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Home My WebLink AboutPermit Plumbing 1988-2-17 ( nau.e ) Phone (address) INFOR11ATION U~t. II 726-3753 Sq, Ftq, 1,Iain ~q. Ftg. Access. Sq, Ftg. Other ~ew Add Alter Rep. Ranqe --Fence Demo Change/Use Valut of Hork: Other- - Dl) ($.&'&3. ~ '. ,^ Builaino Permit Info: Describe \~ork{i~e.. Build Single l ~ Familv Ilesidence IHth ".ttached Garaoe) N ~Y'l.n'~ ~ S;~ ~.Mhh""~ j;;R ~~;'&P j2,$:Pc.4r -6s7: I (ohone no,( . .. IrISPECTlDN LINE 1 726-3769 . CIlY OF SPRINGFIELD COMB IllATION APPLICATION/PERMIT E!IERGY SOURCES: Heat Hater Heater ~ ~ Job Address 702 Nc:>RrAt A ( 57 Legal Description /7-0 "'r-?)"-"f':< ,o:?<:><::>c=> Owner ~(A--;t{~NC~ Address ;;? 0 -z:;> r. . r>C>JC , , _<)'PPLr>. /0/< Construction Lender _-:)c: H ,c~ ~/i<> &,/, Phone ') </?- ;riu~,) Address DESIGr~ lEAJ1 (l ics. no.' (exoi re",) Primary MCj7J/~~ Structural Electrical Mechanical CONTRACTORS (name I General fM//':"'P/5# {addre",,,,l l1in. no.' (exoirp~l (ohnnp nn.' ~8S-/?~ Plumhinn Electrical "7d,.T;Z?/c~fr._ M~<;h~ni~~l Pl.lJIlBHlG ELECTRICAL MECHANICAL NO,' ffF rHAaf.F Nn ~~~ r~~Rh~ NO_ I=FF rHARr,e.. SQ, FT, furnace/burner to BTU's Each s'i~le fixture Residence of Relocated builrling (new fix~ additional) ~ew circuits alts. ~ or extensions dAf'E ttC/2C~/r /S-:"" Floor furnace and vent S,F, P.esiden"" (] bathl Duplex (1 bothl each Additional both SERVICES Recessed wall ~o~rp hp~tpr ~nrl vpnt ISo' Storm Sewer ~,<W Of amps, Appliance vent !,poo'lr.'l.tp Stationary evap. cooler Vent fan with ",;nole duct Vent system apart from heatina or A.C. Mechanical exhaust hood and durt Water service Temporary Construction Change in existing rpc;irlpnrp multifamily. comm. or InrllJ<;.trial Sewer COMM,/IND. FEEDERS Install/alter/relocate di,trih. fppdpr<;. Wood stove/heater Of amps. TOTAL CMARGES WHERE STATE l,~ REQUIRES shall not be valij 'until the 5".0, - TOTAL CHARGES that tile Electrical work be done by an label has been signed by an Electrical ISSUANC, OF PFR'1IT /5:~.> TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE u.REf11llV EXMlINED the completed aprl;cation 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 aoo the Laws of the State of Oregon pertaining to the work described herein. and that rlO OCCUPAfKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderls Board is in f~ll force and effect as required by ans 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. IW'1E(please print) RlDO V lC10R rt3FiliJTTISIGIlATUR,tli.lvdE:;jio1it: DATEce-/7-~!f Zone C:.G Fire Zone Flood Plaln TY?e/const.&v/~7 Bedrooms Stories Units Occy Load Occy Group FO~ OfF! CE USE Oi~L Y Sq, Ftg, 11ain x Value Sq. Ft~. Access x Value Sq, Ftg, Other~h,,,,,:.,,r~,_..-~alue TOTAL VALUATION /~~3. - BUILDING PERI,IlT PI an Ck. Corrrn/lnd Charges an~ ------------ 65%/Bldo Ppr ~pp Surcharges Plan Ck, Res 30%/Bldo Per Fee PLUI~BING PERMIT 5"E? -- Fence Charges and ----- _...:_--- Surcha rges "2,$"O Demo ELECTRICAL PERfilT 4- Sidewalk Charges and ----- ...::---- Surcharges , 75 Ale Paving MECHANICAL PERMIT "".,~ 'f /7'1' Charges and Curb ut ------------ Surcharges ~,2,~ Systems Development Charqe (1.5~) '2&'2. <9 S /31,$"0 ,%,/0 TOTAL :2 ~8.B:5'" 53a~ T~~al Comb. Permit . . . " 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 II 03 ~3 2, ~xample- Lot \, Block 3, 2nd Addition to Springfield Estates 'C: Name. etc. of owner and construction.lender D. Energy Sources 1. examole-< heat/electrical ceilin~!or forced air Qas 2. example- waterheater/electrlcal/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, check add. ete. F. Building permit information: 1. example ~ construct single family house with an a ttached 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 TEM1 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 fu 11 schedu 1 es C, BUILDiNG DIVISION STAFF WILL FILL OUT ALL FEES ANO 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. --- 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. " (6 q7q t -;)-10/ $ , V. FOR OFFICE USE ONLY Permit Clerk LV PROJECT CONDITIONS TO BE SATISF~ED BEFORE GeCUII\IIl-I: "<!!7'i:M~T /~:>CJ.4'-,;Jj/c.cS ~r.:;N~ ,.2/~y",c-,(,C>P/7?~Ar7 ~,z:e:/?7C-/YT ~~ :8'~ jZiE//C/VEZ::> ~/~...R M /GsUA-A/C'e: C::=:>~ ;2>~/>.?......?-S. Permit applicant exempt from registration with the Builder's Board because: " , Additional ~roject Info~ati~n: . PLANS REVIEWED BY: . 'name- 'l.-&RAlE fiEZ;'~ 5 iiinature/Z_...-- _~.--r> // . ,I" ....... ' date //~-z-rB? . ,. ,>. ..',.--="