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Home My WebLink AboutPermit Plumbing 1981-12-2 I IrlSPECTlON LINE . . \'. CITY Uf SPRINGFIELD INFDRllATlDN UNt 726-3769 COI\BIIIATlON APPLICATlON/PERMlT 726-3753 Job Address <<"tb ~- _ ~~ G. ~~~;~GY SOURCES: ~~: ~~~: ~~~~ss. Legal omriPt;;C2fJ ~U_{) /'CJ u.L- ...J ~:~:,: Hea_.t_e.r",,__ Sqile~tgAd~th~~ter Pep. ,~ ~I :1 ~ --Fence Demo Change/Use- Owner ~ -~ _' j:~~ ~ ~ Valu€ of Hork: Other- - I Builoino Permit Info: Oescr be Workli,e" Build Single Address s:t ~. y .. ("', - __ -. Phone Famil V ~esidence '-lith J1.ttached r,araQe) '''.'..'~."" I , (ornnp nn. i , '. Construction Lender Address OE,IGN TEAll Phone {address 1 (lies. no.) (name) Primary Structural Electr;cal f1echanical CONTRACTORS (namel (address) (lies. no.) (exn; res) Genera 1 'I ;lumbino 'F<~JJ._. " ; Electrical ~ vI< <::!_ 7 ,~J;3 ~~,- ~lechanical ~f/)" / ::1 PlUI1BWG C' 9110, ~ I Each single fixture ( I Relocated building (new fix. additional) Is.F. Residence (1 bathl 10uplex (1 bath) each IAdditional bath IHater service Sewer ELECTRICAL MECHANICAL . "'"-----==.- FFE c~ilBGL ...1'0' ;fa FFF r'WlliE. .Jill, Residence of furnace/burner to BTU's SQ. FT. New circuits a1ts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~~ hp~tpr Anrl vpnt Temporary Construction Change in existing re'i14eJlce multifamily, comm. or Industrial Appliance vent s~o.arate Stationary evap. cooler Vent ran wi th sing 1 e dIA~t- Vent system apart from I heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater Storm Sewer Of amps. CO~1./INO. FEEDERS Install/alter/relocate distrib. feeders Of amps. \, ex' -- () 0- ~ no.') ! I ;";'"!'--~FF ..c.HARiiE.. ~ " <l ..... '1>0 ISSUANCf OF PFRtllT TOTAL CHARGES If ( )CO TOTAL CHARGES TOTAL CHARGES WHERE STATE L\lj REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that all infonnation hereon is tr'ue and correct, and I further certify that any and all work oerfonmed 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 <<0 OCCUPAr~CY 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 sUbcont~o~em~s, who t:f in com~h.Op.s 701,055 will be US~d)/n this project. UA:IE(PleaSe~) , ~ SIGUAT~ (I G..f OtA./ DATE AF.;1-JO FOr. OFFICE USE OIll Y Sq. Ftg. Sq. Ft~. Sq, Ftg. Zone Tvpe/Const. Bedrooms Units Occy load Occy Group tiain Access Other x Value Value Value Fire Zone Flood Plain x Stories x TOTAL VALUATION BUILDING PERf.1IT ' Plan Ck. Conm/! nd Charges an~ ------------ 65%/Bldo P~r F~~ Surcharges Plan Ck. Res 30%(Bldo Per Fee PlUt1BING PERMIT --ill pU Fence Charges and Surcharges 4( ) Demo ELECTRICAL PERI:IT Sidewalk Charges and ------------ Surcharges AIC Paving rlECHANICAl PERMIT I Curb Cut Charges and ------------ I Surcharges 'Syste~s Development Charoe (1.5~) Total Comb. Permit I TOTAL {n 4IJ \ ...... '" . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B. Legal Description 1. examp.le- Tax lot 100. Lane County Map Reference II 03 43 2, exa")Ple- Lot 1. Block 3, 2nd Addition to ~prlr.gtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electr;cal/or solar E. Square footage or valuation, etc. ------ I. examole- 1250 sq. foot house. 500 sq. foot garage 2. examp'le- if new project, check-new . if addition, check add, etc. F. Building pennit information: . 