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Home My WebLink AboutPermit Plumbing 1986-1-9 l1,fiY.kIwIzU'a;tiClv . y I i INDUSTRIAL COMMERCIAL RESIDENTIAL Phone 687-1351 1299 Ocean St. E~Qr~~g 7402 ~l( rft1 ~ BACKFLOW DEVICE TEST REPb'R Pu b Ii SA/Ale{ N. fJ:jJ --.J 8:15'Y FIRM NAME; A",Ti../r :?;< (') Pressure Drop Across Check 7 Leaked Leaked Closed Closed / Relief Tight ,....( Tight (V,' Valve Opened at 7,a, 3,'" .P.~ SERIAL # D .;;{ 3 '/4 LOCATION OF DEVICE; 80/ /E4'"" RrfI. BY; I PASSED; y'" I FAILED; REDUCED PRESSURE DEVICES lb., TESTER; ~:,~o?Jl-;jJjLt # tPJ- ;;;.,q() lb., DATE: 1- 9- Rt:. C~efk CJteik Relief TESTE R # Closed Closed Valve Opened at NAME; Tight Tight ( , ( , IbS.1 DATE: I CERTIFY THE ABOVE TEST HAS BEEN PERFORMED, /)..f/A.~'- ~, , '/'\. JO!? -# &COC>/9 ADDRESS' SIZE .3/ <i' MODEL , ~ III W ~ ..l .. i= z DOUBLE CHECK VALVES I Check #1 Check #2 New Parts and/or Repairs Made If Needed Final Test After Repairs (COMPANY OFFICER) Job Address .3 .::2.() AI, I-} CITY Uf SPRINGFIELD CGrlBHIATlON APPLICATION/PERMIT EilERGY SOURCES; Heat Hater Heater Ranqe ValuE. of Hork: __ ',WiNJJdf) INFORtIATION liNt 726-3753 Sq. Ftg. f.tain ~q. F'tg. Access. Sq. Ftg. Other New Add A 1ter P.ep. -Fence Demo Change/Use Other- - ~ ~ I~ ~ ., I INSPECTION LItlE 726.3769 . Legal Description Owner t1 ~ Address S2/J f/ J-L~~~ri AI, /J t!o Phone Buil~ino Permit Info: Describe Work(i~e.. Build Single Familv r.esidence With Attached Garaae) //~ I &'uklJ:ffxJ <- /J /J()J#~ l!le-u U' P' ./ f Construction Lender Address DESIGN rl::Ar~ (name) Phone {addressl (1 ics. no.) (exo; res) (ohone no.l Primary Structural Electrical I~echani ca 1 CONTRACTORS (name) (addrp~s) (l ir~. no.) (pxoirps) (ohnnp nn.) General Plumbino ffAAMIh1.. PjLltlj~ J Eof/t& c:2 () - 71/ PL3 o -=3Q.f6 0'61-/35/ Electrical /llechan; ca 1 " ,; PLUtlB I NG ELECTRICAL MECHANICAL NO, FEE r.HARf,F Nn !=H" I rI-lARr:;I= NO_ n=F' rI-lARr:;F SQ. FT. furnace/burner to BTlI's Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (I bath) each New circuits alts. or extensions Floor furnace and vent , , SERVICES Recessed wall SD~ce he~ter ~nrl vent 15m Of ICDMM./IND. FEEDERS I Install/alter/relocate rlic;tr;I'L fpprlprc:: IOf I I I amps. Appliance vent seaa ra te Stationarv evao. coo 1 er ~ , Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood and dud Additional bath Sewer Temporary Construction Change in existing res.; rlJ"ne:e multifamily. comm. or Tnnllstrirll ~Jater servi ce Storm Sewer 1J:j:ff:j ;:1.UJ0~ f)h.l /..u-.- Wood stove/heater amps. &'0 TOTAL CHARGES /5 !dJ TOTAL CHARGES WHERE STATE l,'I~ REQUIRES that tile Electrical work be done by an, shall not be vali1 until the label has been signed by an Electrical i% ISSUANCf OF PFRrHT Electrical Supervi sor I TOTAL CHARGES Contractor, the electrical portion of this permit and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed application for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and al' 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 fjQ OCCUPAr~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 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. Zone Fire Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy Load Occy Group SIGtIATURE...iJ..i.J., _: FO~ OFFICE USE OtIL Y Sq. Ftg. 11ain Sq. FtQ. Access Sq. Ftg. Other 4..J.! ,:j (/ Dm~/Rr IWtE(please print) W: I f..a - .7: I.J. 'co Ie x x x Value Value Value TOTAL VALUATION BUILDING PER/,HT Charges aOG Surcharges , Plan Ck. ____________ 65%/Bldo Plan Ck. 30%lBlda / s: ~ I Fence ---------;-G;,o-I D~mo I Sidewalk I A/C Paving COI11l1/I nd Per l=pp Res Per Fee "Systems Development Charoe (1.5%) PlU'~BING PERMIT Cha rges and Surcharges ElECTRICP,L PERt~IT Cha rges and Surcharges Total Comb. Permit tlECHANICAl PERMIT Charges and Surcharges Curb Cut TOTAL / S; 60 .. . 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 11 uj 43 2. example- lot 1. Block 3. 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinqjor forced air oas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 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. example - construct single family house with an attached garage 2. examole - 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 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 lssued. [b 1.0 5'b c\ &-- ~\\ ,9 ~(p orC) ~r ~ .. I V. FOR OFFICE USE ONLY Permit Clerk Cf/ I 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 .