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Home My WebLink AboutPermit Plumbing 1983-9-2 ) lrlSPECTION LINE 726-3769 Job Address 1 qg 7 ~.. ~ .J..i Legal De<cription {I 0 ()2,,912-1 . - CITY UF SPRINGFIELD Cm1BiIIATIDN APPLlCATIDN/PERMIT EIIERGY SOURCES: Heat Hater Heater Range INFORliATION LINt 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftq. Other New Add Alter Rep. Fence_Demo _ Changel Use _Other o I~ N M 00 Owner A-l:'1.JI/'tI 1/1 f.(~ Addres~ I; 1/(7 ~ /~I>a--1T A 1(/ il'cF Construction l~nd~ - ValUE of Work: Phone BuildlnQ Permit Info: Describe Work{i.e., Build Single Familv nesidence With Att~ch~d Garaa~) Address UtSltiN rU\Ii (name) Phone (address) ~6~/ t'-/.J 1,-(Ju.~;.A (cf) flies. no.l '"'"'"" ...ji' no.') I Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (address) 11 ;("0:;,. no.) (pxoirps) lohnnp no 1 Genera 1 Plumbina 3IU~. CU,.-..~t\ (j).Q-,~~ UI ~. 067 ;1/tt<..{k IS-tu:/'f!. ~a--t d; J.ldI J U I " Electrical ~1echan;cal PLUIIBING ELECTRICAL MECHANICAL -1!Q..,,1 Lf Each single fixture Relocated building (new fix. additional) FFF rHARr.F 'll' I Residence of I ~~~ fl-l.;&G[ Nn I furnace/burner to SQ. FT. BTU's I ~~~I...cHARG.E.- i ~.oo 20.oD New circuits alts. or extensions Floor furnace and vent S.F. Residence {] bath 1 Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp np~tpr ~nrl vpnt l.-{ "!i) ,~D lTempOrary Construction IChange in existing rp$ i dJ'.nrp . Imultifamily, corrm. or Indllc:.tri~l IOf amps.1 ICO~~./IND. FEEDERS I IInstall/alter/relocate I dic:.trin_ fppdprc:. IOf amps.1 I I I Appliance vent !!~oaratl':' Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I hea ti no or A. C. Mechanical exhaust hood and durt Wood stove/heater Water service Sewer ~Storm Sewer ISSUANCE OF PFRlIIT TOTAL CHARGES lj.<(O TOTAL CHARGES TOTAL CHARGES WHERE STATE L\II 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 f HAVE CAREFULLY EXAtiINED the completed application for permit, and do hereby certify that all information hereon is true and correct. and 1 further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Ore!)on pertaining to the work described herein, and that UO OCCUPAIlCY 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 ::ll:(:~::::t:::::~S and employees who are in compliance with :::Il:::C\~~ tz:tfLJ-. DATE9~-8s FOP. OFFICE USE 0;1['( 0 /1 Sq. Ftg. rlain x Sq. Ft9. Access x Sq. Ftg. Other x Zone Type/Const. Bedrooms Units Occy Load Occy Group Value Value Value Fire Zone Flood Plain Stori es TOTAL VALUATION BUILDING PERmT Charges and Surcharges Plan Ck. Comm/Ind ____________..M!/81do Ppr ~pp Plan Ck. R'es 30%fBldo Per Fee Systems Development Charqe (1.5~) . PLUt~BING PERMIT Charges and Surcharges --~'--~--- .YO Fence ELECTRICAL PERI~iT Charges and SurCharges D~mo I'Sidewalk I AIC Paving I Curb Cut I I ITotal Comb. rermit liECHANICAL PERMiT Charges and Surcharges I I TOTAL c 20.~() - COMBINATION APPLICATiON/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100, Lane County Map Reference. II oj 43 2. examele- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electrlcal/or ~ E. Square footage or valuation, etc. I. examele- 12S0 sq. foot house, SOO sq. foot garage 2. example- if new project. check new - if addition, . cneck add, etc. F. Building penmit information: 1. example - construct single family house with an attached garage 2. examEle - remodel existing garage into family foom 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 TEM4 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 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. --- 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , PERMIT VALIDATION ~ v , Permit Clerk . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s~gnature date