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Home My WebLink AboutPermit Plumbing 1985-10-23 I INSPECTION LHlE 726-3769 e . ~wA Job Address G:,c. S HAt tJ Legal Dmription /7 033S,3 J CITY UF SPRINGFIELD C0I1BIIIATlON APPLICATION/PERMIT EIIERGY SOURCES, Heat 10/0 0 Ilater Heater Ranqe INFORlIATlON LINE 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A lter ~ep. -Fence Demo Change/Use Other- - ~ Owner FiR.ST {~"r1'i.QS...... "- I~At.l(c.. Address lObS' MAIH ValUE of Hork: -..... Phone BuilrilnQ Permit Info: Describe Work(i~e.~ Build Single Familv Residence With Attached Garaael i!P/j Jlfmt) /JAt!J)I~~ I I o - --h Construction lender Address Ul~lurl IlA,., (namel Phone (address) llics. no.' (exoires) (ohane no.) ~ rr' I Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (address) fUrs no.' (pxoirpc:) (ohnnp nO,l Genera 1 Plumbina MJl>Nl...F~ PLAh ~ H.1b (',... 25S0Wtll~ &-. '2.0-(-41"8 EV~F~ Cfl. Q'7o.l.0 ~ &.~ 4-XL\--liool Electrical ~lechanical PLUIIBING ELECTRICAL MECHANICAL NO. Each single fixture Frf rH~ ..lli' ITL ..clIARIiE Jlll......1 Res; dence of furnace/burner to SQ. FT. BTU's ~~I=" I rl-ll1RGE... ,/ Relocated building INew circu!ts alts. (new fix. additional) or extenslons . S.F. Residence ISERVICES 11 bath) Ouplex (1 bath) each I IAdditional bath ITempOrary Construction Iwater service I IChange in existing rp<;; j dJ"pl"P I Sewer I Imultifamily, corrm. or Industrial IStorm Sewer I I 10f "2- I ~/);.~. I In Ion ICOHlI.IIND. FEEDERS I I I Ilnstall/alter/relocate I ni<:trih fppnpr<: I I I 10f amp~1 I tf% I 11"0 I I I I I I I I I I I I TOTAL CHARGES /0 -'IV I 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 Floor furnace and vent Recessed wall S~~rp hp~tpr ~nrl vpnt I I Appliance vent seoarate I Stationary evap. r'ooler I Vent fan wi th sinale duct I Vent system apart from I heatina or A.C. I Mechanical exhaust ' hood and duc.t. I Hood stove/heater I I I amps.1 ISSUANCE OF PFRllIT I HAVE CAREFULLY EXAMINED tbe 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 Spri ng fi e ld and the laws of the Sta te of Ore(]on perta i ni ng to the work descri bed herei n, and that HO OCCUPAIlCY 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 701.055 will be used on this project. llAl-IE(please print)_H~..LE'" C?.4l..b.. t H'1lo G... SIGIIATURE ,^^o..L,.L Z.lu....J.. ~ FO~ OFF I CE USE Q;lL Y \ Sq. Ftg. f1ainx Sq. Ft9. Access 1 Sq. Ftg. Other x OATE~ O<:.v- as Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group Value Value ValuE' TOTAL V ALUA TI ON BUILDING PERmT Charges and Surcharges Plan Ck. Comm/lnd 65%/Bld~ Ppr Fpp Plan Ck. R-es 30%/Blda Per Fee Systems Development Charp. (1.5~) " PLU'1BING PERMIT Cha rges and Surcha rges -----LQ~~-I ::::e I Sidewalk I AIC Paving I Curb Cut I Total Comb. Permit '~ ELECTRICAL PERI:IT Cha rges and Surcharges MECHANICAL PERMIT Cha rges and Surcharges I TOTAL (~~';Ql . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map Reference 17 03 43 2. examole- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/eleCtrlcal/or SOlar E. Square footage or valuation. etc. - 1. examDle- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project, check-new - if addition, check: add, etc. F. .Building permit information: 1. examole - construct single family house with an attached garage 2. examole - 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 delays. Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. II. Abbreviated Pl~mbing. 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. PERMIT VALIDATION , . ~ r 0 C'7 ~ d ? ~O .~ V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: (lG l Permit applicant exempt from registration with the Builder's Board because: Additlonal Project Information: PLANS REVIEWED BY: name signature ~ . I date .