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Home My WebLink AboutPermit Plumbing 1987-12-29 I INSPECTION LINE 726-3769 -- /YC;g' Jrl~ /I Legal Descr~ ~ /'~J") l/~/1,o~ ) / Address 6>50 ;J, &'0, fI!;7-. Phone 1)1/7 c/Lj &J CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Ran~e Valu~ of Hark: .. INFDRllATION LINt 726-3753 Sq, Ftg, 1,Iain ~q. Ftg. Access. Sq, Ftg. Other New Add Alter Rep. -Fence Demo Change/Use ,r Other- - oS\ ~ D ~ ~ ~ Job Address Owner rd~ Buildina Permit Info: Describe Work(i.e.. Build Single Family ~es;dence With Attached Gara~e) M'.8P/j U Construction Lender Address UI:SlliN II:.At~ lname} Phone (address) (l ics. no.) (exn; res) (ohone no./ Primary Structural Electrical ,..., 'A /""') ..../"\ v/7 I I 5:>,)'-"v )~"'b~ Mechanical CONTRACTORS (name) (addrps.~) (1ir:s.. no. \ (pxnirpc;) (nhoop nn.) Plumbina ) IlIJ /11/ Jt/ Genera 1 Electrical ~1echan;cal PLUIIBING ELECTRICAL MECMANICAL NO, ' FFF rHARGF NO_ FFF rHAR(;F NO. FFF rHARr,F SQ, FT, furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent S. F. Res i dence (] bath \ Duplex (1 bath) each Additional bath SERVICES Recessed wall SOrtC~ heatpr ann vpnt Storm Sewer Of amps. App 1 i ance vent seoarate Stationary evap. cooler Vent fa-n with sinale duct Vent system apart from heatina or A.C, Mechanical exhaust hnnn rtnd nud Sewer Temporary Construction Change in existing rps;rlenrp multifamily, comm. or Tnrluc;.tr;al ~Iater servi ce / / hdtf./r 1) COMM,/INO, FEEDERS Install/alter/relocate rl;c;.tr;h_ fppdprc;. Wood stove/heater Of amps. r.f\ ISSUANCf OF PFR!HT TOTAL CMARGES J TOTAL CHARGES . TOTAL CHARGES WHERE STATE L'l~ REQUIRES that the Electrical work be done by an."Electrical Contractor, the electrical portion of this pernit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed apfllication 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 herein, and that un OCCUPAfKY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that ::111:(::::::t:::::~S ;;~~ees~~~;;nce with :::N:::~:55 ;;;:~'- DATE/Z-Z9-J7 FOR OFFICE USE DillY I, Zone Type/Const. Units Sq. Ftg. riain x Value Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value Flood Plain Stories Occy Group Sq. Ftg. Other x Value TOTAL VALUATION BUILDING PERHIT Charges anG Surcharges I Plan Ck. Comm/Ind 65%/Rlda Per Fee ------------ Plan Ck. Res 30%/Blda Per Fee /S 00 Fence _____L:...._.:-___ , 75 D6mo Isyste, T:1S Development I Cha roe (1. 5%) PLUMBING PERMITr: Charges and Surcharges ELECTRICP,L PERtHT Cha rges and Surcharges "Sidewa 1k A/C Pavi ng Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL Is ?s .. -- , . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I." Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. exarn21e- lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilin~/or forced air qas 2. example- waterheaterjelectrlcal/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, cneck add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) 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 abbreviated schedules you should consult the full schedules C, BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is.not authorized to sign the electrical label. --- 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 type written 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. I01iJ-3 / ?