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Home My WebLink AboutPermit Plumbing 1987-4-24 UlY Uf SPRliIGFIElO. iNFORnAT.~:1 Ll,.:, CO/1BIIIATION APPLICATION/PERMIT. 726-3752 / E~IERGY SOURCES: So. Ftq. I':ain Heat :q. Ftg. Access. ~'Jater Heater Sq. FtQ. Other R !lel'!' Add P.l ter .r~eD. anQe -Fence Demo Change/Use r /)-11/ /J ValuE of I-lark: Other- - ~:::j/,~ f~ TI}tjtf1Li Phone!Jt.f7 ~~~11:~n~e~;d~~Ze lnf~h ~~i~~h~~er,~~;~~J.e., Bui Id 7;n91e 3.3V/ r-/~ ~ &dcdtf)J /~ Oev~ . '7:2;2 katdfJ H Legal Description / '70 j 35 q.;) O'Z lfot '] ItISPECTrOII. LItlE 726-3769 Job Address Construction lender , Address LJESIGrl TI:Af1 Phone (address 1 (1 ics. no.) (name) (exn; res) Prlmary . ! Structural Electrical \~ ~~~\ '-\~ :1echani ca 1 CONTRACTORS (name) (address) (lies. no. (exnirps) Genera 1 /7. I, I .I (J_~i1T~ /Mrr Plumbinq [1 ectriJ:i! 1 I'~echanical PLUI1BIIIG ELECTRICAL MECHANICAL 1'10. , J:J:~ I rHl\R(;~ rm. , FFF I rHMH~F IJn Each single fixture Residence of furnace/burner "to BTU's SQ. FT. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath I Duplex (1 bath) each SERVICES Recessed wa 11 Snn(:P hPntpr ~nd vpnt Additional bath Apol iance vent seOfl \"0 te Stationary evao. cooler ~ Vent ran \.li th sinole duct Vent syste~ apart from heatina or A.C. Mechanical exhaust hood and dlJct Wood stove/heater ~!ater service Temporary ConstructiQn Chance in existing . rpc;icLpnc:p multifamily, comm. or lndllstriill Sewer Storm Sel.ler Of amps. CDr11'I./lND. FEEDERS Install/alter/relocate rlid.rih fpF>rlpr-o;. Of i!mps. (ohone (ohnne nn.) I ~I="I=" I I I I I I I i i I I \ i ~ \::::) ~ ~ ~ I I " no. ) I rHARr.1=" ~ I ISSUANCF nF PFR11IT TOTAL CKARGES TOT~L CHARGES TOTAL CHARGES HHERE STATE L'U REQUIRES that the Electrical \'lark be done by an Electrical Contractor, the electrical portion of this perr.1lt shall not be vali1 until the label has been signed by an Electrical Surervisor and returned to the Building Division I HAVE CAREFULLY EXM1INEO the completed aprlication for !)ermit. 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 Soringfield and the Laws of the State of Oregon pertaining to the wor~ described herein, and that tm OCCUPAIKY \~i11 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 ons 701.055, that if exemot the basis for exemntion is noted hereon, and that only subcontractors and employees who are in comDliance with ORS 701.055 \','i11 be used on this project. e/ 11Ar.1E(please print) ~M<\) ~~ om <+- :2 c.{- f'J ~ (( rJ'O UJ Sl(;il^TURE nFFl~C USE Oi~ '5~. Ftg. 11ain SQ. FtlJ. Access Sq. Ftq. Other x FO~ Zone Fi re Zone Flood Plain Type/Canst. Bedrooms Stories Units Ocey Load Occ.y Group x Value Value Value x TOTAL VALUATION BUILDlIlG PERt.IIT Charges an~ Surcharges Plan Ck. Comm/lnd 65%/R1~n Ppr I="pp ------------ Plan 0:: Res 30%/Bl dr, Ppr Fee Fence Systef,ls Development Charqe (1.5') PLU'1B I1IG PERf1IT Charges and Surcharges r~.6P ------------1 . &"0 I Dmno . ELECTRICP.L PERI~IT Charges and Surcharges /1ECHANICAL PERf1lT Charges and Surcharaes Total (omb. rermit Curb Cut I TOTAL I (S roo 1 . . .- COMBINATIOII APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address 8. legal Description 1. example- Tax Lot 100, Lane County Map Reference 1/ oj 43 2. example- Lot 1. 8lock 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. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- 1l'l1ew project. check-new - if addition, , cneck add, etc. F. Building permit information: 1. examole - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - 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. DES I GII TEAI.I AIW 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 scaces 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 8. 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 O. As noted on the CAP. the label must be delivered to the electrical contractor for sianature by his electrical suoervisor. The general contractor is .!lQ! authorized to sign the electrical label. III. Applicant to sian 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. " Bio 8' 4D to IJ}j2 (0- q ~ <61 b~~U00 l(-;;2 ~-f; 7 V. FOR OFFICE USE ONLY Permit Clerk Cc .- 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 i gnature date . .,. N~2333 3.50 . BACKFLOW PREVENTION DEVICE TEST REPORT V . ~~~ ._- - r- $, p, r,-0J.J ~ /r. tsL, , I /9 y,0,-/,4-, , , , , I , , ~~~~ss ,'7 (J,~,'f) 16c.l 'irA- I A Isit1t:re, f, , I I ,',5/?~I,'rya C,,~c:.IJl.EE~ , , I , , ' I , , I , , I , , , ,fu\. ZIP ~/II ~~~CE I' :~ffl I ~~~ m 7{:>.....LJ MOOEl' ~6? 7 I ~g~~ON p//9-.JI(r' bv M~f~rd~",.'A,;~Rtl,:l...-~ en/..8:...I , , , I REDUCED PRESSURE'"DEVICE II PRESSURE VACUUM I INITIAL TEST I DDUBLE CHECK VALVE I CHECK -1 BREAKER . PASSED. I CHECK -1 CHECK -2 I I AIR INLET CHECK FA'lED 0 ~SS~OP INITIAL llGHT . llGHT ., flE1:A:FjO..P.f.NE~T OPENED AT PRESS DROP OATE:LfJ/~/LS7 nST ljJ I2.J ,..... LU.UI"SII U-J-UPSll REUEF VALVE lEAKEO 0 LEAKED 0 PASSED . FAlLED 0 FIRM NAME: DID NOT OPEN 0 LEAKED REPAIRS I ANOjOO , PARTS ~ r r 'I I ~:: I OPENED AT PRESS DROP llGHT 0 J I REUEF OPEN 'I LLJ'U", LLJ'U... U--'. UPSCJ AFTER ~EPAIR PATE:LLJ/LLJ/LLJ TEST I AfTER! llGHT 0 REPAIR I OETEClOR METER READING IN COMPLETING AND SUBMITTING THIS TEST REPORT. THE TESTER CERTIFIES THAT Tt'iE DEVICE HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPUCABlE RULES AND REGULATlONS OF THE WATER SYSTEM OWNER AND THE STATE OF O~EGQN. -JU~ ~ //0 GAUGE . j3-3Y/> CERT tIJ BY: . ;';i tk/t'JU// /( A -/ / ) (}JJ1{.""'---'-;REPRESENTATlVE OR F'RM) / -, CERnFV' THE ABOVE TEST HAS BEEN PERFORMED WATEfl SYSTEMS COPy j n i' .