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HomeMy WebLinkAboutPermit Plumbing 1985-12-9 n ._O:S-5~-q'Z-OCZOO l:ft:uuu-/ ,,' /'.~ fl), f-} Phone 1't/-J ,5:?~ .l.v--:,>,z 0'" ':D\ \ I IrISPECTION LlIIE 726-3769 Job Address Legal Description Owner Address 70,;( Construction Lender Address UI:.SIGN II:.Ar~ Primary Structura 1 Electrical Mechanical CONTRACTORS Genera 1 /fJM Plumb;no Electrical "lechanical NO, Each single fixture '10;).. (name) (name) PLUIIBING Relocated building (new fix, additional) S.F. Residence (l bath I Duplex (1 bath) each Additional bath ~Iater service ~[f Sewer Storm Sewer ~ 6u.l{1 !0:J 'dtuke-- \ LiZ . ~(& CITY Uf SPRINGFIELD ~ COMBINATION APPLICATIONfPERMIT EIIERGY SOURCES: Heat \~ater Heater Range ValuE of Hark.: ~ 1 "'-.... -, IGo K INFORlIATION UNt 726-3753 Sq, Ftg, I,'a i n ~q. Ftg. Access. Sq, Ftg, Other New Add Alter P.ep, -Fence Demo Change/Use Other- - #/1 Builciina Pennit Info: Describe Work.(Le.. Build Single Family nesidence With Attached Garaae) /31F uJtt7it ~ /a.- rMa:ft:lf bdddltnJ rI/,V'iL.u I Phone (address) (lics. no.) (exoires) (ohone no.l (address) (l ic~<;. _ nn.) (pxnirpc;) (ohnnp nn_ ) ( J ./iA1Ud / /01/d V lit! ') .../ ELECTRICAL MECHANICAL FEE r.HARGF Nn I I-Residence of SQ, FT, INew circuits alts. or extensions . I SERVICES I ~H I nlARh~ Nn_ I ~~~ rl-lARh~ furnace/burner to BTU's ,/ Floor furnace and vent Recessed wall I ~o~rp hp~tpr nnrl vpnt II) rJtJ !TempOrary Construction IChange in existing rP'l j <1pn('p Imultifamily, COl11T1. or Inrlu<;tr;~l IOf amps. lCOMM,fINO, FEEDERS I Install/alter/relocate rl;c;trih. fppdprc; jOf amp~ Appliance vent SeD!lrate Stationary evap. cooler Vent fan with sinale duct Vent sys tern apa rt from I heatina or A.C. Mechanical exhaust hnnd and durt Wood stove/heater I/O ,0 ~ ~ ISSUANCe OF PFRf1IT TOTAL CHARGES ;.-:( 60 I TOTAL CHARGES I TOTAL CHARGES WHERE STATE L'H REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication 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 rw OCCUPAHCY 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. SIGNATURE ~:P/~LA /dA~- NAME(please print) kOB8?-r ~H-EREI2' DATE FOr. OFFICE USE, DIlL V Zone Type/Const. Units Sq, Ftg, t1ain Fire Zone Bedrooms Occy Load Sq, Ft9. Access Flood Plain Stories Occy Group Sq, Ftg, Other BUILOING PERfllT Charges an~ Surcharges PLUI1BING PERMIT Cha rges and Surcharges ELECTRICAL PERI:IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Value Value Value x x x TOTAL VALUATION , Plan Ck, COIlIDf!nd 65%/81 do PI'''''' l=03p ------------ Plan Ck. Res 30%fBldo Per Fee ______~~_ Fence .60 D6mo 'Sldewa 1 k 'Systems Development ' Charoe (1,5%) " A/C Paving ____________1 Curb Cut I Total Comb. Permit I I TOTAL /5&0 . . c. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Applicant to furnish A. Job Add'ress B. legal Description 1. example- Tax Lot 100. lane County Map Reference II oj 43 2. examele- lot 1. Block 3. 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources ~ 1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electnca (lor solar E. Square footage or valuation, etc. 1. examele- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. checklruew - if addition, cfleck 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. exam~le - 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, BUILOING 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 issued. 6 b I,ps1G; ~)~/) ,f::,L) \f~ 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