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Home My WebLink AboutPermit Plumbing 2000-9-28 'bOI../ . /J fJAtfJ CITY Uf SPRINGfIE.D COMBINATIOII APP.ICATION/PERMIT E/lERGY SOURCES: Heat \~ater Heater Range / Valu€. of Hark.: , INFORllATION liNt 726-3753 Sq. Ftq. I~ain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - I INSPECTION LINE 726-3769 Job Address -It Address Builtiinq Permit Info: Familv nesidence With I Describe Work(i.e., Attached Garaoe) Build Single ~ JJ .....:) c> legal Description Owner ~ ('d;_ -?-j..(<) rl , Construction Lender \'p.J- ,yJ.. ~1"'IOY 1 Phone (address) l~) ~/ , U (j Address UI:.S 1 l:iN r cArll {name} (1 ics. no.) (exn; res) (ohane no. I Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (li(:<;. nn.) (pxnirpc;) (ohonl'> nn_) Plumbina O(~k /! / I ( ~h t?~~ _ .nt\ tll' I ' Genera 1 Electrical ~fechan;cal P.U/1BING ELECTRICAL MECHANICAL NO. FEE rHi\Rr,F Nn ~~~ r~QQr.~ NO ~~~ rl-l.l1Qr.~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (] bath 1 Duplex (1 bath) each Addition.l bath New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt ~Iater service Temporary Construction Change in existing rp<:irlJ'Jll'"P multifamily, comm. or Tnr1lJ..tr;~l IOf amps. ICOMH./IND. FEEDERS I Install/alter/relocate rl;<:;trih. fPPrlpr<:; 10f amp~1 Appliance vent seoarate Stationary evap. cooler Vent fan with sinale durt Vent system apart from I' heating or A.C. Mechanical exhaust hood ~nd rllJrt Sewer Storm Sewer Wood stove/heater TOTAL CHARGES I TOTAL CHARGES WHERE STATE L.'I~ REQUIRES that the Electrical work be done by an. sh~ll not be valid until the label has been signed by an Electrical ISSUAlIcr OF PFRmT I 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 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 rw OCCUPANCY 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 comoliance with ORS 7nl.055 ~~~~~iS~ject. IlAI.1E(please print) }/f,L C!t."....l....--- SIGIlATUREh~~A. DATE f~u -cf";- FO~ OFFICE USE OIIL Y / Sq. Ftg. 11.in Sq. Ft9. Access Sq. Ftg. Other Zone Type/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value Fire Zone x Flood Plain x TOTAL VALUATION BUILDING PERfllT Charges and Surcharges , Plan Ck. Corrrn/lnd 65%/Bldo Ppr FpF' ------------""""PTan Ck. Res ./ 3D%/Bl do Per Fee 'Systems Development I Charqe (1.5%) . PLU'lBIIIG PERMIT . / Fence Charges and../ ------------ Surcharges . D~lf1o ELECTRICAL PERlm Charges and Surcharges 'Sidew.lk AlC Paving Irotal Comb. Permit MECHANICAL PERMIT Charges and Surcharges ~-----------, Curb Cut TOTAL Nt) Ft~- . '" . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference :11 6] 4J 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, 'etc. - 1. exarnole- 1250 sq. foot house, '500 sq. foot garaqe 2. examole- 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. example - remodel existing garage into family room 3. examyle - 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 OIVISION 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 issued. V. FOR OFFICE USE OIlLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .' PERMIT VALIDATION Permit Cl erk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: '. .. PLANS REVIEWED BY: . name signature . . date .