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Home My WebLink AboutPermit Plumbing 1983-10-13 . ~ ,j I INSPECTION LINE 726-3769 JobAddress \ ~om ~iffin1AU Legal Description \, D32S:39r- ()L\4.C)Z.. CITY OF SPRINGFIELD CO/l8I Nil. Tl ON APPLI CA TI ON/ PERM IT E:iERGY SOURCES: Heat Hater Heater INFORr1ATrON LiNt: 726-3753 Sq. Ftc]. r.lain :q. Ftg. Access. Sq. Ftg. Other tiel. Add Alter Rep. --Fence Demo Change/Use --Other -- -- y '.j) '\) j) ~ Range Owner \Gt/ ,-~\"\tl'('"S\J\ to . ffil L ValuE of Hork: . Add m, l\ O~ ~~ 0 \1\ to n J\1 n () . Phoo, ~:~l \;01,:;;:::;, I nf1h ,1i:~;:~' G:~::l:'.' B"il d S; 0,1, ~l'Od" ''12.642...<;\ ~r ff~) peuJ. 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 performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further .certify that my registration ~Iith the Builder's Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that .ooly '"',oot",to', "d ,mploy", who '" ;, ,omoli,"" wIth D'S 70I('5S~' " ""d ~i~t. , rW1E(please print) -::JAME:.CSB')u~ SIGtlATURN);1,I11kJ . ~ DATE lo~- FOr; OFFICE USE Oilt:!, " Sq. Ftg, /1ain x Value Sq. Ft9. Access x Value Sq. Ftg, Other x Value Plan Ck. ____________ 65%/Bldo Plan Ck. 30%/Bldq ~_L~~___I ::' I Sidewalk I A/C Paving ___________J Curb Cut I . Address DESIGN TEM1 (name) Primary Structural Electrical . Mechanical , CONTRACTORS (na~e) ~ . ~ , General ~ \\J~ ~ I Pl u.mbi nq Electrical . ~1echanical PLUr1Bl NG NO. ' Each single fixture Relocated building (new fix. additional) S,F, Residence (] bath) Duplex (1 bath) each Additional bath ~later servi ce Sewer Storm Sewer .;~W JC1-rt 0 L\O)~ I LI 1 ~t hti Jh.,J I ~. I I I I I , TOTAL CHARGES WHERE STATE L'\H REQUI RES shall not be valid until the Zone Fire Zone Type/Cons t. Bedrooms Flood Plain Stori es BUILDING PERf.1IT Charges an~ Surcharges PLur~BING PERMIT Charges and Surcha rges ELECTRIC,c,L PERrm Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Phone (address) (lics. no.) (exnires) (phone no. (address) '~lliJ(~ . f. \<=\(2/' no.) . (exo-ires) .sAt ~o:one no,) . ~D-\C\l~ ELECTRICAL MECHANICAL , FEE 'CHARGE NO , FFF 'rHAR(.;F NO. 'FFF fHAR(.;F Residence of furnace/burner to BTU's SQ. FT. New circuits alts. or extensions Floor fu rnace and vent I I I I I SERVICES I Recessed .wa 11 Soacehe~te~ ~nrl vent I I I I Jl:).CO 1- lill pc. I Appliance vent separate Stationarv evap. cooler. , Vent fan wi th sina1e duct Vent system apart heatino or A.C. Mechanical ex~aust hood and duct Temporary Construction Change in existing residence multifamily, comm. or Industrial Of amps~ COHM./IND, FEEDERS I IInstal1/alter/relocate I distrib. feeders ' 10f amp~1 I I I from I {S.CX' TOTAL CHARGES I I I I I I ( I SSUANCEOF PFRrlIT I TOTAL CHARGES Contractor, the electrical portion of this permit and returned to the Building Division Wood stove/heate~ that the Electrical work be done by an' Electrical label has been signed by an Electrical SU[lervisor --. I Units Occy Load Occy Group TOTAL VALUATION Comm/Ind Per Fee Res Per Fee Systems Deve lopment Charqe (1.5%) . I I ~ I Total Comb. Permit I TOTAL I~.~o \ . ~T .. i " I ! a ~ i ~ ~ ~ II ~ j jj ! . lJ 'I j .. a m g . ! !Ii ! f i t ~ . . CJI .. . ;l i . .; . i COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A. Job Address B. Legal Description 1. examp 1 e- Tax Lot 100, Lane County Map Reference 17 03 43 2. examp1e- Lot 1. Block 3, 2nd Addition. to .Springfie1d Estates C, Name, etc. 'of owner and construction 1end~r D.. Energy Sources 1, examp1e- heat/electrical ceiling/or forced air ~as 2, example- waterheater/electrical/or solar E, Square footage or valuation, etc. 1. examp1e- 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, example - convert single family residence into restaurant (change of use) G, Value of work as defined in Section 303 (a) of the . Structura 1. Specia lty Code H. DESIGN TEAM AND CONTRACTORS :To avoid design or construction delays, Building Di~ision Staff'must be able to contact appropriate persons regarding design information or job site corrections, etc, II, Abbreviated Pl~mbing, 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, --- .111. 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 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 PERMIT'VALIDATION '9t:D~ \~q83 ~lu!L' ~ La \~/L q Permit Clerk ~t J)tl~ i ; PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ j ! J ~ J .J I ~ . . 1 ~ J Permit applicant exempt from registration with the Builder's Board betause~ f ~ f Additional Project Information: PLANS REVIEWED BY: name signature date . ,:."