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HomeMy WebLinkAboutPermit Plumbing 1982-5-3 Job Address 6.r~ UJ, C?<V 7/ MF1-?L Legal Description J 7 - 0 .3 -;;. 7 - 'Y :? rL.~<9 ,.. ....-- rJ -- ~-_.- - ~I' iNSPECTION LINE : 726-3769 ~ CITY OF SPRINGFIELD ~ CmlBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat Hater Heater . INFORtlATION UNt. 726-3753 Sq. Ftg. r.1a in Sq. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- \l) N \) ..( N Q Range ValuE of Hork: Owner ilIA fT 8t?o.r, Ccl~S'T Address &&3 lAJ, C "F-vT,;.......,4 ~c: Construction Lender Address . DES I GN TEAr~ . ; Primary ! Structural ! : Electrical Phone Buildinq Permit Info: Descr be Work(i.e., Build Single Family nesidence With Attached Garaqe) JAd" f -f.11mJJ {)p lL,iruJzJ I I I (name) Phone (address) (exoires) (ohone nO.'J (lics. no.) ~ Mechanical : CONTRACTORS 'Tv-4"v K. j'.(.JIC r/,~ General 1 Plumbinq , Electrical ~1echani ca 1 NO. (name) (iiddrp.ssr------ ('jics. no.) (exoires) (ohone no. l PLUtlBI NG ELECTRICAL MECHANICAL FEE I CHARGE NO ... . rHARGFI NO. FFF rHARI;F; S:'- 10..... Residence of furnace/burner to BTU's Each single fixture SQ. FT. 2 Relocated building (new fix. additional) I New circuits alts. or extensions Floor furnace and vent /4- IS,F. Residence (1 bath) IDuPlex (1 bath) each IAdditional bath I ~Iater servi ce Sewer Storm Sewer ISERVICES I I Temporary' Cons'truction IChange in existing residence multifamily, comm. or Industrial Appliance vent seoarate I Stationary evap. cooler I Vent fan wi th sinale duct I Vent system apart heating or A,C. . Mechanical exhaust hood and duct from Rece$sed wall Soace heater and vent amps.1 1 I Of ICOMM./IND. FEEDERS Install/alter/relocate distrib, feeders I I Of amps. I I I I I I I 1 / ()..I> TOTAL CHARGES /~.o. TOTAL CHARGES that the Electrical work be done by an,Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division Wood stove/heater ISSUANCE OF PFR1m ~ "-. ~ TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be valid until the I HAVE CAREFULLY EXA11INED 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 NO OCCUPAr~CY 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 701.055 will be used on this project. tW1E(please print) T 1//-1- A.l K Hv Icl-I u:",S SIGrMTURE ~~ FOR OFFICE USE ONLY Sq. Ftg. tlain Sq. Ftg. Access Sq. Ftg. Other ./<'. /M~ DATE S- ~ ?- 8'~ x Value x Value x Value Zone c:::: .. :< Fire Zone H.A . Flood Plain BUILDING PER~1IT Charges and Surcharges PLur~BING PERMIT Charges and Surcharges ELECTRICAL PERtHT Charges and Surcharges tlECHANICAL PERMIT Charges and Surcharges Tyoe/Const.~.N' '5~ ~nits Bedrooms Occy Load Stori es I Occy Group "E-2 TOTAL VALUATION J.~""" ,dE" Plan Ck. CommlInd L~~'YI 65%/Bldq Per Fee --- -------- Plan Ck. Res 30%/Bldq Per Fee _____Lq~_~~J Fence . '-/ C> D6mo It:::>. PO Sidewal k - --- -- -~~~-l A/C Paving _ _ _ 'Y-e: !L ~_ _I Curb Cut I Systems Development Charge \1.5%) , ~J. A-- !Total Comb. Permit ,- A IIOT L ::l~. ,8tD " <'~B<\t '. . .. COMBINATION APPLICATION/PERMIT (CAP) ". ~;.. ----.:....?~... Co . !'- PERMIT VALIDATION <' I. Appl.icant to furhish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 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 ceil inq/or forced air qas 2. example- waterheater/electricalior solar E. Square {ootage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-n€w ~ if addition, . check add, etc. ' F. Building' permit information:'. 1. example - construct single family house ~ith.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 ~ortion ~f the Mechanical ~nd 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 Eiectrical Schedules are available a~ the Building Division 1. To conserv,e space on the permi t 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 schedul es 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 ~sed 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. ~ 'f1J' V. FOR OFFICE VSE ONLY Permit Gl erk .. ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 5' /0.00 .40 /O.OQ' . LjD ----- ,^ ~o.fu .-' f~/ Permit appl i cant exempt from regi strati on with the Buil der IS' Board because: Additi ona 1 Project Informati on: ~.' . PLANS REVIEWED BY: name L.~IV~' ~~~. ~'~~. , ". signature da te S-:r.-4S ~