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HomeMy WebLinkAboutPermit Plumbing 1985-12-3 { -, . Job Address '3;;-OS-CO.47~~c/",c.,;/Ye.. Legal Description 17-DZ -'3/-2/ ,<7 :5'"?C:SO ,. - CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT, I E"ERGY SOURCES: Heat l~ater Heater Range ValuE of Hork: . ~ " "J I INSPECTION LINE 1726-3769 Owner ~?~;d;Y .~FJ!?? ~~T.R.,..k. Address 7S"-,,,,) c:6/??;"c='ec;,~ Phone , L~, '!" P. _ ~7L _ 7'1/-39/<-- /~ . / /'~ Construction Lender INFORllATION liNt 726-3753 Sq. Ftg. r'lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- ~ ~ " ~ Address DES I GN TEAr1 (name) Phone (address) Builriinq Permit Info: Descrlbe Work(Le.. Build Single Family nesidence With Attached Garaae) /~7..;?e~L ~~L~~ .~-. , . liffcy~tt>Ar ~Y/C:::::C'- C}y ~ (*---1'<' ~~CE' VA€:" .. " - 'nics. no.) (exoires) (Dhone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) General Plumbina p~"S I .. - /tU/blV~ .... .. " , ~ ;~~ ' (exr,; r~5 , (ohon~ 00........' 2~~ 1"'/1'" - ~.:;>/'~ . - - 2S'S03 A~iW'-r~~, ~(.7V~. 61?>?-:~:;> Electrical ~1echani ca 1 PLurlBING ELEc::TRICAL MECHANICAL NO. I' Each single fixture ,7.4/k.k.~7)~I/. ~~ted builcfing (new fix. additional) FEE CHARGE NO. ~~~ rl-1ARr,~ I NO I I ~~~ I rl-1ARr,~ Residence of ~~&> SQ. FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each IAdditional bath I ~Ja ter serv i ce I Sewer IStorm Sewer SERVICES Recessed wall Soace heatpr and vpnt I I I amps.1 COMM./IND. FEEDERS I Install/alter/relocate I d;~tr;b, fppdpr~ IOf I I I amps. I I I I Appliance vent seDarate Stationary evap. cooler Vent fan with sino1e duct Vent system apart from I heating or A.C. Mechanical exhaust I hood and duct Wood stove/heater I I I I Temporary Construction Change in existing residence multifamily, comm. or Industrial Of ISSUANCE OF PFRMIT TOTAL CHARGES , WHERE STATE L~W REQUIRES shall not be valid until the /0_ ~ TOTAL CHARGES TOTAL CHARGES tha t the El ectri ca 1 work be done by an, 'E1 ectri ca 1 Contractor, thee 1 ectri ca 1 porti on of thi s permit label has been signed by an Electrical Supervisor and returned to the Building Division 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 pertaining to the work described herein, and that NO OCCUPAIlCY will be made of any structure without the permission of the Building Division. 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 ORS 701.055 will be used on this project. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stori es ;t:)LEX"qIY~~ SI'(;NATUR~ ~-:/~DATE /,,;1";'-1- FO~ OFFICE USE ONLY v Sq. Ftg. r1ain Sq. Ftg. Access Sq. Ftg. Other rW1E(please print) ~HcMY Units Occy Load Occy Group x Value Value Value TOTAL VALUATION x x BUILDING PER~lIT I Plan Ck. Comm/lnd 'Shstems Development Charges and ------------ 65%/Blda Per Fee C arqe (1.51), ' , Surcharges Plan Ck. Res 30%/B1dQ Per Fee PLUf1B ING PERMIT 1.t!J -=- Fence Charges and --- --~----- Surcha rges . 'It:> D~R1o I ELECTRICAL PERIHT I Sidewalk I Charges and ------------ I A/C Pavi ng Surcharges ITotal Comb. Permit MECHANICAL PERMIT I Curb Cut i TOTAL Charges and "/0, qo ------------ I Surcharges . COMBINATION APPLICATION/PERMIT (CAP) PERMIT 'VALIDATION "..... 