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Home My WebLink AboutPermit Plumbing 1988-1-12 .....----- --- ,,/ . A 5.-1' CITY Uf SPRINGFIELD COMBIIIATlON APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Ran!'le~_ ValuE of Hark: . INfORltATION LINt 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. Sq. Ftg. Other ~ew Add Alter Rep. -Fence Demo Change/Use Other- - I' INSPECTION LItlE 726-3769 Phone I BuildinQ Permit Info: Describe Work(Le.. Familv nesidence With Attached GaraQe) Build Single I 1J DQ 8 w -t::.... Job Address \ So () Lega 1 Oeser; pt ion 'S, Owner \r\. . I \0. JVv"v>~ Address - SA-vn"'d T,,,",,-J. Construction lender V-AU r:1 ",A J Address DtSl(ir~ TEAr., {name} Phone {address} (1 ;cs. no.) (exo;res) (ohone no. I Primary Structural 4';<"), ,..,......, ,.,r) ...::>:J -- Electrical Mechanical CONTRACTORS (namel (address) (lies. no.) (exo;res) (ohone no.) Genera 1 Plumbina Electrical ~1echan;cal PLUI,IB I NG ELECTRICAL MECHANICAL -1!Q.,. FEE rHARr,F NO 'U-..cJJAB.G.E. NO. ~~r: nl~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (1 bathl Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~~p hp~tpr ~nn vpnt Storm Sewer Of amps. App 1 i ance vent seoarate Stationary evap. cooler Vent fa.n wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hnnd and duct Sewer Temporary Construction Change in existing rp~ i dJtncp multifamily, COlTlTl. or Induc;trial ~Iater service 00'\ CO~1./INO. FEEDERS Install/alter/relocate dic;.tril'L fppnprc;. Wood stove/heater Of amps. "'ll tv ,K F'\,\vJ TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali~ until the ISSUANCE OF PFRI1lT TOTAL CHARGES TOTAL CHARGES that tile Electrical work be done by an.-Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical 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 all work oerformed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the laws of the Sta te of Ore~on perta i ni ng to the work descri bed herei n, and that UO OCCUPAIKY 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 7nl.055 will be used on this project. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories Units Qccy load Occy Group SIGNATURE FO~ OFF I CE USE DIlLY Sq. Ftg. riain Sq. Ft9. Access Sq. Ftg. Other OATE~ IWIE(please print) x x Value Value Value x TOTAL VALUATION BUILDING PERflIT Charges and Surcharges I Plan Ck. COlllll/lnd 65%/Bldo Ppr Fpe ------------PTan Ck. Res 30%/Bldo Per Fee ISystems Development I Charoe rl.5~) , PLU!1BING PERMIT Charges and Surcha rges ~ __J5-,QQ___h 5;'J, .is Fence D~mo ELECTRICAL PERIHT 'Sidewa 1 k Charges and - - -- - - --- --- Surcharges A/C Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL IS-IS , , . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Appl icant to furnish A. Job Address B. Legal Description 1. example~ Tax lot 100. lane County Map Reference II oj 43 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 ceilin9/or forced air Qas 2. examole- waterheater/electricaltor solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-nfw - if addition, check add. etc. ~. Building pennit information: 1. example - construct single family house with an attached garage 2. examyle - 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 TE~I 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 issued. )D1~9 r-rv1Z V. FOR OFFICE USE ONLY Permit Clerk c~ 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 . . . " reo f~ /( ------""7- NCW/ 3JYJ ,N (..v.".."",.) 51)'( a N J ;;z. )., () '-<.I-eS'1JACK HUNLEY PLUMBING, INC, ;j.. 'J.e '" S2 367 Hayden Bridge Way I!:."-I '"""e -' - Springfield, Oregon 97477 o.cz. '7 , ~,,__ 746-6151 BACKFLOW DEVICE TEST REPORT C!~'~I ADDRESS: . /..fr'} 0 - ~- a J SIZE / /1 MODEL905 ~t SERIAL.J-16-cz.L LOCATION OF DEVICE: a r /11.,.& - FIRM NAME: a4dJ~_ REDUCED PRESSuRE DEVICES ;-- PASSED: DOUBLE CHECK VALVES. P....... OnlP_ Choca /rZi4 CERTIFICATION ./3 "2,~-1 DATE:/2-/6 -9'5 FAILED: ... .. .. ... .... .. ;: ! ChocI< .. Laaed ( I CIwd< .2 ~I Ibo. Relief V.... ()poMd .t C"'- T;ght IV" ~ ' .2't- '- C"-d T.., cL-r' t;~# " / S;>( P'lr~ Ibs. _ Ports -f!' _in - ,.- F...... Test crt CW R.ltef TESTER III AI.., V.... C...- Clmod R...n Opened .1 NAME: T....t T....t ,I I I I ,...., DATE: _~V TH~EST HAS? P/ORMEO. BV: / /s./ ----/ ./'"lc:; ICOMPANV OFFICERl ~/,--/ / .