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Home My WebLink AboutPermit Plumbing 1981-9-14 1:.:" if 'I INSPECTION LItlE 726-3769 Job Address '\8\~ l'n f\\]n f\1(1~ Legal Description n iJ ~ 2..loL\l.\ ' ' ~ \\"Z.CO . ownert\~'tCl.r<\ ('f\.(\r\~ iJ, ' Address~ ~\ ~ 0w1.o..N\1Qj)) l\ ,~rQJ..o 0lJr\~ n e der l - () --- CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat !'Jater Heater -- INFORt1ATION LINt. 726-3753 Sq. Ftc). r.1a in ~q. Ftg. Access. Sq. Ftc). Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- =xJ - o Range ValUE of l'lork: Phone Buildino Permit Info: Fami ly P-es i denr:e Ivi th 6.u LJe 1'- \A~ Describe Work(i,e., Build f1.tt~ J~ :t , (lies. no.) '-(exnires) Single ---- 'V ~ Address DES I GN TEAt-1 (name) Phone (address) (ohone no.) Primary " t1echanical CONTRACTORS (name) (address) (lics. no.) (exoires) (ohone 110.) [I " n ri ~ ,I , ~ ! Structural . Electrical , ' , General _ . Plumb i no I ] lLtD Y\Jl...:rt...- . El ectri ca 1 amps.1 I I I Recessed wall Soace heater ilnd I I App 1 i ance vent seoarate I'Stationary evap. cooler I Vent fan wi th sinole duct I Vent system apart from I heating or A.C. I Mechanical exhaust hood and duct I ~Jood stove/heater I I I vent I' ~ '-~ -~ e . ~ -FFF- r1 I ~ ; ~ I I I I I I I I I I I i' ~~cal~="~~,~~_~~~=..;=~~=_,:~_~~=:_..~,_____._._ ,h_ .... - ~==-:';~';':"'-'::=-""-..._- PLUI1BI NGELECTRI CAL MECHAN I CAL ~-c~NO~- ..-..-"----.-~~-~=-~~----n-F-EE;-- -CHARGE 'NO~--=--~~~-:~~=--=-:==TFFF fHA'Rr,F' NO~ -- ."-'-~-===.-=~-=-. Residence of furnace/burner to SQ. FT. BTU I s Each single fixture, Relocated building (new fix. add,itional) IS.F. Residence I (l bath) . IDuPlex (1 bath) each I IAdditional bath I 1~later service I I Sewer I I IStorm Sewer I I I I I I I I I I I I I New circuits alts. ' or extensions' Floor furnace and vent I I ITempOrary Cpnstruction I /Change in existing I residence I multifamily, comm. or I Industrial IOf ICOMM./IND. FEEDERS I Install/alter/relocate distrib. feeders 10f amp~1 I SERVICES I ISSUANCE OF PERMIT -Zone Fire Zone Flood Plain TOTAL CH.A.RGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'l.lV REQUIRES that the Electrical ~Iork be done by an Electrical Contractor, the ,electrical portion of this permit t" shall not be val i:l until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAt1INED 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 oerformed 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, ana that NO OCCUPAHCY will be made of any structure without the permission of the Building Division. Board is in full force and effect as required by. ORS 701.055, that if exempt the basis f r exem' oted here h, and that :::I::::::t:::::!r1:?'1;?dZ;;;;th :::N:O:R~ will b,", ~" hi, D~ ~~ 4QI.I. FOr. OFFICE USE DrIL Y ~ ~ I Sq. Ftg. t1ain x Value -1 Sq. Ft~. Access x Value I Sq. Ftg. Other x Value TyrJe1'Const. Bedrooms Units Occy Load Occy Group, Stori es TOTAL VALUATION BUILDING PER~1IT Charges anc Surcharges I Pl an Ck. ____________ 65%/Bldo I Plan Ck. 30%/Bldq tfJD CO Fence - .. '80- - D~~o ISi dewal k I A/C Pavi ng I Curb Cut I Comm/Ind Per Fee Res Per Fee PLUr~BING PERMIT Charges and Surcharges I I I I .I I ISyste,ms Development Charqe 0.5%) I I I I ITotal Comb. Permit iTDIAL&:) M \ · ELECTRICJ!.L PERt~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges .. :,". - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish 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 ceiling/or forced air qas 2. example- 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-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 