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 Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources , . 1. example- heat/electrical ceilin%r,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. 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 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 fu 11 schedu 1 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 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 Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . -. , ' . , '. \.';- ,..,. " " ... '- -:.. ~~.;..~ ~ Permit applicant exempt from registration with the Builder's Board because: r Additional Project Information: " " " ......... .........;..'-.. " PLANS REVIEWED BY: .' ,.-' , ) ( . name , , / 6a#;-?~~ \.. ".,' ( ,~..~ ; " ." signature ~~ " " 4 date-.-l ~ - f ~~ r - '.::,~~..,~,,;"': .<'! ~'~LA'';:~i;~', ::;,~;;~;'<.: ,3, ' >--.;,~ I. ,_ \..1 .'" ; ~~~~~~MON Ll,rl~;'~'.(;'i,':" ~Y,lI9- I - , ,:'t:' Job Address :'?,5""~S- ~/h/h.~c'/ 4(;, dYe. .' . '. i '''' " '-~...',;',.vv-1'n~-"~""'7 'It'' ':;':)r>'.!"'i"'lf:t"~""'''' .... .:..: t.':\y. '\.l:\',~';;, " Legal Description ".';::; '-,,,~'Zc:.'t.:'\;:~~',;{J<W'f";;',~',,,."I'J':-,'<:':' ,t,', .,:<>;,~>"",,;,:::! ,I,,,,,,.,, . "\o.;\~~ . ,'..:'" o. ..~: ".' '\o'~~'''''!;i::;':~~::1,'i!,~,_,.,f.;W}''!''~,::-.".'~;'~.;~1;. .~~ ....~....~~ .,.' ".... './ ._:,r,~"',~^"~)",, . ':.~;,)~ t~ , ..:,: :,\: >.' '.' . ..... "", ",-"J _.' ~ .".".. . . .'. . . ." ,,":.,: ~~~':,,~'<~J:'~I~.,,",,~i ;,:;;~;i:' i/:' :" ~,:,t;~7~" '::' " -", " . ~ . ." '.' ,~:_:.//~~:;..:' .".:,...:.,. ..... .....;: .. ;': .::'q,. . ;, ,,-/!~.....,. "':t:-:,' .:' '. 1." .' . . . ," t I.: ~ \" . " " " CITY OF SPRINGFIELD ".".. ", .' ,_ :,' INFOR/1ATION UNt: " COMBINATION APPLICATION/PERMIT .-'......, ..._~( .':-~~W:'~l"~'~"" ".".' . 726-3753 EUERGY SOURCES:.- Sq. Ftg. I'lain . Heat ~q. Ftg. Access. 'l~ater Heater' ,.',,' '.( ~>:' ":Sq'."ftg. 'Other'., , "I'" .',' .. I' Add Al t 0 ..' "f.~;'h;;,~~,,,,.:;"\..... :YI'_~ "-" '_, __' . '... ,ew er. ..ep.f':. Range ';'~""":'''''~'''''''',''''.'''~'''''''' .., ,,,,~. -.' -Fence Demo Change/Use' -Other - "'7'" ValUE of Hork: " ~. ~ ~ .'.. ~ .': "-:\.~.'. -f':)'~!''':'':';': ;~.j '~~"'-;'~ " . .~ .0,,\.,.'.'. .: -_ .~-:,., _ ..;.;..$i..,......._ ....{~~...,;.".:.::~r.'.,.,>r.",,-...~....... '.~..llr6..,tt~~;~..~~w~~\tqf...:.<\;J,t\~~..s.' .jI.l:;<;~ .{,J~1.,'(.t..~~f!t1~ <:'....,....:~_"',~~ __1;:~ \\.. r....:J.~~:-J,:!.~.;.... ,...r.:~J~;;t,...~;,;:,it.'w-'f, r''':;;;~~.r;j'~'~_~,~. ~.." '..,., 1""....,_. ;' "_'_' ._' ".;" ,- '. . " . .' ""'. Owner ~/~.J1diN./~~c..:r ~'f"T)Ir..,.k. Address ~~ _ ./'- __' ...._~ Phone J~~ C6..............~_z:;-#-v- _ ' "/' ' t::::>.7L ' ") Y ;)-3'7/'2..... ~~C-P. _ /~.., --. / . Construction Lender . ,", " Address DES I GN TEAI~ (name) Phone (address) \ BuilGinQ Permit Info: Describe Work(i.e., Build Single Familv nesidence With Attached GaraQe) /~V~t."L ~~L~~ ' /i)t?="~~~~...