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HomeMy WebLinkAboutPermit Plumbing 1982-12-6 . . INFORlIATION LINt 726-3753 Sq, Ftg. 1,Iain :q. Ftg. Access. Sq. Ftg, Other Ilew Add Alter P.ep, -Fence Demo Change/Use Other- - t(\ #J IJ ~ ~ 53s m#,i, Legal De,cription 1,-0<'-::>'5-31- ID'100 CITY UF SPRINGFIELO COI1BIiIATION APPLlCATION/PERMIT E!IERGY SOURCES: Heat \-la ter Hea ter I INSPECTION LlIIE, 726-3769 Job Address Ranqe ValuE of Hork: Owner. .?~ sr ;.::Ltch IMd LA Address S3S rnt1.~..... ?~"..."O! O? BuilciinQ Pennit Info: Describe 14ork{Le., Build Single Family nesidence With Attached Garaoe) ,l(~P.l;R W,fI.,r=,... _J~v'C~ ,,' ~~c r= S:Z:J~t:tA9c..~ Construction Lender Address DESIGN TEAll (name) Phone (address) (1ics.no.\ (exoires) (OhOM no. Primary * Structural Electrical !1echan i ca 1 CONTRACTORS Plumbino ~ name) Se.l0 , <:: '!-Ii? (addrpsd (lies. no. \ (exoi ree;.) (ohone no.) Electrical I _ r c."...~ I.lJ,J/J4_e l , t.J? -o30? Genera 1 ~'echan; ca 1 PlUlIBlIlG ELECTRICAL MECHANICAL' NO,I Each single fixture I FEF I rW\Rr,F NO I Residence of I ~~~ 1...ctlARG..E. NO I furnace/burner to SQ, FT. BTU's I ~~~ I 21ARGE. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath) Duplex (I bath) each Additional bath SERVICES Recessed wall Sn~~p ~p~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent ~eD~r~tp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hnnrl ~nd rlu~t ~Iater servi ce > Temporary Construction Change in existing re}id~n;p multifamily, comm. or Inrlustri~l Sewer CO~1,/IND, FEEOERS Install/alter/relocate rli~tr;h fpprlpr~ Wood stove/heater Of amps. ISSUANCE nF PFR!lIT TOTAL CHARGES $;: - TOTAL CHARGES TOTAL CHARGES WHERE STATE L."~ REQUIRES that the Electrical work be done by an,.Electrical Contractor, the electrical portion of this pemit shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 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 rw OCCUPAI~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 7Ql.055 will be used on this project. IIAf.IE(please print).Ga"", lLJ,II,c;.Iow' SI('IIATURF~~ IA)/t?~ FOr. OFF I CE USE OIlL Y Sq. Ftg. riain Sq. Ftn. Access Sq, Ftg. Other DATV.! ~ -PL Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Units Occy Load Occy Group x Value Value Value x Stories x TOTAL VALUATION BUILDING PER~IIT Charges and Surcharges Plan Ck, 65%/Bldo ------------ Plan Ck, 3D%lBldo _____s-'. ~ Fence . ~c:o D~mo I.Sidew.al k I A/C ~avin9 CorranlInd Per Fee Res Per Fee Isyste.ms Development CharQe (1.5~) PlU'1BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges /lECHAN I CAL PERMIT Charges and Surcharges -;;.-- Total Comb. Permit Curb Cut TOTAL 1"< . ~e> . COMBINATION APPlICATION/PERMIT (CAP) . , I. Applicant to furnish A, Job Address B. Legal Description 1, example- Tax lot 100, lane County Map Reference 1/ uj 43 2, example- lot 1. Block 3, 2nd Addition to Springtield Estates , ."' \ C. Name, etc. of owner-and construction lender' D. Energy Sources , 1. . example- heat/electrical ceiling/or forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ I. example- 1250 sq. foot house. 500 sq, foot garage 2. example- if new project. check-nfw - if addition, check. 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. examale - convert single family residence into restaurant (change of use) G, Value of work as defined in Section 303 (al of the Structural Specialty Code H, DESIGN TEN1 ANO 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(sl 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. I f the item( s) to be ins ta 11 ed are not covered on the abbreviated schedules you should consult the full schedules C, BUIlOING DIVISION STAFF WIll FIll OUT All FEES AND CHARGES ON THE SCHEOUlES 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ifc Pf. #- ~(X> 5''1 Permit Clerk 4~ , ,~ ..c45'':> I Permit applicant ,exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . 'Si;nature~ - name __'-".......~.........__.-...... ~........ri~........_...........'"'....-....-__...."..;..; date 12.€-e ~ - . .,