Structural Specialty Code H. DES IGN TEM,' AND CONTRACTORS:. ' To avoid design or constructfon'delays, Buildfng 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 portton.,of the Mechan1cal and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanfcal, and 'Electrical Schedules are available at the Building Divis{on 1. To conserve space on the permit form the schedules have. been abbreviated 2. If the ite~(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 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 payab 1 e when the permit is issued. V. FOR OFFICE USE ONLY' PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: - PERMIT V AU DATI ON Permit Clerk ',i , :J ::j !1 .~ . .f ;~ .i 4 ~ Permit applicant exempt from registration with the B~ilder's Board because:, Additional Project Information: PLANS REVIEWED BY: name ~ignature date I INSPECTION LINE 726-3769 Address DES I GN TEAfl (name) Primary Structural Electrical f1echan i ca 1 CONTRACTORS (name) " Genera 1 Plumbino I~CLJ,.DR~ Electrical .J~anjcaJ. PLUflBING --- INFORflATION LINt 726~3753 Sq. Ftc). r.1ain :q. ~tg. Access. So. ,FtC). Other Ne,,, , Add Alter Pep. --Fence Demo ,Change/Use --Other -:- -- , i. 'i" ~, " " 'CITY OF SPRINGFIELD . Cm1BIilATION APPLICATION/PERMIT ErlERGY SOURCE): Heat !'Ja te r, Hea te r Ranqe ValuE of \,Iork: Builldno Permit Info: Describe,t'Jork(Le., Build Family rtesidence \-lith Jltttfed Garaoe) , ~ue~ ""\~ \~:s' it)]: (1 ics. no.) '-'( exni res) Job Address "\ 8 \ ~" (' 0 r~\_o f\f\ i(1 ~ ' Legal Deseri pt ion h () 32..1...0 L\.l.\ ':/t, -,.: ~ \ \-zeD owner\ \ \ \)~ \~ (' f\ r\ r\ 0 1 ~ ' Address~ ~\ ~. 0w1 0 Ml0J0) !\. _ Lf\ l (1JJ.Q Q.t~' n e der () Phone, Phone (address) (address) (lies. no.) (exDires) .- ~:'..-.-:..::::......;-:--=c_~....,.....;::_ ELECTRICAL MECHANICAL Each single fixture "==r~FrrICHARG'E~ "'Nn-+=-':--='" Residence of furnace/burner to BTU's --- - ~-1'- , NO. Relocated building' (new fix. additional) IS. F. Res i dence Cl bath) IDuPlex (1 bath) IAdditional bath I ~!ater servi ce Isewer each Storm Sewer Zone' Fire Zone TYDe/COnSt. Bedrooms Flood Plain Stories BUILDING PER~lIT Charges anc Surcharges PLU~1BING PERMIT Charges and Su'rcha rges ELECTR I ct.L PERr~lT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges I I I I I I I I I I I I " Fen' I rl-llllu~L ~NO: SQ. FT. New circuitsalts. or extensions I I ITempOrary Construction I IChange in exi~ting, I residence Imultifamily, comm. or I Industrial 10f amps.1 ICOMM.jIND~ FEEDERS I IInstall/alter/relocate I distrib. feeders 10f amp~1 I I I ISERVICES I I' I I I I I I Units Occy Load Occy Group Floor furnace and vent I Recessed wall Soace heatpr and I" vpnt I I I I I I I I TOTAL CHARGES J TOTAL CHARGES WHERE STATE LA\l REQUIRES that tile Electrical work be done by an shall not be val i'luntil the label has been signed by an Electrical I I' I I I I Apoliance vent seoarate Stationarv evao. 'coo 1 er" , I Vent fan with sinole duct I Vent system apart from I heating or A.C. ' I'Mechanical exhaust hood and duct I Hood stove/heater I I I I SSUANCE OF PFRr1IT '=xJ - o Single , :---- ~. (ohone no.) ~ ~ II f; t! ~, ~" ~ ~. ~' , .