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Home My WebLink AboutPermit Plumbing 1984-7-23 " 4I!'I., " "''''' . lldSPECTlOlI LlIIE 726-3769 IIL/o -I/_-::JISf.,;y;f _ _ Legal DmnptlOn n K:)~~:j ()\C\Ci ) Owner l~itjJ j ik J~h1 h IJ ~J2 JJoJ -II 'C}/ ~~ LITY OF SP~IdGFIELD COI1BIdATlON APPLICATION/PERMIT E'IERGY SOURCES Heat llater Heater Ranqe INFORlIATION LiN' 726-3753 Sa Ftq flam :q !:"tg Access Sq Ftg Other r~ew Add Alter Qep --Fence Demo Change/Use -Other- -- Address )140 ValuE of lIork riJ q>?I /O,(fIJ I BU11c1no Permlt info Descrlbe Work(l e Phone7Y'(,,/o<l..( 1 Farnlv f'tesldence H1th Aq.'l.rhed Garaoe) ~ P-JlA., . BUlld Slngle ~'<J '-1::: '> VI '- ~ I Job Address .t- Constructlon lender Address DES 1 uN {tAl' (name) Phone (address) (llCS no) (eXOl res) (ohone no Pnmary Structura 1 Electncal 11echamcal CONTRACTORS (name) (address) fl,cs no) (exOl res' (ohone no , Genera 1 -~ PlumblM El ectn ca 1 ~1echan' ca 1 PLUlIBING ELECTRICAL MECHANICAL NO I lEach slngle flxture IRelocated bUlldlng (new flX addltlonal) Is F Pesldence (1 bath) louPlex (1 bath) each Add,tlonal bath FEE I CHARGE NO SO FT I n:t:" I fI-lAR{;J:' NO. I I I="H" I niilQ{;1=" furnace/burner to / BTU's ReSldence of INew ClrCUlts alts or extenSl0ns I SERVICES I Floor furnace and vent Recessed wall SOnC:P hp;ltpr .:Inri 'u>n.t Water serVlce !TempOrary Constructlon Change In eXlstlng rp"_ldenrp multlfaml1y, comm or TnrllJ<;tn;l1 I I I I I I I I TOTAL CHARGES I TOTAL CHARGES WHERE STATE L'14 REQUIRES that tile Electrlcal work be done by an shall not be vallj untl1 the label has been slgned by an Electrlcal Storm Sewer Of I COI1/1 II NO FEEDERS I Install/alter/relocate ell <;tn h fppdpr<; 10f amps I I Apollance vent seOilrate Statlonary evao cooler I Vent fan wlth 51nole duct I Vent systef'l apart heatlna or A C I Mechanlcal exhaust hood and duct ~Iood stove/heater from Sewer amps. ISSUANCE OF PFR'llT TOTAL CHARGES Electrlcal Contractor, the electrlcal portlon of thlS permlt Supervlsor and returned to the BU11dlng Dlvlslon I HAVE CAREFULLY EXA~INED tie completed apnllcatlon for Qermlt. and do hereby cert1fy that all 1nformat1on hereon lS true and correct. and I further certlfy that any and all work performed shall be done 1n accordance wlth the Drd1nances of the C1ty of Spnngf1eld and the Laws of the State of Oregon oertaln1ng to the work descrlbed here1". and that tiC OCCUPArKY wl11 be made of any structure wlthout the perm1SSlon of the BU1ld1ng 01V1s1on I further cert1fy that my reqlstrat10n w1th the BU1lderls Board lS 1" full force and effect as requTred by ORS 701 055. that If exempt the basls for exemptlon 1S noted hereon, and that only subcontractors and eMployees who are 1n comollance wlth OPS 7n1 055 w1ll be used on th1S proJect HAlIE(please pnnt)/(/-ft//J) n t)~fiJ~;?~<j__SIr,il^~~,-,,-p~ DATE 7--.:2 ?~.8'4 FO" OFFICE USE DIlLY Zone F1 re Zone Flood Plaln Tyoe/Const Bedrooms Stones Unl ts Occy Load OCCY Group PLU'1BING PERMIT Charges and SUrcharges Fence So Fto t1a1n x Value Sq Fta Access x Value Sq Ftg Other x Value TOT^L VALUATION S~steMs Development C aroe (l 5~) /R'. cro BUILDING PERflIT Charges anc Surcharges Plan Ck Comm/Ind 65%/Blda Ppr Fpe ------------""""Pian Ck Res 30%/Bldq Per Fee Demo ELECTRICftL PERI'IT Charges and Surcharges S1dewalk I A/C PaVlng Curb Cut Total COMb Permlt /1ECHANICAL PERMIT Charges and Surcharges I -I TOTAL /8 - cr6 !.'~:~__ f 8L/O~J~ COMBINATION APPLICATION/PERMIT (CAP) II Appl1cant to furnlsh A Job Address B legal DeSCflptlon 1 example- Tax lot 100. lane County Map Reference II 03 43 2 examole- lot 1 Block 3. 2nd Addltlon to ~prlngtleld Estates C Name~ etc of owner and constructlon lender o Energy Sources 1 examole- heat/electrlcal cell lng/or forced alr qas 2 example- waterheater/eJectrlcal/or solar E Square footage or valuatlon, etc ------ 1 examole- 1250 sq foot house. 500 sq foot garage 2 examole- l7Inew proJect. check-new - If add,tlon, check add, etc F BUlldlng permlt lnformatlon 1 example - construct 51091e faml1y house wlth an attached garage 2 example - remodel eXlstlng garage lnto famlly room 3 examOle - convert 510g1e faml1y resldence lnto restaurant (change of use) G Value of work as deflned ln Sectlon 303 (a) of the Structural Speclalty Code H DES I GN TEAll AND CONTRACTORS To avold des1gn or constructlon delays, BU11d1ng Dlvlslon Staff must be able to contact approprlate persons regardlng des1gn lnformatlon or Job slte correctlons. etc Abbrevlated Plumblng, Mechan1cal, & Electr1cal Schedules A Except where blank spaces occur 1n the descrlptlon port1on of the Mechanlcal and Electr1cal Schedules, the appllcant need fl1l~ln only the No Boxes adJacent to the approprlate ltem(s) to be lnstalled B rul1 Plumb1ng, Mechanlcal, and Electrlcal Schedules are avallable at the BUlld1ng D1v1slon 1 To conserve space on the perm1t form the schedules have been abbrevlated 2 If the ltem(s) to be 1nstalled are not covered on the abbrev1ated schedules you should consult the full schedules C BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES o As noted on the CAP, the label must be dellvered to the electr1cal contractor for slgnature by hlS electr1cal superv1sor The general contractor 15 not authorlzed to slgn the electncal label - Appl1cant to slgn and date Whenever poss1ble. the 1nlt1al appl1cat1on wlll be used as a worksheet only Where poss1ble. BU1ldlng 01vls1on Staff wl11 prepare a type wr1tten copy and return lt to the appllcant at the t1me the actual permlt lS lssued for h1S slgnature Fees and Charges Plan check fees are due and payable at the tlme of the appllcat1on. and no plans w1ll be processed untll these fees are pa1d All other fees and charges are due and payable when the permlt lS 1ssued .~ .,. . PERMIT VALIDATION :il &'3 tJ.. G~ < !PaLY 7h7 S''/ 4~ Perml t Cl erk {)J/1 J~Jl~, III IV v FOR OFFICE USE ONLY Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Addltlonal ProJect Informatlon PLANS REVIEWED BY name slgnature ~ date