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Home My WebLink AboutPermit Plumbing 1988-8-23 1-- - I INSPECTION LINE 726-3769 . CITY UC SPRINGFIELD COMBINATION APPLICATIONIPERMIT EIIERGY SOURCES: Heat \~ater Heater Range ValuE of flDrk: . INFORllATION llNl 726-3753 SQ. Ftg, 1,Iain ~q. Ftg. Access. SQ. Ftg. Other New Add Alter Pep, --Fence Demo Change/Use Other- - Owner. I), ~,-,--,.,t..,1 Lf-/ c.I rn n if. Phone BUlldlnQ Permlt Info: Descrlbe Work(l.e., Familv nesidence With Attached Garaael i1 )/n h-.. ~ l..J I Ie ~ 0 ~a.L'^ Build Single' ~ ~ -t:- ( Job Address ~/ r.J- rn~ ;:s:t- Legal Description Address Construction Lender Address DESIGN TEAI1 (name) Phone (address! (lics. no.' (exoires) (ohone no.l Primary Structural Electrical ..;I., I -I~..... I C' ~~I') l b"'1.'t> Mechanical CONTRACTORS (name) (address) (l ir:s. no.) (pxoirpsl (ohnnp nn \ Plumbina (t)'JJ .t ~ ('0"., J . lt~~L PJl,-,---.k...""':"'" 13^" 1z..5<.. (J ';:;0 -I,3:Ll)P, 2(7P,/13...q Genera 1 Electrical ~lechani ca 1 PLUIIBING ELECTRICAL MECHANICAL NO, FEF rHiHU::F NO ~~~ r~AQr.~ Nn ~t"~ rUQl)(.:c ~ Each single fixture Residence of SQ, FT. furnace/burner to BTU's Relocated building (new fix, additiDnal) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath\ Duplex (I bath) each IAdditional bath I ~Ja~er servi ce I Sewer I Storm Sewer SERVICES Recessed wall So~rp hp~tpr ~nrl vpnt I ~ c:9- Temporary Construction Change in existing rpc;.i (tp_nrp Imultifamily, comm. or Industrial IOf amps, I COMI,I./IND. FEEDERS I Install/alter/relocate rli<:trih. fppdprc; 10f amps. I I I Appliance vent seoaratp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart ?-Vl ISSUANCF OF PFRIIIT U-' TOTAL CHARGES 15--- TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an..Electrical Contractor, the electrical portion of this permit shall not be valid 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 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. Zone Fire Zone Flood Plain TYDe/CDnst. Bedrooms Stories Units Occy Load Occy Group SIGIIATURE ~t~ FOP. OFFICE USE OIIL Y Sq, Ftg, 11ain x Sq. Ft9. Access x SQ, Ftg. Other x DATE-.!/ZV6'B rWIE(please print) M~c:Ao..d C'N~W-,sL Value Value Value TOTAL VALUATION BUILDING PERIIIT Charges and Surcharges Plan Ck, 65%/Bldo ------------ Plan Ck, 30%lBl da I Fence I D~mo I Sidewalk I AIC Paving I Curb Cut I Canm/lnd P..er Fpp Res Per Fee Isyste,ms Development Charae (1.5%) " I I I I ITotal Comb. Permit I 'I TOTAL )5 '75 PLU!1BING PERMIT Charges and_....- ~ Surcha rges J ____l~_42.__ '75 ELECTRICAL PERrHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ,_. . COMBINATION APPLICATIONIPERMIT (CAP) I. Applicant to furnish A. JDb Address B, Legal DescriptiDn 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2, example- Lot I, BIDCk 3, 2nd AdditiDn tD >prlngtield Estates , C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qas 2. examyle- waterheaterjelectrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exa~le- if new project. check-nfw - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage ~2. exam~le - remodel existing garage into family room 3. examyle - convert single family residence into. restaurant (change of use) G. Value Df work as defined in SectiDn 303 (aJ of the Structural Specialty CDde 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 adjacent to the appropriate item(sJ tD 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 Dn the CAP, the label must be delivered tD the electrical contractor for signature by his electrical supervisor. The general contractor is ,not authorized to sign the electrical label, --- Ill, Applicant tD 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 ;s issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ~l'" ~blt 12./3"1 . Permit Cl erk a ' c;<)~." ~-d ">-~ I Permit appl icant _~xempt from registration with the BuiJder! s' Board because: Additional Project Information: '. PLANS REVIEWED BY: name signature date v '... .. '.. _ ....~"..