical Sched
are available at the Building Division' ,
1. To conserve space on the permit form the sc, ("
have been abbreviated' ,
2~ If the item(s)to be installed are not co~er
the abbreviated schedules you should consult ("
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
, CHAR~ES O~ THE SCHEDULES
D. As noted on the CAP, the ,label must be del ivered (:,1-'
electrical ~ontractor for signature by his elect! \1
supervisor. The aeneral contractor is not author
to sign the electrical label. -
Applicant to sign and date 's'
Whenever possible, the initial application will be us, ~
,a worksheet only. Where possible, Building Division:
, will prepare a type written copy and return it to the
applicant at the time the a,ctual permit 'is issued 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 are du'e and
payable when the permit is'issued.
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, Received For:
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Amount
'f5x'60
Received ~
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. AUTHOFllZ.ED 51.GNATU:RE 97401 !S8!!5-1l-e
5HELTO"I.TURNBULI.. PRINTERS - EUGENE. , . - ".
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BY
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V. FOR OFFICE ,USE ONLY
Permit Clerk
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f.....~."'O'~~............_....! ..hl.IiL~I~.illl~",,""L ~ ......\.1~.. U.;:l~.......L.'- '!!.oloO ',Q,~ b.o,'. =~I.ll:l .1IL~1~I~oI:!,' ..... , ----" -- .---- - ---------
! PROJECT CONDITIONS TO BE SATISFIED BEFORE, OCCUPANCY:
I
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1
,
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Permit appl icant exempt from registration with the Builderl s Board because:
.
,.
Additional Project Information:
PLANS REVIEWED BY:
name
signa ture
'date
,
.ri
-"
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