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Home My WebLink AboutPermit Plumbing 1985-11-6 I INSPECTION LIflE 726-3769 . . ''I.'' CITY UF SPRlriGFiELD COMBIIIATlON APPLICATION/PERMIT E!IERGY SOURCES: Heat Hater Heater Jab Address /~/ /IItVAt) /703 3S 3;;1 , '1'17 ;rt) l.egal De~cription Ranqe__ _,_ ValUE of Harle Owner j\' L f)~d Address /1Clr; AAlUl~ WGAJ!-- Construction le<<der Address UI:.~lliN Tl:.Ar1 Primary Structural Electrical Mechanical CONTRACTORS Genera 1 (name) (name) Phone 3lfS !!N'?-I ~~ INFOW1ATlON UNt 'I 726-3753 I, Sq. Ftq, 1,Iain ~q. Ftg. Access. Sq, Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - 01 '- (:) I~ Builciinq Permit Info: Describe Work.(i-.e.. Buy'1d Single Fami..lv nesidence IHth ,ll..ttached Garaoe JhA;t--a.i/ I%:I.//C. mJ /);;IA)~ 'I /LL/ I Phone (address) nics. no.) (address) nil"e;. no.) Plumbino /J A;t!4-IiJ~ Electrical f,lechanical ..-!iQ.." I I I I I 'I 1 I I Of amps,l 1 ICOMM,/IND. FEEDERS I I IInstall/alter/relocate I rl;c:;trit'L fpprlprc:; ~tye) 'rt- amp~1 I W'2) I I I 1 I I 10 70 I TOTAL CHARGES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division PLUr1BING Each single fixture IRelocated building (new fix. additional) Is.F. Residence (] bath) IDuplex (1 bath) each IAdditional bath -----Iwater service I Sewer lstorm Sewer Il1vJ(~ Iflll'IJ~ t'uJJI~ " ) -I I I 410 TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the I FFF I r.HARr.F I MECHANICAL 1..cJJABJiE..lill.....1 I furnace/burner to BTU's I Floor furnace and vent 1 Recessed wall I ~n~rp hp~tpr ~"rl vpnt I ELECTRICAL NO I~ I Res i dence of SQ. FT. I New circuits alts. or extensions " I SERVICES I I ~~~ 1 I I 1+- (exoiresl I' (ohone no. I Temporary Construction Change in existing re)jdpnrp Imultifamily, COTml. or InrllJ<:;trial (pxoirp<:;) (ohane nn 1- W " ~ I ~~~ I r 1-1 AB!iE. I App 1 i ance vent seoarate I Stationary evap. cooler 1 Vent fan with sinale r1llct I Vent system apart from I heating or .A.C. I Mechanical exhaust hood i3nd dud I l'/ood stove/heater I I 1 ISSUANCE OF PFR,lIT TOTAL CHARGES I HAVE CAREFUllY EXM1INED the comp~eted 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 OCCUPAIKY 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. AOfol)sT A R? .s ' SIGNATURE~.P;( ~ -- !JAr.IE (p 1 ease print) DATE I /-Co -8 "> . , FOP. OFF I CE USF DIlLY I Zone , Type/Cons t. Uni-ts Sq. Ftg. f1ain x Value Fire Zone Bedrooms Occy load Sq. Ftg, Access. x Value Flood Plain Stories Occy Group Sq. Ftg, Other x Value BUILDING PERfIlT Charges an~ Surcharges PLur'B ING PERMIT Charges and Surcharges ELECTRICAL PER'~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/Blda P~r Fp~ ------------i'ldn Ck. Res 30%/Bldo Per Fee 10, en Fence '------~~ib-I D;ma ISldewa 1 k ------------1 A/C Paving I Curb Cut ------------ I TOTAL VALUATION Systems Development Charoe (1.5%) , Total Comb. Permit I I TOTAL J /0.1-0 .. 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 II 03 43 2. examole- lot 1. Block 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le. heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcal/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 pennit information:<<, _.-, 1. examole - construct single .family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change of use) G. Value of wark as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid deslgn or construction delays. Building Division Staff must be able to contact appropriate persons regarding deslgn informatlon 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 Electrlcal Schedules. the applicant need fill-in only the No. Boxes adjacent to the appropriate item{s) to be installed B. Full Plumbing, Mechanlcal. and Electrical Schedules are available at the Buildlng Division 1. To conserve space on the permit form the schedules have been abbrevlated 2. If the item(s) to be installed are not covered on the abbrevlated 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 posslble. 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. ~ 10 l)7 ,~S' \ \/ 0 V, FOR OFFICE USE ONLY Permit Clerk Q1/ 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE DCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project InformatiDn: ( \ :\ ,/, '. ( PLANS REVIEWED BY: , -- -, . ~....... I ~ '\ 0,.- . , name signature date . "