-s-- ~Y/C~ :"4/ ~ ---- '( ;2;-....,. Wee=- U~C" , ilics. no.) (exoires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (exoires) (ohone no,) General PlumbinQ ,P~'5'?LU/b~ F Electrical -Llli:s. no.) ~/6- 2C>/~ I"'(t' - 2S'S03A.~,J'4'~~'~ ~.~~. ;r..:?~.!ii?C . 6~~~:;>~ - ~Iecha n i ca 1 ",', '. PLUllBHlG ELECTRICAL MECHANICAL NO. /' Each single fixture .~~~~fY. (new fix. additional) S.F. Residence Cl bath} Duplex (1 bath) each IAdditional bath l~later service I Sewer FEE CHARGE NO, Residence of ~~~ r~ARr,~, NO. ~~~ SQ. FT. furnace/burner to BTU's ~~~ rHARr,~, , ... New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Soace heater and vent Storm Sewer I I I I I I , I I Temporary Construction Change in existing residence multifamily, comm. or Industrial Of amps. ICOMM./IND. FEEDERS I Install/alter/relocate distrih. feeders , 10f amps.1 I I I I II I I I I I I I I Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatinQ or A.C. I Mechanical exhaust hood and duct Il'JOOd stove/heater I I I , I I I I I I I I I " ISSUANCE OF PF.Rr1IT TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali1 until the /0_ ~ TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this label has been signed by an Electrical Supervisor and returned to the Building Division perr.ti t 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 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 NO OCCUPArlCY 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. I ,L}t..EXA/YCJe,e.. S;r,N^TUR~ /?/-:/~DATE ~~1-R::L' FOP. OFFICE US{ Orll':'v Ir ~ Sq. Ftg. 11ain x Value Sq. Ftg. Access x Value Sq. Ftg. Other x Value Units Occy Load Occy Group IWIE(please print) J'#~Y .. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stori es TOTAL VALUATION ELECTRICAL PERr~IT Charges and Surcharges ------------ ____________ 65%/Bldo Per Plan Ck. Res 30%/BldQ Per Lt:9. .:: - I Fence --- --~-9ti-1 D6R10 I Sidewalk I A/C Paving I Curb Cut I , Plan Ck. CommlInd Fee BUILDING PER~1IT Charges and Surcharges Fee ISystems Development Char~e t1.51,) , I I I I PLur~BING PERMIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ITotal Comb. Permit ------------ TOTAL ,'/0;. qo ",.:" '. '".., ''-;''',''', ..',.. ,,' .'. ".;i,~, ";;.;J:;,':::,;.,",..,'l,.".;r.::"".':i.#~~"'r'..:':'.," ::"'.':.''''''f''ITY OF SPRINGFIELD . ~:~.; , , . . ' ':, , '"',,, 't',0~'i. ' ' : '" ,','..Clty Hall, ' ,,' ~ ".. '~":'."':<::~,.:-:~::,,~,~,;",:,'~::',.~.~' ~.:"".,,,:;.. ,.'. "~..: q'.~~""",.-,.. ..d, ",. "..',., '., ,," . i' ....". ~',.'..' :." . . 'Yf "",' ';; -. t*"'1;'!'~. ". : '~,\:'~:,.-=-:.~:i'" . ''l:~.\'!(~~i:':''{:;''.i '.f,~.:;~\~ti;.:.-~'/', ; ....~r.." t . ,. . (~/ " . ..,.'.. ' ", "I ".... " '..;,.."", . 'T"~~""f;'" "" '''" " ;' ,..."".,.,cuy.'. Sprlngfteld,.Oregon c " ;.: ','_:~ . ,': ~~.. ..; ,:, ",., .:...... ....:.- ......:.J.. ~...:~......... f"t" ';";'..::~~'":;~f: Coo '~;>;-i'~ .....:..:.'.:.:'.J./::..:::.(..z:~\~~~*.~!;.; . ___ ," . ., ;.,/,~:,;:. ,",'f' , -, "-',,:-'.', '::,.' ':: .:,~:-:":. "',",,~,. . " ',',' ..",',,'; ..., ' ;":-:"~'!" ""'&;,'/!':'~:'{i<1;.",':"'!?C'VDepartment of Public Work. ' .' , ..' ,.' ,,-,:;~;:l~.~~~~.~?