~,,:,~ I i litF ' CffARGE1' ':1 1 ! (ohone no.) I I I I I I I I I I I I I I I I " ,1 r TOTAL CHARGES Electrical Contractor, the electrical portion of this permit r Supervisor and returned to the Building Division TOTAL VALUATION I I I I' I I I I Systems Development Charqe (1.5%) ITotal Comb. rermit ht" I HAVE CAREFULLY EXNllNED the completed apfll ication for permit, and do hereby certify that all information 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$pringfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAfjCY will be made of any structure without the permission of the Building Division. I further certify that my 'registraty'o ~lith the Builder's Board is in full force and effect as required b~ ORS 701.055, that if exempt the basis f~exem ~,is hoted hereon, and that only subcontractors and emnlovees who are in 0 oliance with OPOS 7n1.055 will be us on his . ct ?-I '- /2 ' """I,lm, ,d"~, '.~I · fA' ;/;5 S1",^~ ':(.." . ",Jf~ Far. OFFICE USE O;~L Y ''-., __~ {/ t I So. Ftg. r1ain x Value ,Sq. Ftg~ Access x Value Sq. Ftg. Other x Value Plan Ck~ Comm/Ind ____________ 65:.UBldo Per Fee Plan Ck. Res , 30%/Bl do Per Fee -C{)D.!E~~J Fence .80 I D~mo . I Sidewalk - - -,..- - - -- ---I AIC Paving _ __ _ __ ___ __J Curb Cut I dJD&j '. ~ .". ... M .. '...... .. ..,_J, Applicant to furnish A. Job Address B: Legal. Desc~iption L ,exampl e- Tax Lot 100, Lane County Map Refe,-"." ',\,,-:e: . 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 ' L examp1e- heat/electrical cei 1 inq/or forced ,2: example~~aterheater/electrical/or solar E. Square footage'or va1~ation, etc. ( 1. examo1e- 1250 sq. foot house, 500 sq. foot ~r 2. example- if new project, checknew - ,if adc check add, etc.' F. Building'permit information: . , 1. example - construct single family ho~se.wi1 'n attached garage' . : ' 2. example - remodel existing garage into fami 3~ examo1e - convert single family residen~e i restaurant (change of use) G. Value of work as' defined in Section 303 (a},of Structural S'pecia1 ty, Code " , H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Bui1~in ( Division Staff must be able to contact appropri persons regarding design information or job sit corrections, etc. ' II. Abbreviated Plumbing, Mechanica1,"& Electrical Sche 'S A. Except where blank spaces occur in the descript ' , portion of the Mechanical and Electrical Schedu the app1{cant need fill-in only the,No. Boxes a, to the appropriat~ item(s) to be installed (~ B. Full Plumbing, Mechariica1, and E1ectrica1Schedl are available at the Building Division L To conserve space on the permi t form the scl have beeri abbreviated (' 2. If the item(s) to be installed are not covel the abbreviated schedules yriu should consu11 full schedules " C. BUILDING DIVISION STAFF WILL FILL OUT ALL'FEES J CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be de11verec electrical contractor for signature by his elect /" supervisor. The general contractor i snot authc ',ed to sign the electrical label. -, Amount Applicant to sign and date Whenever possible. the initial application will beu a worksheet only. Where possible, Building Division ~f' will prepare a type written copy and return it to th app1icarit at the time the actual permit is issued fo signature. Fees and Charges (, Plan check fees are due and payable at the time of t app1 ication, and no plans will be processed until thJ-.:-" , fees are paid. All other fees and charges are due and payable when the permit is issued. ~ . . . , COMBINATION APPLICATION/PERr:lIT (CAP) I. III. IV. V. FOR OFFICE USE ONLY '.> 'j" ~...~, . :' BV (I PROJECT CONDITIONS JO BE SATISFIED BEFORE OCCUPANCY: .::~ ',''G'':, ., . <>'~ ~. :', ""I' " PERMIT VALIDATION '. II 'I' I~ t f\\ f\l\ b c:D{)~ ~. ~'- l/9!0 ,ffi_G .. ~. Received~O ,~ ~ f , -~t(fb ~ AUTHORIZED SIGNATURE ...,,'. (,' SHELTON-TURNBULL PRINTERS' EUGENE. OR 97.01 4, I I ,I l Permit' Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED,BY: name Signature' . ~. '......... date