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Home My WebLink AboutPermit Plumbing 1987-12-5 , I INSPECTION LINE 726-3769 , . CITY UF SPRINGfiELD C0/1BHlATlON APPLICATlONfPERMIT --- E!lERGY SOURCES: . Heat . \~ater Hea ter Ranqe lNFORt1ATION Lll'lt 726-3753 Sq. Ftq. 1,Iain ~q. Ftg. Access. Sq. Ftq. Other ilew Add Alter Rep. -Fence Demo Change/Use V~U~,?"I?~ Other- - Bu~lGinQ Permit Info: Describe Work{i.e., Build Single Family nesidence With Attached Garaae) . i ~ G ~ I\f\\ :5 e- )tf' _<)7: ...., Legal Description /~3~Z;>:<,..., p;J--/ " /.~ 6. 5' Job Address Owner, _D~~ VJ ~. 1/-:/ ...,., Address G~BS) / R 57": ;-_I,h:!.'),e?! _, C-t:-/?.;-".,.-c;.bA _ 4;.<;/~ Construction lender Address OESIGN TEAl1 (name) Phone (address) (lies. no.) (exoires) (ohane no. 1 Primary Structural Electrical Mechanical CONTRACTORS (name) (addresc; ) flic:s. no.) (~xoirpc;.) (ohonl'! M.) Genera 1 Plumbina~MS~~ ~//,E ~_ /He... Electrical 7":46-X 2._~ ~1echanical PlUIIBING ELECTRICAL MECHANICAL NO. FFF CHARGE Nn ~~~ r~dRr,~ NO, ~~l=' n.rAIU~r: Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (] bath) Duplex (1 bath) each INew circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~p hp~tpr ~nrl vpnt Storm Sewer );J~~FL$,I1,f 2. ~Y. '~-. p ,... --;" Of amps.l Appliance vent seoarate Stationary evap. cooler Vent fan with sin9le duct Vent system apart from heatina Dr A.C. Mechanfcal exhaust hood nnd riuet ~Iood stove/heater Additional bath Sewer Temporary Construction Change in existing rpc;jc:j'i'ncp multifamily, comm. or lnrlustri<ll ~later service COMH. flND. FEEDERS Install/alter/relocate distrib. feerlers Of amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the I I I ISSUANCE OF PFRIIIT /",- -- ~}. . TOTAL CHARGES TOTAL CHARGES that tile Electrical work be done by an..Electrical Contractor, the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXArlINED 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 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 im OCCUPArKY 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 OP.S 7nl.055 ~l be used on this proje~ WAIIE(please print)~J\/A 1 d /?/p/~f"">N &/\16' SIGNATURE 6fJ..-<ry0 /1 ~ DATE!) :J'-?;J FOP. OFF I CE USE 0111. Y (/ Sq. Ftg. tiain x "Sq. Ftg. Access x Sq. Ftg. Other x Zone Fire Zone Flood Plain Type/Cons t ~ Bedrooms Stories Units Occy Load Occy Group Value Value Value TOTAL VALUATION BUILDING PER~l1T Charges and Surcharges Plan Ck. 65t1Rlda ------------ Plan n. 30UBlda __n{s:.~_ Fence . 7v Dcmo _ ___ _ _ ___ __J 'Sidewalk I AfC Pay; n9 I Curb Cut I COIl1ll/lnd Per FpE' R-es Per Fee syste,ms Development Charae (J.5~) PLU!~BING PERMIT Charges and Surcharges I ELECTRICAL PERI~IT Charges and Sur..cha rges ITotal Comb. Permit I I TOTAL IS 7S- I~ECHAN I CAl PERMIT Charges and Surcharges . ., COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference 1/ oj 43 2. example- Lot 1. Block 3. 2nd Addition to ~pr'ngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinQ/or forced air I 2. example- waterheater/electnca(/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house. 500 sq. foot garal 2. exa~le- if new project. check-new - if additioi check add. etc. ~. Building permit information: 1. exam~le - construct single family house with an attached gar~ge 2. example - remodel existing garage into family rl 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 TEAll 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. Abbreviated Plumbing, Mechanical, & Electrical Schedule: 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 adjac1 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 schedu have been abbreviated 2. If the item(s) to be installed are not covered I the abbreviated schedules you should consult thl 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 Q electrical contractor for signature by his electric, supervisor. The general contractor is ,not authorized to sign the electrical label. --- 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 s i goa ture. 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. I!. !II. IV. V. FOR OFFICE USE ONLY c Cln.F-~;~I~~~~~~~----' ... City Holl Springfield, Oregon Office of Community and Economic Development OFFICIAL RECEIPT 10621 . Date l;JEc. - J 19 &?;7 Rec'd From nl.T';"~ ~~~ E:f)f'. #- $7 - Address ~~. c~ r~~ R~ceived For ../~;P? 8/C>9q:s;-/0"'-': _ PP'- A-~ ~ "):" ~ _7-S- c:- //~ /s-.. >r- /.. ~ :?.;L;L , , Amount Received -- ..~5:"~- -_...-~~_._--- ~ // ~/~ ,- Ajl6~~' A~ r _ OUSINESSfORMS,INC, 15031:142,'''' ".n 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 !.5/-?#c . , -----. 5ignature~~~,-~ date /7.P. . ;/ /;J- ?-f?"")