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HomeMy WebLinkAboutPermit Plumbing 1986-5-19 --_...~--.- "-"'~-~._' -.... ...1.. - ", ,'." . .'u .;.. _._'... _...;.. ..'_ ....,~... ~ -".-- 'Y--:- , 'C.~, . 4 . '.~.. '01 _"4_ INSPECTION LINE, ,726-3769 . CITY UF SPRINGFIELD COMBINATION APPLICATIONIPERMIT ElIERGY SOURCES: Heat l~ater Heater Ran~e ValuE of Hark: INFOR/lATION LINl I 726-3753 , S~. Ftg. flain !~. Ftg. Access. S~. Ftg. Other lIew Add Alter Rep. -Fence Oemo Change/Use Other- - '- Job Address ~(tj '/// ~ Legal DescriptlDn Address UlSiGN TEAI1 (namel Phone faddr~ss\ E:)': D lrv -c. I~ I I Owner' Address AJe.M-O 4{(c( ~~ /J G"'L-;;" r Pho e //1/1 Builciino Permit InfD: Descr1be Hork(Le.. Build Single /1C- ;1./1~~ n Ii' Familv nesidence With Attached Garaoel n (;J/s-f, "J:'lAfJ/~/X:~ M ;Jflf m 0/l/u/ U' ./ /' t:I Constru~t.ion lender (1i~s.no.l (~xoir~sl (ohon@ I\~" ~.. no. ) Primary Structural El ectri c'al MeChanical CONTRACTORS (name) (addrpss) (1i,.~ !'In 1 (pYnir"p~' (nknnp nn \ Genera 1 Plumbino (14/ L Electrical 4 ~A~'/ 6 ~'echanical PLUI1BING ELECTRICAL MECHANICAL ....!!Q.,. Each Single fixture FEF rHAP,r.F tj(l 1CEL1..cJJABliE'-Jj~1 Res i dence of furnace/burner to 5Q. FT. BTU's F<LI Relocated building' (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence _ 11 bathl Duplex (1 bath) each IAddltiDnal bath Temporary CDnstructiDn -Iwater service '/f{+ Change in ex;sting---- , "p~jc!fJ1"P I Sewer I multifamily , COITm. or Inrlll<.t,.;;jl I 10f amps I StDrm Sewer 1 I ICOMJ.1./IND. FEEDERS I I I -CO I Install/alter/relocate I ,~. rI;<.tr";h. fpprlpr"c I 10f amps.1 I I ~.fo ,hO I . I I I I I I I ISSUANCE OF PFR1UT TOTAL CHARGES /6.(!L TOTAL CHARGES I TOTAL CHARGES WHERE STATE l'W REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portiDn Df this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division SERVICES Recessed wall _ _ ....,Sg,a,cp hp;jtp,. Plnrl v,,"nt Appliance vent ~eo~riltp Stationary evap. cooler- I Vent fan wi th ~; no 1 educt, I' Vent system apart heatino or A.c. I Mechanical exhaust hond ;jnd dlJl"t I Wood stove/heater I I I from JUU1E(please print) I HAVE CAREFUllY EXAMiNED the cDmpleted application for permit, and do hereby certify that all InformatiDn hereon is true 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 Df OregDn pertaining to the work described herein. and that UO OCCUPAllCY 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 comol;ance with ORS 7nl.055 will be used on this project. , . , Ru F '( SIGUATURE a ' II~ ~P,V' .. . .FOP."iifFICE USE mil Y \ w/ Sq. Ftg. l10in S~. Ftg. Access S~. Ftg. Other Itf<~H/E DATE -9'9/~-6 Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy lDad Occy Group ,x Value Value Value TOTAL VAlUATIOtl x x BUILDING PERf.llT Charges and Surcharges Plan Ck. Cornrn/lnd ____________ 65%/BldC1 J:p!, ~.... Plan Ck. Res ' 30%/Blda Per F..e jS. e:;o I Fence ---- ---:-(po-I D""" j'S1dewalk ------------ I AIC Paving I Curb Cut ------------ I Systecs Development Charoe tl.5~1 ' PLlJlotBING' PERMIT Charges and Surcharges ELECTRICAL PER/m Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ITotal Comb. Permit I I TOTAL 15. iP'O , , .".,' ,~.., " ;.,..., ;, . '.- ..:........ . ......, ,~~{~~rr~l,j::'~~:, .. ,-."~"" ..' - . . ,;. to".'. ~ .~ . ....;. ~"";;:......."",..~_~...):?;,;.d.;\...........;-o:.~____ COMBINATION APPLICATION/PERMIT (CAP) co: ' ',,,,"r,,,.. '".' 1. Applicant to furnish" ",,-; "...._,- A. Job Address ' '," . ' \- "," B. legal Description 1. examDle- Tax lot 100, lane CDunty Map Reference 11 oj 43 ' '; 2.examele' lot 1. B1DCk 3, 2nd Addition to <' , . ~pr.lngtield Estates '., . . :~"':~'f.;.. C. Name. etc. of owner and construction lender '. .,.;.' ,". D. Energy SDurces ' , 1. example- heat/electrical ceilinq/or forced air aas 2. examDle- waterheater/electrlcal/or solar _ E. Square footage or valuation, etc. - . 1. examDle- 1250 sq. fDot house, 500 sq. foot garage 2. example- if new project, .check-new.- if addition, check add, etc. F. Building pennit information: . 1. example - construct single family house with an a ttached garage '" 2. examole ~ remodel existing garage into family room 3. examole - convert single family residence' into. restaurant (change Df 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 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 apprDpriate 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 cDnsult 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: . " "'-', \ , -. \ ;~ l-, .... _. " . PERMIT VALIDATION '.. ~ \ . /c04;)} Permit Clerk cv' Permit, applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ',' date ,..- "'. . .'...;.:;,....,..,... , .."; '~ ;. .:;..L~_,...."..."1:.;.....'"'oJ~"'~.' 1 " .' ...... ...'.::"-. "'1' ........_.