~\i;~~;~~~:lifo'FFICIAl;'AECEIPT'",,,~':'i.n~1l},~,*,.;".... ' ,: ,.':~O~BI~A;~bN::.KPp:.L~CATI~N/~E~~'i:+;('i:A~:);-41.~~i~~*qjl~~~~~~,~~:~'~;IO",',~\\r~Jiif~~fk:~~:i::;;j~,.,~1\:,'~~~:No~~'B '..::' 6 57 d 5 . '. . , ~. ~ ",,"~"'i"'.f~ J\'!t...v,~....~y"" -,i'I"'~'''''I,'I'''''~'\-~~~:~~P '.... ~.,~~''''~\l'':..?il!:"t.;.., 4-'it.,j.\t,~r -,~b.";"'; >- .,~.t. i' _",.. _. ~:;.~ . '5~: \\t.:'j""'~~;~~~~' ~.': : ~\.:'.4,\I, .:~l";~;'~'~ ~'~;.:tl,,,\~:I'\l~:',~.:~~I-;o,G~S{!\';,t:i''':.i:.~l:,;, \N,'{' ')V~th:j,:,,;:':"" :'~!.::.;6-'~_-;!: ',~.~.'''''~~;!.:i-'k+i~~~'~~', 1~(if.,~: ~ '.;-,~,l,\: " "'~!h;':r'~~~bt~(i"":''I-,~':!J'",t~.'.:~.,,., ,'_ lr'-~:fm ~~~~:;fl.f'>'"' "'.; ~>'. . . ....:. ...:'~ ". "., ,~. , ... ~.~1'.f' . t<.~.'~ .' " . .- .;,. ", ',', ." : !."'\ ..",'~':'f~ :. .-~'.". ,. I '..,-" .." .~-,' ;.. '.~, ti(;-r.~'!'1::i~::t,"'~1,.' ",,' -'. ,.;.,':"JI:!;~ -.,y..~~_,. ,.~ ..:,)t\~iC",~:.~'1,' f,,~ '.' '\..~._,;,...'.~{_. f., " .t~,it., ';1. Applicant to furnish"'"';";':~',li:'~;f,::~';'~ .,:~!;:";,;":,"~;,;..~",,,,..I::;!~"'i~':1i.\f'r:-'::~~,':"""'DateJ' ' "~' "'~"i>l19';' ..." ".... 'I .,:... ....':"....,'.A.' Job Address <,,:,-, ,~:,><:::.:, ,.':."" ",,:,~'~::;K3'1'~...:y..\~;'?"i"''''__ -I :<.; z;:; , ~' , ,'- ~ ~ . " .. ". . ~.> <If'~' , ' . '... ,_ ..,' ..'ri.',,'. " _." '.--" , B. Legal Description ' ,:..,.,,~.~ ' 0 Reel'"Ci From ~/AH*(.~)~~ V~~'Pf. i ' '..' 1. example- Tax Lot 100, Lane, County Map Reference',....;);..,;!,.,'","':;;:,),;s6>~",r,::,i . _y.,' r" ..,', " y / ' 2. ;~a~~l:: Lot 1. Block 3, ~~~"~~~i't~~~to....':'<,I",?t~~~{,~ddr~~~ ~~O_'''''' ~&q~~ _4~1 , Springfield Estates' , .' :- 'y~~' . tj "',' - C. Name, etc. of owner and construction lender "~',: "l;{;f:,i<J~~,";,;'':';:t("~'.if(:if'~':;::' ':;\:" 'h" "~ s:p' D. ' Energy Sources . "';:';; ~ ~,,*';'-'~," l , ' ~ ~ C) ~/ g:a . '1. example- heat/electrical ceilinq/or forced air qas"':::,;~~"Recelved Fort) _~ ~ 2. examole- waterheater/electrical/or solar ':' ',(I":, 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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding designLinformation or'job sit€., 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" , '(I 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' O. 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 'payable when the permit is issued. :.":':~t,;~.:t:~;';~~~'.\,~.. .' -r.;.~i~::. '. ,. f ".': . Ct :,'p.?.. -H/% Ie:>. Go ,,~C> ..... :1 I I J I - - . , , (t M-r /tD . iT t:> " 1-, . " CI " ( (I ... OPY'?29~ , Amount Received /C>. ~~ ;', , ,........~ Z '''I ! BY (: ~:, Y AUTHORIZED SIGNATURE ~ (" (I ", .'. ,. '.... r BUSINESS FORMS. INC. , , 15031342.8149 , " 63, v. FOR OFFICE USE ONLY Permit'Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ " , .. ," ,.., ...-", . , .: ..~, "" '~'. , , Permit applicant exempt from registration with the Builder's Board because: Additlonal Project Information: , , _" ., ..... , r , .. .... ,;" '.~.. '.. \-~ -. '. " '" ..... - , , " ....~.. \. PLANS REVIEWED BY: '. '.~ ... ,~ -...da~eJ ~ - f c,~ ,.. , '~ name / ~?l#-e /' ~~ ~ - J signature ~~ ."