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Home My WebLink AboutPermit Plumbing 1988-7-13 I INSPECTION LINE 726,3769 . CI1Y Uf SPRINGfIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat toIa ter Hea ter Range . INFORIIATION liNt 726-3753 Sq _ Ftq. 1.Ia i n ~q. Ftg. Access. Sq. Ftg. Other flew Add A 1ter Rep. -Fence Demo Change/Use -Other- - Owner /L/ 1/ (; fJ ht7h J4 Legal Description /1 D 3 ;:);;., 3;) () 7SvV 'I/~ Address ? _33 TtLt-,/1M till( Afthone ~cu'..If..L I 1-1//7 Job Address Construction lender " ~ OQ o ~ o (0 \yJ _C (/ I Value of Work: I Buildinq Permit Info: Familv nesidence With f-.Jr,~ J;u~ Describe Work(i.e.. Build Single JI,ttached Garaae) )- (kurf'A Address DESIGN TEAM In_) Phone (address) (1 ics. no.) (exnires) (ohane no. Primary Structural Electrical Mechanical CONTRACTORS [""""" Ol/?~ (address) bx- c..cuJ ceIi~---a (l ie,. no.) (pxnirpc;) (ohnn/" no.) General Electrical 0."';;1] - C;-:.f>Z) /I/\~ Plumblna ~1echan;cal i't\ll'lllIl\1G ELECTRICAL MECHANICAL NO_ fEF t:HARGF Nn ~c~ r~ARr.~ NO ~~~ rI-lAIU~j:" SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fi~. a~itiona~) New circuits alts. or extensions Floor furnace and vent S. F. P.es;a<:e (j b.t'" Duplex il botb) each Additi""",l bath SERVICES Recessed wall SOnrp hPntpr nnn vpnt \:111 ,,~ , -~ I"Y 1 1 ITempOrary Construction IChange in existing rpc;;npnCfl Imultifamily, COrrID. or Innuc;tr;nl 10f amps. COMM./IND. FEEDERS Install/alter/relocate d;c;tr;h. fppderc; Appliance vent seoarate Stationary evap. cooler Vent fan wi th s;nole duct Vent system apart from heatino or A.C. Mechanical exhaust I1nnrl and duc t Water sef"'iice Sewer Storm Sewer Wood stove/heater Of amps. ISSUANCE OF PFRrl1T TOTAL CHARGrs TOTAL CHARGES TOTAL CHARGES WHERE STAff l"\'\D REquIRES that tile Electrical work be done by an "Electrical Contractor, the electrical portion of this pernit shall not be vall'! until tile label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE tARlfUlLY EXAMINED the completed apr1ication 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 of Springfield and tlle laws of the State of Oregon pertaining to the work described herein, and that I'W OCCUPAfKY will be made of any strut:ture 'Without the permission of the Building Division. I further certify that my registration with the Builder's Board is in f~ll forc~ and ~ffect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon, and that only subcontractors and ~loyees who are in compliance with ORS 701.055 will be used on this project. Zone Fire Zone Flood Plain Type/Canst. Bedrooms Stari es flIlFTC. D'DN '" LDSIGtlATURE t1t}~ FOn OFFICE USE Oill Y Sq. Ftg. f1ain Sq. FtD. Access Sq. Ftg. Other 71IaL [JehAJd OATE)-/J-8R NAr.IE(please print!vlE LISSA Units Occy Load Occy Group x Value x Value x Value TOTAL VALUATION BUILDING PER/lIT Charges an~ Surcharges - Plan Ck. CommlInd 65%1B1 do Ppr Fpe ------------ Plan Ck. Res 30%lBlda Per Fee (5 C"'D Fence _nn_ -~7s=1 D~mo S1dewalk Systems Development Cha rae (I. 5~) PLUMBING PERMIT~ Charges and Surcha rges Cit P ELECTRICP.L PERr~IT Charges and Surcha rges A/C Paving ____________ Curb Cut 1 '\\ I ~~ 1 ('8.00 l!c. Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges I , 901 TOTAL 11.b5 . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. exarnple- lax Lot 100. lane County Map Reference 1/ uj 43 2. example- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examEle- heat/electrical ceilinqjor forced air qas 2. example- waterheater{electrlcal/or solar E. Square footage or valuation, etc. - 1. examDle- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - if addition, check add. etc. F. Building permit information: 1. examele - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. example - 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. OESIGN TEAM ANO 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO 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 wi 11 prepare a type wri tten 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. (l q riD 1~ 17 ~r1 V: FOR OFFICE USE ONLY Permit Cl erk cL PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant.exempt from r~gis~r~tion with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date I