-;J 1-f1 V, FOR OFFICE USE ONLY Permit Clerk c:e-.-- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: name signature date . - . ~t9~ ;Jo FtRM-I'I /Uew 3~?- ~' r JACK HUNLEY PLUMBING, INC, 367 Hayden Bridge Way Springfield, Oregon 97477 746-6151 BACKFLOW DEVICE TEST REPORT FIRM NAMF' {'!A t"'. U I S A 'r-? .;> ADDREsS: -j Jf q 51' R , RP-', SIZE 7~J_ MODEL 7;l.5 ~9 SERIAL# , LOCATION OF DEVICE: J .,., q, A 1.'?~ 0 J:?" ~/p_ ;?-"., REDUCED PRESSURE DEVICES ~ PASSED: DOUBLE CHECK V ALVES Preslure ... to W ... .... .. ;: ! Check lit 1 Check #2 Drop AcrOSS t Check:D' UI <') I..., FAILED: Le.k~ Leatc.d TESTER: RI)~ CE RTI FICA TION # i~ tJo-l lbo, "DATE: "1 -/1- Y 1 Closed Tight C . Closed Tight I ) Relief Valve Opened at ,}. ;,/ New Parts and/or Repain Made If Needed Final TIt.t After Repairs C~efk crr Relief Closed Closed Val..,. Tight Tight Opened at I I I I TESTER # NAME: 'bl. DATE: I CERTIFY THE ABOVE TeST HAS 8~ PERFORMED. BY Ue~~ - tCOMPANY OFFICER) , ;()etJ JACK HUNLEY PLUMBING, INC. 367 Hayden Bridge Way Springfield, Oregon 97477 746-6151 BACKFLOW DEVICE TEST REPORT FIRM NAMF' t' J,1 r:-, VI I S A 'r L:: ;Z ; ~/ lJ'o'~v () ~i, ADDRESS: '''.' I _ .,<1" .i.:)( , '-r ./ Rt"', SIZE ~ MOD~L :;:~,7 t5 - ~ SERIAL # ~ I LOCATION OF DEVICE: / .,..,. .., " /"""',.fp~ DOUBLE CHECK VALVES REDUCED PRESSURE DEVICES .... '" w .... ... .. ;:: z Cheek #1 Check #2 L..ked C L...d I I Closed Closed Tight (I Tight I , New Parts and/or Repain Made If Needed Fiml Test Alter Repairs C~efk Closed Tight t I Ctr Closed Tight I I Pressure Drop AcrOU , C....k!:>" (~IOlbs, Reli.f Valve Opened 8' -," P f _ / Ibs. Reli.f Valve Opened a. 1. "II.. 0 R'M ' PASSED: ~ FAILED: TESTER: R(J~ cliii'FICATION ' # I~ ~ol DATE:?.. -1/-)11 TESTER # NAME: Ibs. DATE: I CERTIFY :HE ABOVe TEST HAS ~ PERFORMED. BY jl~e~ --, ICOMPANY OFF'CERI ~1 i tv ew_tJ Sf /'< 0 Nl , '1 ...... 0 JACK HUNLEY PLUMBING, INC, p4., ~ I lAJ-e ~'1 . ,. tc 367 Hayden Bridge Way r::...., <"rv~ 1 - ~pringfield, Oregon 97477 doll. ~ , 'f~~ 746-6151 BACKFLOW DEVICE TEST REPORT ~ /r /J (7r tl. '~~AJrl~: L'{p-.<..Y Yf~I" .D ESS: /:?t'){') - -41. 0/, /, SIZE /1 MODEL 90-5 ~I _ f~/ j-?L LOCATI~ PEVICE: af-- 7ft",;!. I R~EDPRESSURE DEVICES DOUBU CHEC"~LVES Chock C #1 # ~ I I LoMOd ~I ~f;r ;:'~~." lbo, 7 I DATE:)2-/d- -~<5 11.:'7.;/ , 6 I iP'-r' 7- vi !' ; , I-- . .,", PASSED: i I I, I: II II : ! ;j FAILED: .... ... w .... ~ . ;:: z , lbo, Ire) dJ~r CERT!fICATION f"':j ':l' - I #/:-:;1 .. ," , ' I ; I I .... Parts _Of Res-in - . IlNeeded Fw-.IT"t I CrI" CW Relief :;. AI... Closad Valve C_ Repairs Opened at NA : T;ght T;ght t I I I 1In, DATE: _iE':'FY TH~~EST HAs".. P/ORMED, IBY / /~ ---/:/"-:' L_ ,.. '-./ / ,