1. example -' construct single fi\mily house with an attached garoge ;; 2. examole - remodel existing garage into family room 3. examole - convert single'family residence into restaurant (change of use) ;\ G. Value of work as defined in Section 303 (a) df the Structural Specialty Code " H, DESIGN TEAM AND CONTRACTORS , To avoid design or-construction delays. Bun~ing Division Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. " II. Abbreviated P1"umbing. 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: . . I I I. t~-"'l \ PERMIT VALIDATION . . \, Permit Cl erk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date I " ~ 1 ;.! (j ;1 i I ~ ., :' i " 1 :1 '1 1 :, l , , 'I "~ , " ': " '. \ I I .1...;,..[ ... '1j",:,,';J,,1~"'i',.v~t .' " .'.... - ~ , . ~ - j ~'. "'..~ ..... ;" t I.: !. . " ~ . I I~SPECTION LINE 726-3769 C I TV OF SPRIIIGF I ELD COtIBI :IATI ON APPLI CATION/PERMIT il". e E!IERGY SOURCES: JI.- Heat .4 . Hater Hea ter Job Address ~6~- :?H'~ Q Legal oe'cripti~ ...J/.'JJ.dP (lJ u.L_ r ~ oV"' ' I Owner f{o"",,-- ,-~- _.....4J1~ ,'""\..... - Address s:t 10 '2'" ' 'C" - Phone Ranqe --, ValuE of Work: ~ BuilGinQ Permit Info: Describe Work(i.e.. Build Single Familv nesidence With Attached ~araae) Construction Lender ..\Jdress Ot:::'llirt I tAf.1 Phone {address} (name) flies. no.) Primary I Structural Electrical . f1echanical CONTRACTORS (addr~ssl Inamel (lice; no.' Genera 1 'PI'timbina 'K~..QII."'"- Electrical " LlN, II INFORltATlON 726-3753 So. Ftg. "lain ~q. Ptg. Access. Sa, Ftg, Other 'Iew Add Alter ~ep. -Fence Demo Change/Use' Other- - (exoi res) I I ij (ahoM no.) (pxoirpsl (~nnnp nn i :J- (.LJ. ~ _ 7 Uf'~ ~o-JLe - , ~ I I I I I I I I I I I I I I TOTAL CHARGES -( ( .cC'> TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an' Electrical Contractor, the electrital portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXN1INEO 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 Derfonmed 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 rm OCCUPAr~CY 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 I1nly sUbcont~o~e~~ who (Jnin com~h.Op.s 7~l.055 will be uS~dln this project. UAIIE(PleaSe~) -{ mrlAT~ V Q.. OLef' oAT,E/O--J-JD FOP. OffICE,USE OilLY Sn: Ftg. Sq. Ft9" Sq, Ftg, ~1E'danical ( '/::' PLW1BIriG . ---1!Q" , '\ Each Single fixture /-., / ELECTRICAL FFF <+ /Hi\R(;F Jj(l . r::.EL 1.CIJABliE. .1Jll Residence of SQ. FT. Relocated buildin9 (new fix. additional) Is.F. Residence 11 bath) louPlex (1 bath) IAdditional bath Il-later service New circuits alts. or extensi.ons SERVICES each ITempOrary Construction IChange in existing rp~jdJ"_nr:p Imultifamily. comm. or Induo;trial 10f ICO~1./INo. FEEDERS I Install/alter/relocate ,rl;~tr;h fpP~pr~ 10f amps.1 Sewer Storm Sewer amps.1 Zone Tyoe/Const, Bedrooms Units Occy Load Occy Group t1ain Access Other Fire Zone Flood Plain Stories BUILDING PERmT Charges an~ Surcharges Plan Ck. Comm/Ind 65%/Bld~ PE'r Fpp Plan Ck. Res 30%/Blda Per Fee Fence PLUtlBING PERMIT Charges and Surcha rges D_ r Sidewalk I A/C PaYing I Curb Cut I ELECTRICAL PERI:IT Cha rges and Surcharges I1ECHANICAL PERMIT Charges and Surcharges I '.. 