The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 1985-10-25 . ~ .. J IrISPECTION LIIIE 726-3769 . Job Address 1/( d 11/ ~ H Legal Descript'ion /i'J O.~ ,~5.3;:) t1/ I J 0 I Owner ~ Address Construction lender Address DESIGN HAr-' Primary Structural Electrical Mechanical CONTRACTORS Genera 1 CITY Uf SPRINGfIELD C0I1BIIIATlON APPLICATION/PERMIT EIIERGY SOURCES: Heat \4ater Heater Ranqe Va 1 U€ of \'/orl<: INFORlIATlON LINE 726-3753 Sq. Ftg. '.lain .~q. Ftg. Access. Sq. Ftg, Other ~ew Add Alter Rep. Fence_Demo _Change/Use _Other ~ \)1 --. \:) t\J o m~~) (j Phone 'i Lft, - Q(P6h Builc;ina Permit Info: Describe Work(Le.. BUild}Single Family nesidence With Attached Garaoe) ~~ ',~dLt:i2J , .. ~ . / ;:l-4 hJ;J A 1!arr- rY (/./ /; /' JL,J // (name) Phone (addres s ) (ahOM no. (1 ics. no.) (exn; res) (name) (addrps<; , (lies. no.) (pxoirp<;) (ohonp no.) Plumbino fJ// fiJ ~ ~f'-p'm~ '-.l -p(( - II) 5b Relocated building (new fi~. additional) S.F. Residence (l bath I Oup1ex (1 bath) each IAdditional bath I~Jater service I Sewer Electrical ~lechan;cal 110, Each single fixture WOd / I PLUI1BlNG ELECTRICAL MECHANICAL FEE" r.HAR(;F Nn ! l"Residence of SQ, FL New circuits alts. or ex.tensions 1="1="1=" I nUll:;or::1=" ~Jn I 1=1="1=" rl-ldlU::1=" I furnace/burner to BTU's Floor furnace and 'lent SERVICES Recessed wall Snacp hpatpr ann vpnt Temporary Construction Change in existing rp~ i dpncp Imultifamily, COITm. or Tnrlu~trial Appliance vent senarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from 'heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater Of amps. Storm Sewer Jt1dri~ ~VL/.JtnJ ~p.~Tu:;.. COMM,/INO, FEEDERS Install/alter/relocate rH<:;trih fpprlpr<:; ID 00 Of amps. I '-1(0 140 1 I ISSUANCE OF PFRI1IT TOTAL CHARGES /0, tfo TOTAL CHARGES TOTAL CHARGES WHERE STATE L;,\\~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work oerforrned shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Ore(]on pertaining to the work described herein, and that lW OCCUPArKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Goard 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 and employees who are in compliance with ORS 701.055 will be used on this project. IlAlIE(please print) lJETf: R t H It fll\J SIGIlATURE j tK ~ FOr. OFF I CE USE OIlL Y , Sa, Ftg, rlain Sq. Ftg. Access Sq, Ftg, Other J <;t -Z -. ~ '-!:l' :z '" t :) ~ Zone Fire Zone Flood Plain ~ VI ~ -.. BUILOIlIG PERI.IIT Charges an~ Surcharges PLU/1BING PERMIT Charges and Surcharges ELECTR I CP,L PERI:IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges DATE,t,-.1S-e- , Tyoe/Const. Bedrooms Stories Units Ocey Load Occy Group x Value Value Value x x TOTAL VALUATION Plan Ck. Comm/lnd 65%/p,ldo PE>" ~"p ------------ Plan Ck. R-es------- 30%lBI do Per Fee ({) OV Fence ------------ ,t(V D~mo I Sidewal k ------------1 Ale Paving ____________1 Curb Cut I Systems Development CharQe tl,5~) , ITotal Comb. Permit I II?), -1-0 I I TOTAL J ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Applicant to furniSh A. Job Address B. legal Descriptlon 1. example- Tax Lot lOa, Lane County Map Reference 11 oj 43 2. exam~le- lot 1. Block 3, 2nd Addition to ~pr'ngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electricaJ/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. examjle - 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 ~taff 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 AND CHARGES ON THE SCHEOULES ' O. 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. --- Ill. 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. 05SJi Pf (~ ~ (D / {}- V, FOR OFFICE USE ONLY Permit Clerk (~ 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 . .