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HomeMy WebLinkAboutPermit Plumbing 1990-6-11 jINSPECTION LINE 726-3769 'Job Address 30 ':77 -(,]o. vtdtVl P;..-J d I1R lId Legal Oescription )7/) '2-ld{ 00 (J :)~r,-n . CITY OF SPRINGFIELO COMBINATION APPLICATION/PERMIT E!IERGY SOURCES: Heat t~ater Heater Ranqe_ ValUE of Hork: . '. IN~aRiiATiON UW~ 726-3753 ': : Sq, Ftg. I,;a;n Sq. Ftg... Acces.s.~__~ Sq. Ftg, Other Ilew Add Alter Rep. -Fence. Demo Change/Use -"Other- - , , ~ J \ 0 , I.... :::> - I "t' 29 '~ Owner' eVJCI~ {name) Phone (address) BuildinQ Permit Info: Describe Work(;~e.t Build Single Family l'I.esidence ~"ith JI..ttached Garaoel flH"ev, l.l\f\{\ed1Ci"'-'~9I\HV\ \I)JVI~ n:~ lclL \ 1"'1 "'1", [); ,/1'" ) '. 0 Address J?r-,,-) E L/--j'V\ r1'VL ()~ Q7QO I Phone 'iIX' LJ -2</11 t:::':>IA/{dA,. , Constructi'on Len.' er . Address DESIGN TEAr~ (1;es.no.1 (exniresl (ohane no. ) Primary Structural Electrical Mechanical CONTRACTORS (name) (addre~~ , (1 ics. no.)' (exoi re<;.) (nhnop nn , Genera 1 PlumbinQ wi.. l~'Ytllev ('(',,/')/)1.1. (iflc;, J /id.2-3 ntdovfwnr/1}!' 2r!il-8 M/ ) i.!J fo-2C;~ Electrical ~1echanical PLUI,IB I NG ELECTRI CAL MECHANICAL NO, '9 Each single fixture Relocated building - (new fix, additional) FFF CHARGF NO FFF C~ NO, FFF C~ SQ. FT. furnace/burner to BTU's 7.,9', Cl-9? Residence of New circuits a1t5. or extensions Floor furnace and vent S.F. Residence 11 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall SnAce heatPf and vpnt Storm Sewer Of COMH,/IND, FEEDERS Install/alter/relocate rli~tr;h_ fpprlpr~ amps. Appl ;ance- vent o;.eoaratp Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and dur.t Sewer Temporary Construction Change in existing rp~jdr.nl".p multifamily, conm. or Industrial Water service Wood stove/heater Of amps. ISSUANCE OF PFRlllT TOTAL CHARGES 67SZ> TOTAL CHARGES TOTAL CHARGES WHERE STATE L~H 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 EXAMINED the completed application for pe;'mit, and do hereby certify that all infonnation 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 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 ons 701.055, that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project. IWtE(p1em print)m 41/v 1. /)J; !Ipv _SIr,IlATURE~d ,J /}J /L om&"- /1- 16 FOP. OFFICE USE QilLY , Zone Tyoe/Cons t, ',' Units So. Ftg, riain Fi re Zone Bedrooms Occy load Sq, Ft~. Access Flood Plain Stories. Occy Group Sq, Ftg, Other x Value Value. Value x , TOTAL VALUATIOIl BUILDING PER~IIT Charges an~ Surcharges Plan Ck, Corrm/lnd ____________ ~/Rlrlt:'l ~"r F",p Plan Ck, Res 30%/Bldo Per Fee _nnIi.Z-.2~_ Fence '"3- 3'~ O~mo ' Systems Development Charoe (1.5~) , PLU!~BING PERMIT Charges and Surcharges ELECTRICAL PERmT Sidewalk Charges and ------------ Surcha~ges AIC Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 7c:?8g . . . .,: . ,..,__ ',,' - , ';'1 ' " V' ~ COMBINATION APPLICATION/PERMIT (CAP) PEro~IT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference 11 oj 4j 2. example- Lot I, Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 'I. examRle- heat/electrical ceiling/or forced air qas 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. I, example- 1250 sq, foot house, SOD sq, foot garage 2. example- if new project, check-new - if addition, checl< 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 d~lays. Building ~ivision 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 Electr;cal Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2, h 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. --- Ill. 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 8uil~er's Board because: Additional Project Information: PLANS REVIEWED 8Y: name {6/'3'~P(c:x:;~ signature ,~~?~ ~~' date ':;-,('/-9= I INSPECTION LItlE 726-J769 Job Address 3{/ 57 . CITY UF SPRINGFIElO COMBHlATlON APPLICATION/PERMIT --~-- E!IERGY SOURCES: Heat I~ater Heater Ranqe_ . , INFOliiiAiiON LWt. _.__ _ 726-J7~1 Sq. Ftg. flain ~q. Ftg., Acce... Sq. Ftg. ,Other New Add Alter Rep. -Fence, Oel1'O Change/Use -'Other~ - ~ ,~ .r~( ly:kLIl R" d c'r o_d legal De5Cription 17 () '2./ I CO :-j :;:l.,r,j) Owne r . (l'JCI~ ValUE uf Work: Address r~~() E '-1-1'-" t-\ V C-... ~17'f() J D~ Phone 'tIC( l..J -2'/lL ....11lh::v Llw\e..