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Home My WebLink AboutPermit Plumbing 1981-7-30 .. ~ 102- 7& . .~ INFORMATION LINE 726-3753 INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES, Heat Water Heater Rcnae Value of Work: ,.. ; Sq. Fig. Main Sq. Ftg. Access. Sq. Fig. Othe _New_Add_Alter_Rep. _Fence_Demo_Changel Use _Other ~ ~ ~ ~, Job Address ~.zq-Na/9~PV I Legal Description I \1 n s ~ ~ ~U n?!r.f'O I Own" ~ ~LGJAJR]) I Add....177t'J - ai -24 4t/c: e/.//.;,.PA//C' ~L. 1 Construction lender /0..7 ~ ;1 t""": -Building Permit Info: Describe Work (I.e.. Build Single p~O J-...G.:.A..J.d ~milY Residence With Attached Garoa.,) Z;>.I."'~AAJA/8/-'T Rt:J6r Z),e/9/A.J cr S~h2P /J.i>s- .LhJr&R.I'JL Address phone DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lies. no.) (expires) (phone no.\ I I I . I , I I I I I r.;"'~"""'1:1 Plumbina IIjn Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO.1 FEE I CHARGE NO. I FEE CHARGE NO, FEE 'CHARGE SERVICES furnace/burner to ~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 Residence of Each sinQle fixture Relocated building (new fix. additional) S.F. Residence (1 bath) '9' ft. New circuits, alterations or extensions Duolex /1 bath) each Temporary Construction Additional bath Amps. Water service Sewer Wood stoveJheater Storm Sewer FEEOERS Heat Pump Air handler to 10.000 CFM Air handler over 10,000 CFM AmDS. TOTAL CHARGES I U/J;:€e- ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Eledrical Contrador, the electrical portion of this permit sholl not be valid until a label has b..n signed by on Electrical Contractor and attached to the electrical panel. 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 011 work performed sholl 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. 1 further certify that my registration wit~ the Builder's Board is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption' NAME (please print) MA/?/( /-. 6f; IJ .......d SIGNATURE 7??.J'/ /~ ---< DATE 7-30-'6/ FOR OFFICE USE ONLY Zonr Fire Zone Flood Plain Type/Canst Bedrooms --tori.. I !nits nccy Load Occy Group Sq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other , Value Value x x "alue TOTAL V ALVA TlON BUILDING PERMIT Charges and Surcharges Plan n. Comm/lnd 65%/ BldQ Per Fee Plan Ck. Res 30%/ Bldg Per Fee Systems Development CharC"e (1.5%) PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk AIC Pavinn MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL . COMBINATION APPlICATION/PE. (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example-tax lot 100, lane Caunty Map Reference 17(03{'43 I -, ,-.\' 2. example-lat 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/eledrical/or solar E. Square,footage.or voluatiol"!, etc. 1. exomple.1250 sq. foot house, 500 sq. foat garage 2. example4if new project, check new-if adClition, check add, etc. F. Building permit information: 1. example.construct single family house with an attached garage I 2. example-remodel existing gorage into family room 3. exampl~-convert single family residence into restaur~nt (change of use) G. Value of "(ork as defined in Section 303 (a) of the Structural Specialty Code I 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. 'I II, Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the opplicant 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) ta be installed are not covered an the abbrevi. ated sohedules 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: Additional Project Information: PLANS REVIEWED BY: nam'" ")ignatur"" .. . PERMIT VALIDATION 1.1. I Permit Clery "'atF'