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
-
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, ---, ,- , ' 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::>
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