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Home My WebLink AboutPermit Plumbing 1985-1-11 1 INSPECTION LINE 1726-3769 Job Address 'Cl\~ .(yJ' 'A: KloQL . Clf' Uf SPRINGfIELD fOMBIIIATION APPLICATION/PERMIT . INfORlIATION liNt 726-3753 Sq. Ftg. I,Iain ~q. Ftg. Access. Sq, Ftg. Other .. Uew Add Alter f'.ep. Fence_Demo _Change/Use _Other legal Description , E!IERGY SOURCES: Heat Hater Heater Ran!1e _____ ValuE of Work: ownerl.'>\'Im. 9..X1'\ ' \ \~~. dd \."\ \~~C> Buildina Pennit Info: Describe \~ork(Le.. Build Single A rest ~ - ~ ~~ Familv ~esidence Wi~h Attach~d GaraQ~) Pllr\Qr\O l'CP. ()~ (\~[\~l\~.eJ . Construction Lef'fr I ("<a~-5"ddI.~,,~fj.J' -. ~Q. l 0 0&n)\f'Q._ Phone ,r" "-~ ~1. 9- {address} ~ (1i~. no.) (exoires) ., $ Address Ut~ 1l.:iN TEAf1 (name) . (ohane no. Primary Structural El ectri ca 1 Hechanical CONTRACTORS (namel (address) (1 ;r:~ nn.) (F!xo;res) (ohnnp no.) Genera 1 Plumhinn lS.lt. .~~ ~ Electric"l 7 ~1. . ~tI ~., _M'" ~._ ".r-- ~lechanical PLUr1BING ELECTRICAL MECHANICAL NO. ffF r.HARr,F-,," ~n r\.l.qftG,[ ~m . I=H nl~. SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (] bath) Duplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~nnrp hPntpr ~nrl vpnt Tnrlustrinl Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood ilnd dur:t Wood stove/heater Additional bath Sewer Temporary Construction Change in existing rp'2 i dJ'nrp fA..l"'~&7-~1; or ~/ater service Storm Sewer Of /.,bs~ I DO amps,l COMM./IND, FEEOERS Install/alter/relocate rl;c;.trih_ fpprlprc;. Of amps. I I TOTAL CHARGES TOTAL CHARGES WHERE STATE L\lJ REQUIRES that the Electrical work be done by an. shall not be vali~ until the label has been signed by an Electrical ISSUANCE OF PFR!11T TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division 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 all work oerformed 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 IW OCCUPA[~CY 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 sis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will b ed on this project. Zone Fi re Zone Flood Plain " / Type/Const. Bedrooms Stories Units Occy load Occy Group om/-il-d'S- rWfE(please prin~ ) :Ji /1"'73. !-ItA ( ~€ <t f1ain Sq. Access Sq. Ftg. Other x x x Value Value Value TOTAL VALUATION BUILDING PERIIIT Charges ant: Surcharges I Plan Ck. COl111llInd 65%/B1dCl PJ'r Fpp Plan Ck. Res 30%/Bldo Per Fee Fence I Systems. Development I Cha rqe (1. 5~) . PLUMBING PERMIT -L~.<:JC:) Charges and - - - ~(') Surcharges ~~;;~:;C:~/ERrm. -JO-,- . 0 Surcharges rY1JfJ~) . () MECHANICAL PERMIT Charges and Surcharges Dt1mo 'Sidewalk A/C Paving Total Comb. Permit TOTAL J~.i) Curb Cut . COMBINATION APPLICATION/PERMIT (CAP) I. Appl icant 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 sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy' Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examoJe- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. examp'le- if new project. check new - if addition, check add. etc. F. Building penmit information: 1. example - 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. DESIGN TEAll 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. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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. --- 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION A\O~ - ~0 Jv~\\ 0P t \ ~'0 1;\\ 0-- ~ ~ Permit Clerk ~lJJdJ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date .