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Home My WebLink AboutPermit Plumbing 1985-1-9 , INSPECTION LINE 726- 37 69 Job Address 4: \ \ \-\:(\ 'i\ 9 ~ ~r\l _.;. J Legal Description \1. 0 ~ d... ~r>1;::r,~ Owne~l+-t\\[)(\(\ ('m~. Address 4~. ~\ ~ u ~ci1 "hone '-.~ '. (~ol Constructi~n e er- - CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat l~ater Heater Range ValuE: of work:\j JA. "I BuiloinQ Permit In~:Describe Work(i.e., Build Single Family nesidence With Att ched Garaae) ~ ()1\.Nt,,\, ~ll.tIL> ~{\ ,(1M ~\\.... bl~ , INFORl1ATlDN L1N" 726-3753 Sq. Ftq, /.Iain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use -Other - - ~ ~ Address U",j(jN TcAr~ (name) Phone (address 1 (l;es. no.) (exoiresl {ohane no. Primary Structural Electrical Mechanical CONTRACTORS (name I (address) (l ice;.. no.) (pxnirpc;,) lohnnp nn.1 :~:::::Q lldnLJ< 0 ~ g() I'-thNJ. ,"~ill. a.'J /3D I Electrical ( - tL ~'echan;cal rll/h.-IJRI n7 PLUllBlUG ELECTRICAL MECHANICAL NO. I Each single fixture I FEF I r.HARGF jlO li..E- '..c..tiAB.G.E. NO I ~':..E..-'..c.J1ARG.E... Residence of furnace/burner to SQ. FT. BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (J bath 1 Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p hp~tpr ~nn vpnt Storm Sewer I;:)CZ Of amps. I App 1 i ance vent s~oa ra te Stationary evap. cooler Vent fan with sinole duct I Vent system apart heatina or A.C. Mechanical exhaust hood i'l.nd nlJrt from Sewer Temporary Construction Change in existing rp5 j dynrp multifamily, corrm. or Innuc:.trii'l.l Water service COMM./IND. FEEDERS Install/alter/relocate di~trih_ fppdpr~ Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali~ until the I /5.{)V TOTAL CHARGES 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 ISSUANCF OF PFR!lIT 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 UO OCCUPAUCY 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 OP.S 701.055 will be used on this project. (~G(M~ IWIE(Please~C>at-1 (! 4. a I k.e..... , \. , Zone Fire Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy Load Occy Group SIGrl^TURE FO~ OFFICE USE OIjLY Sq. Ftg. Sq. Ftg. Sq. Ftg. DATE-L!tl Jr t1ain Access Other , , Value Value Value TOTAL VALUATION x BUILDING PERmT Charges and Surcharges Plan Ck. Comm/lnd ____________ 65%/Bldo PJ'r Fpp Plan Ck. Res 30%/BldQ Per Fee _J_~:"~_h Fence _ InO D6A1O 'Sidewal k Systems Development CharQe t1.5~) PLU!~BING PERMIT Charges and Surcharges ELECTRICAL PERliIT Cha rges and Surcharges flECHANICAL PERMIT Charges and Surcharges A/C Paving ITotal Comb. Permit Curb Cut I I TOTAL I / .s-:-tbd tt COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. ~xample- Tax Lot 100, Lane County Map Reference II 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 ceilinq/or forced air oas 2. exa~le- waterheaterjelectrical/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, eneck. add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. examele - 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. OESIGN 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 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: e . PERMIT VALIDATION ~t ~4Cft4 ,(r-C;~8s ~)& ~ Or Permit Clerk (j)t0<J . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date