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Home My WebLink AboutPermit Plumbing 1985-3-19 . . CITY Of SPRINGFIELD COHBIIIATION APPLICATION/PERMIT EilERGY SOURCES: Heat !~ater Heater 17 (p 6' 0, ',4 I , legal Description 11I)~:~/:y~j{)q(d.LJ Ownerl)/;J~4fph.&~~ ~J44./ ~,. / / . f BUllclnq Pernnt Info: Descnbe Work( l.e., Build Single Address J,-~) ')1..." _ Phone 7;1(0'" Family Residence \lith ftttached Garaqe) ~htfrl ,1Jh2 f}7.(/-77' "'13'5 rZ/,~ .-?/;P/~-4d/ r1Ht! hd j/L/-IJ construc~~:n~~r r/ ~~..p J / Mdress Phone ~ OI:.SlGN Il:.Ar1 (name) (address) (lies. no.) (exnires) (Dhone no.) ~ Ranqe Valu€ of l'lark: INFORltATION UNt. 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Iter Rep. -Fence Demo Change/Use -Other - - ~ \'0 ~ D I~ I JrISPECTIDN LINE 726-3769 Job Address Primary Structural Electrical Meehan; ca 1 CONTRACTORS (name) (address) (lies. no.) (pxn;rps) (ohon", no.) General ]! / ill,.j' ,. PlumbinaU~.<1~ 1JdI~.-<[/:I J.~GI . , (J /0{ 9 9ff}f7LJh -LX ~fflJ CN 97<'/.1 :J 0'7- nF/ E1 ectr; ca 1 ~'echan; ca 1 PlUllB I NG ELECTRICAL MECHANICAL lID. FFF CHARGE NO ~~~ rHAR~F NO. ~F~ rHAR~~ 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 New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~cp hp~tpr ~nd vpnt Storm Sew~11l ,I 6o.r1/, 'fJfw AJ;..~ Of amps, Appl iance vent SF'narate Stationary evap. cooler 1 Vent fan wi th ~inole duct 1 Vent system apart heatino or A.C. Mechanical exhaust hood and dur:t ~Jo,:d~ s tove/heh t!r I'. from Additional bath Sewer Temporary Construction Change in existing rPi-;rlencp multifamily, comm. or Indu<;.tr;al ~Jater service JO (ft COMM,/INO. FEEDERS Install/alter/relocate di<;.trih. fpprler<;. Of amps. "; TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the /6 (J7) I TOTAL CHARGES tha t the El ectri ca 1 work be done by an label has been Signed by an Electrical ISSUANCf OF PFR'1IT I TOTAL CHARGES Electrical Contractor. the electrical portion of this Surervisor and returned to the Building Division pemit I HAVE CAREFUllY EXN1INEO the completed app 1 i cati on for permit. and do hereby cert ify tha tall in format i on hereon is true and correct. and I further certify that any and all work oerformed 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 UO OCCUPAIKY will be made of any structure without the permission of the Building Dil/ision. I further certify that my registration ~lith 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 701.055 will be used on this project. SIGNATUR~hL/ ~,I11J}QI) FO~ OFFICE USE (Jill Y , Sq. Ftg. t1ain Sq. Ft~. Access Sq. Ft9. Other IJAl.IE(please print)} A r/l-f R. m; /!er DAT,,3' -! 9- f), Zone Fi re Zone Type/Canst. Bedrooms Stories Units Occy load Occy Group x Value Value Value x Flood Plain x TOTAL V AlUA TI ON BUILDING PERNIT Charges and Surcharges I Plan Ck. 65%1Blda Plan Ck. 30%/Blda ConrnlInd P~r Fpp Res Per Fee ISystems Development t Charae (1. 5%) PlUt~BING PERMIT Charges and Surcha rges _____JJ!2..!!L Fence L! (\ I Demo I S1dewal k ------------ I A/C Paving Curb Cut Irotal Comb. rermit ElECTRIC~,l PERI~IT Charges and Surcharges 11ECHANICAl PERMIT Charges and Surcharges TOTAL -.-ijo JfJ -. . g ~u CL 3 6' COMBINATION APPLICATION/PERMIT (CAP) t. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. Lane County Map Reference II U3 43 2. ~xample- lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ce;l;n~/or forced air qas 2. examole- waterheater/electr;cal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, check add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. example - 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. 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 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 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 ;s 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . .. PERMIT VALIDATION K# 0<1"3&'/ IJ ",/J:J.)S.r Permi t C1 erk M . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . . date .