'j , . MECHANICAL t't'~ . r"U~ furnace/burner to BTU's Floor furnace and vent . I Recessed wa 11 , J::;n;tC'P np"tpr .:Inrl \lpnt I I I I I I I I I I I I I I :~~~~;~~e vent I Stationary eyap. cooler I Vent fan with sinale duct. I Vent system apart from I heatino or A.C. . I Mechanical exhaust hond and dlJr:t. I ~Jood stove/heater I I I ISSUANCE OF PFR:m " Value Value Value , x TOTAL VALUATION Systems Development I Charoe (j.5~) ITotal 1- I'OTAL Comb. rermit \ I " , ~ - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B. legal Description 1. examo I e- Tax Lot 100, Lane County Map Refe (~e 11 03 43 2, examole- Lot 1. Block 3, 2nd Addition to ~prlr.~tield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or" forced 2. examole- waterheater/electrlcalJor sora;;- .r E. Square footage or valuation, etc. ------ 1. examole- 1250 sq, foot house, 500 sq, foot 2. examole- if new project. check-new - if ad check add, etc. F. Building permit information: . ( 1. example - construct single family house wi attached garage . 2. examole - remodel existing garage into fan 3. examole - convert single" family residence (0 restaurant (change of use) :, G, Value of work as defined in Section 303 (a) Of Structural Spetialty Code H. DESIGN TEM1 AND CONTRACTORS ( To avoid design or construction delays, Bui19i Division Staff must be able to contact appropr persons regarding design information or jab si corrections, etc. ' II. Abbreviated Plumbing, Mechanical, & Electrical Set A. Except where' blank spaces occur in the descri~ portion of the Mechanical and Electrical 5chec the applicant need fill-in only the No. Boxes ~ac to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Sch( are available at the Building Division :; 1. To conserve space on the permit form the ~ edlJ have been abbreviated 2. If the item(s) to be installed are not COI the abbreviated schedules you should conSl full schedules . ( C. BUILDING DIVISION STAFF WILL FILL OUT ALL FW 'n CHARGES ON THE SCHEDULES 0:. ,As noted on the CAP, the label must be delive, electrical contractor for signature by his ell supervisor. The general contractor is.not aU1 to sign the electrical label. --- Applicant to sign and date Whenever possible, the initial application will bf tel a worksheet only. Where possible, Building Divis' \.~.~, will prepare a type written copy and return it to applicant at the time the actual permit 1s issued signature. Fees and Charges Plan thec~ fees are due and payable at 'the time 0'>- 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. IT!. IV. V. FOR OFFICE USE ONLY . f ~ " ,.-r.. PERMIT VALIDATION CITY OF S P R I N G FIE L'D ( City Hall Springfield, Oregan Department of Public Works OFFICIAL RECEIPT No. B i~" ;(\\.") '1~'< \ Rec'd From")..~ \ (' ,\~- \- \\ ~ .~'C(~ .l ':-7' Address ~l Jl \ l'rt Lr\ t\ ('\ \")i \ ' , \ (J 'I Date 57395(1 oJ Received For: \ /\ \\ ."'.,'\ ('-. v' ,j 'vI \ \,," \ \ ' '1~J{) \C)C~) '-\-C (" " , ('l ):~~vn .. AUTHO'UZI:D Sla~ATUIU: , 'HI:~TaN'TU"H.U~~ ....'NTUl. . IUOI"I:. Oil '7"0' ..!"" ( (', i- Amount Received :I""':-,t:i-; ,f 'U ,/ 0:X ,.' Permit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date (~ ( ~ I' C. \ (t 'j I I I ( . ( . o (I ( . ("I' ~ ]