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HomeMy WebLinkAboutPermit Plumbing 1985-5-9 ~ / . I INSPECTION LItlE 726-3769 Job Address c2 50 N, 'A J< fr-..u.F CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater . INFORt1ATION L1I'H: 726-3753 Sq. Ftq. 1.lain :q. Ftg. Access. So. Ftg. Other flew Add Alter Rep. --Fence Demo Change/Use -Other-- -- cJ O<J CV) (J ~ \)a legal Oe5cription Address J r"->-J.rl.->le.JrO ~ &,,^-y ..:250 N'U~ $.:f^~ I Phone A pl!'o. Ranqe Valu€ of Hark.: Owner BuiloinQ Permit Info: Describe Work(;.e.. Build Single Familv nesidence I-lith ,lI,ttached l'iaraae) 'l'-lf.-'i'lss/ Address UeSiG" iEAl1 (namel Phone (addrp'is) r:J r&u..LfoU} ~".,~-t; ~ ~~ Construction Len~er (lies. no.) (exn; res) (ohane no. I Primary Structural Electrical Mechanical CONTRACTORS (name) (addrf'~s ) (l ics. nn. \ (plmirf's) (ohnnp M.' Genera 1 Plumbina -(~- $:-~ Electrical f.lechani ca 1 PLUI1BING ELECTRICAL MECHANICAL Each single fixture I FFF I rHJ\Rr.E NL1 I ~n: Res; dence of rl-l8.RG..E.. .llJh.1 I 1="1="1=" I r ---1:ill.:.1 SQ. FT. furnace/burner to BTU's Relocated bUlldlng (new fix. additional) New clrcuits alts. or extensions Floor fu rnace and vent S.F. Residence 11 baUd Ouplex (1 bath) each SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer Of amps. Apo 1 i ance vent ~eoari'ltp Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hnnd and duct Additional bath Hater servi ce Temporary Construction Change in existing rpS; rl.f'nc~ multifamily, comm. or Tnnu<;;trii'll Sewer ;).. ~..,,-,kU~ f~_ I I I S.oP'iO.nO COMM./IND. FEEOERS Install/alter/relocate ni<;;trih. fppdpr<;; Wood stove/heater Of amps. I SSUANCr OF PFRIHT TOTAL CHARGES WHERE STATE L'W REQUIRES shall not be vali1 until the /0.00 TOTAL CHARGES that the Electrical work be done by an Electrical label has been signed by an Electrical Supervisor TOTAL CHARGES Contractor, the electrical portion of this permit and returned to the Building Divlsion 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 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 rw 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 DRS 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. IJAl.1E(please print) .it?,lJ O~ "15:164 SIGlIATURE Q",,^ rnA~ OATE ;- .-..... FOR OFFICE l.r~~ Oil! v '" Zone Type/Canst. Units Sq. Ftg. riain / x Value Fire Zone Bedrooms Occy load Sq. Ft~. Access x Value Flood Plain Stories Dcc'y Group Sq. Ftg. Other x Value TOTAL VALUATION PLUt1BING PERMIT Charges and Surcharges , Plan Ck. Corrm!lnd 65%/Bl do Ppr I="ee ------------ Plan Ck. Res 30%/Bldo Per Fee 10.. () b Fence ------------ . '-fa Demo lSystems Development 1 Charae (1.5~) BUILOING PERMIT Charges and Surcharges ELECTRICAL PERI:IT Charges and Surcharges Sidewalk A/C Paving ITotal Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut I I TOTf<L ,I" . . _ 5'/0. '"Zio . . 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 1/ uj 43 2. examDle- Lot 1. Block 3. 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. examole- waterneater/electrical/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 gar~ge 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 Oivision 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 OIVISION 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 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. ~ll other fees and charges are due and payable when the permit is issued. ~o ~~~ ~ ~;9 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 . I