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HomeMy WebLinkAboutPermit Plumbing 1987-12-5 (2) \ II INSPECTION LINE q 726-3769 . CITY OF SPRINGFIELD. INFORl1ATION LINt CDr1BINATION APPLICATION/PERMIT 726-3753 E!IERGY SOURCES: Sq. Ftg. I-lain Heat ~q. Ftg. Access. Water Heater Sq. Ftg. Other Ilew Add A Her P.ep. Ranqe --Fence Demo Change/Use V~Uw:\'J~~ Other- - BU'lriino Permit Info: Describe Work(i.e., Build Single Familv nesidence With Attached Garaoe) ~ ~ ~ \f\\ ~ ~'r_ :5 =- rr'- -.Y. .... Legal Oe5cription /~_3~..:?:<...... .,:s.;;?_~ Job Address /.'J' 5' Owner p~<,- ~.7)~. r:~ Address gsB~S-) /:.z::. 57": Ec-'?.i&;"?"C:; b/? _ 4~4"~ lhone ~ ....._ 1-.,,",";1>1 ~ , J. '--- Construction lender Address [)1:.~lliN H.Ar~ {namel Phone (address) (l ics. no.) (exn; res 1 (ohone no. I Primary Structural c.., ,,/) ~?r')) - l~"" Electrical Mechanical CONTRACTORS (namel (address) (l irs. nn.) (pxnirpc:.' (ohnnp nn.) General Plumbino?&"MS&,"7 ~~E .::::::...;. kc.... , Electrical ~'echani ca 1 r;Ztt!~-x 2./~ ~ \11 PLUI-1BING ELECTRICAL MECHANICAL NO. - Each single fixture FEE r.HARr;F NO ~H' rl-IARr::r: NO. Residence of furnace/burner to SQ. FT. BTU's ~~~ I nIARr.~ I Relocated building (new fix. additional) S.F. Residence (] bathl Duplex (1 bath) each New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall Sn~~p hp~tp~ ~nn v~nt Storm Sewer Of amps. App 1 i ance vent seoarate Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Additional bath Sewer Temporary Construction Change in existing rF'<;,;d~Jlc~ multifamily, comm. or Tndu<;trial ~Iater servi ce r:~F~-f2.~y.,~-. COMM./INO. FEEDERS TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valij until the I Install/alter/relocate rtic;trih_ fM.rtprc; IOf I I I ?,. '5-=- --"'-. TOTAL CHARGES that the Electrical work be done by an,:Electrical label has been signed by an Electrical Supervisor Wood stove/heater amps. I SSUANCf OF PFRr1IT . TOTAL CHARGES Contractor, the electrical portion of this permit 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 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 rw 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 7Q1.055 ~l be used on this proje~ NAI-IE(please print)~/A1 j j /l/"" /s'-'N_fhN 6" SIGII^TURE NJ.-6'v0,;t; ~ DATEP ~-?;:; FO~ OFFICE USE DilLY (/ Sq. Ftg. t1ain x Sq. Ftg. Access x Sq. Ftg. Other x Zone Fire Zone Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group Value Value Value Flood Plain TOT^L VALUATION BUILDING PERfllT Charges and Surcharges I Plan Ck. COlTll1/1nd 65%181 do PPf Fpp ------------ Plan Ck. Res 3D%!Bl do Per Fee ____t~C'"_j~- Fence . 7~ O~mo ISystems Development I Charqe (J.5~) PLUI1BING PERMIT Charges and ~ Surcha rges ELECTRICP.L PERI~IT -Sidewalk Charges and ------------ Surcharges AIC Paving Total Comb. Permit 11ECHAN I CAL PERMIT Charges and Surcharges Curb Cut I I TOTAL IS;;..) . COMBINATION APPLICATION/PERMIT (CAP) 0' I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100, Lane County Map Reference II 03 43 2. examEle- lot 1. Block 3. 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinQ/or farced air Qas 2. examole- waterheater/electrical/or 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. f. Building permit information: 1. examole - 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. OESIGN TEAM ANO 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 lssued 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . , . PERMI1 VAlIDATION "' .'. -..- .........-"' " 0-" . ."t-~ '. Permit Clerk Permit applica.nt exempt from registOration with .the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name [~0'{/"C Signature~~;~ , // . . ------ ~.:..:--? date :/ /";)- ?-:f?-:J