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Home My WebLink AboutPermit Plumbing 1987-12-8 Job Address \ ?'s"?-' . S^ 'A" CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat ('Sater Heater Range ValuE of f~ . INFORt1ATION LINt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - :x> -.:J o ~ w ~ I I I I no. ) I INSPECTION LINE 72.6- 37 69-. Legal Description Owner ~j .3A'~ &J/\-i t"..J.....- Address .:2, '83,O{) ML<t\L/Yl?[ . , constructio~~ I)e~ 0j ') \I .,...., .cF..'IJ.. ~l.hone Q Builciinq Permit Info: Describe Work(Le., Build Single Family nesidence With Attached GaraQe) ~Ar ..t PlovV Address UI:.~HiN TEAr~ {name} Phone (address) (l ics. no.) {exoiresl (ohone Primary Structural CJ'JPl <'2."0 Electrical Mechanical CONTRACTORS (name) (address) fl ics. no.l (pxoires 1 (ohane no.) General Plumbinq .n \Vl Electrical ~1echanica1 PLUI.IB I NG ELECTRICAL MECHANICAL NO. . FFF cHARr" Nn ~H' r~AI:U::~ NO_ ~~~ r~AIU::~ Each single fixture Residence of SQ. FI. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (1 bath 1 Duplex (1 bath) each New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall Soace henter nnd vent Storm Sewer Of amps. App 1 i ance vent seDarate I Stati onary evap. cooler I Vent fah wi th sinale duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and rllJr.t Wood stove/heater Additional bath Sewer Temporary Construction Change in existing resident::'" mult.{family, COITm. or Industrial \>Iater servi ce . tv...r ~ j:-In vJ 1~ 00 COMM./IND. FEEDERS Install/alter/relocate di<;trih_ fppr!f'r<; Of amps. .s elJ 0 "IS .- ~ j~~ 'S, ) - ~'1 I SSUANCE OF PFRrHT , TOTAL CHARGES Electrical Contractor, the electrical portion of this per~it Supervisor and returned to the Building Division TOTAL CHARGES . TOTAL CHARGES WHERE STATE L\\~ REQUIRES that the Electrical work be done by an. shall not be vali1 until the label has been signed by an Electrical I HAVE CAREFULLY EXM1INED 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 Derformed 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 NO OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 OP.S 7nl.055 will be used on this project. Zone Fire Zone Flood Pl a i n Tyoe/Const, Bedrooms Stories Units Occy Load Occy Group SIr,NATVRE FO~ OFFICE USE OIlLY Sq. Ftg. t1ain Sq. Ft9. Access Sq, Ftg, Other om I ;).J {) h'7 HAI.IE(please print) x x x Value Value Value TOTAL V ALVA TI ON BUILDING PERMIT Charges and Surcharges 1 Plan Ck. Corrm/lnd 65%/Bldo Ppr Fee ------------ Plan Ck. Res 30%/Bl dQ Per Fee ISystems Development I Charqe 0.5%) PLUMBING PERMIT Charges and ~ Surcharges ..) .___JS"Dllu .7S Fence ELECTRICP.L PERIHT Charges and Surcharges Demo Sidewalk A/C Paving ITotal Comb. rermit I I TOTAL 1'S.7S , 11ECHAN I CAL PERMIT Charges and Surcharges Curb Cut . . ~ 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 11 03 43 2. examDle~ Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qas 2. examyle- waterheater/electrical/or solar E. Square footage or valuation, etc. ----- 1. example- 1250 sq. foot house. 500 sq. foot garage 2. exam~le- if new project. check new - if addition. check add, etc. ~. Building permit information: 1. example - construct single family house with an attached 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 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 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. V. FOR OFFICE USE ONLY (00~O (Z-~~9? ~~ 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