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Home My WebLink AboutPermit Plumbing 1985-4-18 I IrISPECTlON LINE 726-3769 Job Address 30 go ~ f?~,... f} legal Description &/ ~/n.,C)..- {f~~ Ea-. \~t' (~44lD Owner'ALrl'-v,--,jfl J~..l~ Address ,I) ,<; hrJuJ {J ~pj Phone7'{7'3,nl .), oU,.../. Construction tInder . . CITY Of SPRINGFIELD INFORlIATlON LJ"c I COMBINATION APPLICATION/PERMIT 726-3753 E!lERGY SOURCES: So, Ftg, r'lain Heat ~q. Ftg. Access. Hater Heater Sq, Ftg, Other New Add Alter Pep, Range_ --Fence Demo Change/Use val#iIH~ 0 Other- - BuilriinQ Permit Info: Describe Work(;.eo. Build Single Familv nesidence IHth Attached Garaqel Address Ut:::d lirl TEAr~ (name) Phone (address) d'...-7A..._(">~i I! 1/ (lies. no.l (~ ~ ~ r'0 - 0 1\0 \5:) (exoi res) (ohane no._ I Primary Structural Electrical Mechanical CONTRACTORS (namel (address) nics. no.' (exr:lirp<; \ {ohnnp !In. \ Genera 1 Plumbina Electrical ~'echan; ca 1 NO, FEF f:HARGE Nn I ~J:"I=" + MECHANICAL I rl-l I furnace/burner to BTU's Floor furnace and vent I 1="1="1=" I rl1ARGE PLUIIBING ELECTRICAL Each Single fixture Residence of SQ, FT. Relocated building (new fix. additional) Is.F. Residence (] bath \ louPlex (1 bath) each Additional bath New circuits alts. or extensions ISERVICES I Recessed wall So~rp hp~tpr ~nrl vpnt ~Iater service ITemporary Construction IChange in ex"i'"Sting rpc;, j rly.nrp Imultifamily, COrmt. or Tnduc;,trial +- 1 I Appliance vent S~Darntp Stationary evap. cooler Vent fan wi th sinol~ duct Vent syste~ apart from heating or A_C. I Mechanical exhaust hood nnd duct I ~'Iood stove/heater Sewer Storm Sewer 10f ICOffi1,/INO, FEEOERS I Install/alter/relocate ,n;c;,trih fppnprc;, Of amps.1 amps. ISSUANcr OF PFRrllT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'l~ REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM1INED 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 UO OCCUPAfKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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. ....,..c SIGII^TURE7~ FOr. OFFICE USE OrlLY Sq. Ftg. tiain Sq. Ft~. Access Sq, Ftg, Other ,.....,.<:..., 4 L.,J DATE S/-/Y-=- rr-- NAME(please print) -::5~.v &;;;:;J Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value x x TOTAL VALUATION BUILOING PERf1lT Charges and Surcharges Plan Ck, 65%/Bldo ------------ Plan Ck, 30%/Blda I Fence I Oemo 1 Sidewalk I A/C Paving I Curb Cut I Conm/Ind P,.er Fpp. Res Per Fee Systems Development I Charqe (1.5~) PLU'~BING PERMIT Charges and Surcha rges >1/ }fJ. &iJ I I I I I ITotal Comb. Permit ELECTRICAL PERIHT Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges I 1 TOTAL ~ 8~'oi) ~ l, . . " ~ ~ COMBINATION APPLICATION/PERMIT (CAP) i. Applicant to furnish A, Job Address B. legal Description 1. example- Tax lot 100, Lane County Map Reference 17 oj 43 2, exam~le- Lot I, Block 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrical/or ~ E. Square footage or valuation, etc. I, examole- 1250 sq, foot house. 500 sq, foot garage 2. exa~le- 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 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 penmit 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. --- 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 penmit 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. 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