-rlc~ pluM haw re~\cI(\~'''J r'~;"1~) , \j llics. no.l (exoiresl ~U'IQ'nQ ~ermlt t"fo: oescr1be WOrk(1\e.. Bu11d s1ng1e Familv nesidence With Attached Garaa.' 1>';)j"'IAJ,. construction Len er Address Ut~lbN [tAr" {namel Phone (address I (ohone no. I Primary Structural Electrical Mechanical CONTRACTORS (name) (addrfl5s1 flics. no. 1 (exniresl t Dhnnf~ no. 1 Genera 1 Plumbino [I\)L 11Y,llev 1\.,dlV(I~v.1 7jd.L-3 ntdrd1Jtrtrlft' 2dl28 1.Q./2/ ) ,(ICr2~;73 Electrical Flechanical PlUllB I NG ELECTRICAL rH~RGF I' NO, MECHANICAL NO. FFE CH~RGE NO FFF FFF r4ARliE. SQ. FT. furnace/burner to BTU's .:; Each single fixture ?9P Cl-9? Residence of Relocated building . (new fix, additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence f1 bath \ Ouplex (1 bath) each Additional bath SERVICES Recessed wall ~~~~p hp~tpr ~n~ y~nt Storm Sewer Of amps. Appl tance. vent ~f!D2H'ate Stationary evap. cooler \,ient fan with single duet Vent system apart from heatinq or A.C. Mechanical exhaust hood it nd due t Wood stave/heater Sewer Temporary Construction Change in existing resi~f.n('e multifamily. corrm. or Tndustrial Water service CO~1./IND. FEEDERS Install/alter/relocate distrih. feeders - Of amps. ISSUANCE OF PFRIHT TOTAL CHARGES b7-SZ> TOTAL CHARGES TOTAL CHARGES WHERE STATE lAl~ 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 Oivision I HAVE CAREFUllY EXAMINED the completed application for pe;'mit. 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 UO OCCUPAUCY will be made of any structure with~ut 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 OPOS 701.055 will be used on this project. Unit.s Occy load Occy Group _SIGtIATURE:&Jd ,,2 FOr. OFF! CE USE DIlLY' Sq. Ftg, rlain Sq. Ftg. Access Sq. Ftg. Other />>d DATEb" - /1- fa IlAIlE(plem print)p; .4/lv 1. /)J: Ilpy Zone Fire Zone Flood Plain Tyoe/Cons t. Bedrooms Stories- )( Value x Value. x Value TOTAL VAlUATlOtl BUILDING PERFIIT Charges an~ . Surcharges Plan Ck. Comm/lnd 65%/Bldo Ppr Fpf! ------------ 'Pi'an Ck, Res JOt/Blda Per Fee _____Ii.Z-;2~_ Fence "3- '?Z$ DfIIl10 Systems Development . Charqe (1.5%) , PlUt~BING PERMIT Charges and Surcha rges ELECTRICAL PERmT Charges and Surcha~ges I1ECHANICAl PERMIT Charges and Surcharges 'Sidewalk AlC Paving Total Comb. Permit Curb Cut TOTAL 7ctJ.8g . ..,' " '.' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. examQle- Tax Lot 100, Lane County Map Reference II oj 43 2. exa~le- Lot I. Block 3, 2nd Addition to ~prlngtield Estates ' C. Name, etc. of owner and construction lender D. Energy Sources 'I. examele- heat/electrical ceiling/or forced air Da 2. exam~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examele- 1250 sq. foot house, 500 sq. foot garage , 2." example- if new project. check new - if addition. cneck add, etc. F. Building permit information: I. example - construct single family house with an attached garage 2. examele - remodel existing garage into family roo 3. example - convert single family residence into , res taurant (change of use) G. Value of work as defined in Section 303 (aJ 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 adjacen to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division I. To conserve space on the permit form the schedule: 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 tt, electrical contractor for signature by his electrical supervisor. The general contractor 1S.not authorized to sign the electrical label. --- Applicant to sign and date I 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. Ill. V. FOR OFFICE USE ONLY - . n;.,~ ~~ .2 , ---, ,- , ' r. t. " 'CITY OF 'SPRINGFIELD """"'t~' 'j : City Hell ,{ Sprlngftold, Oregon Development Services OFFICIAL RECEIPT I,; 17314 I Dale //.F~ /~, 19-:72' ' ~ec'd From 'A/.~ -,/W"-.;; ,.c:-;y' ~~: , ' Address ~-::~~ OZt..;pE7? 5q, /ib:: ~eceived For: . b7'!1hCtt> 7'7' ~ /~...,:,-... v , , RP ~ k. /_~ -\,.-" - ?,-,?g 11 P7~t' 7c9,<e/B Cij/ # L:'~ 3'S v .!!L 7(9. &:8 4P7d'~/a~ v r AUTHORIZED SlGNMfUFlE ~ 1- .. ....10)61 Amount Received .- r. ,_ 8V$INESS fOAl,lS. INC. t!oO.1IJ.1U1.' Pennit Clerk . PROJECT CONDITIONS TO 8E SATISFIED 8EFORE OCCUPANCY: Pennit applicant exempt from registration with the 8uilder's Board because: Additional Project Infonnation: PLANS REVIEWED 8Y: name L6J"!J#G"""Pc..cz::;t!E7f' signature ~~, P/ ,~~~-' date h-/./-"'7t::> I ""