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Home My WebLink AboutPermit Plumbing 1986-01-24Wlbt aant adnrt%)rr$e INSPECTION LINE 726-37 69 U1 IY OI SPRINGFIELD COI1BI NATI ON APPL I CATION/PERMIT I NFORI,IATION LiNE 726-3753 Job Address // lesar Descri otion f r] 0 3 Q S_S S l'? oo0 Hea EIIERGY SOURCES l,Jater Heater Ranqe Owner Value of tlork: Sq. Ftg. Access Sq. Ftg. 0ther her--0t I'lew Add Ai ter_Rep. -Fence Demo Change/Use Sq . Fto. l'lai Address Phone ami l nq l(e s dence tI sc AC De At :e., Build Single Constructi on Lender xlOt)Ui r;a DS (' Do L,0 \ Addre s s Phone DES I GN TEAI{name addre s s I ics . no.EXDI TCS ohone no. Pri ma ry Structura I E l ectri cal l'lechani cal IACTORS n ame addres s (lirs. no'exDt res ohone no- Genera l 0 \) El ectri cal Itlechanical PLUI,IB I NG ELECTR I CAL M EC HAN I CAL FFF CHARGF NN FFF CHARG F NO FFF Each single fixture Residence of SQ. FT furnace/burner to BTU' S Rel ocated bui I ding (new fix. additional ) New ci rcui ts ai ts. or extensions Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Snace hpatpr and vcnt Duplex (l bath) each Additional bath Temporary Construction Apol iance vent seDa ra te l,later service /Oeft 5o oo Change in existing res i dence Stati onar.v evap. cool er Sewer multifamily, comm Industrial 0r Vent fan with s inol e drrct Storm Sewer 0f S Vent system apart from heatinq or A.C. COMI'1./IND. FEEDERS Mechanical exhaust hnod and drre t Instal I /al ter/re1 ocate di sfri h fccdprc liood stove/heater I ZO .amp s.0f ISSUANCE r)F PFRI.IIT TOTAL CHARGES 3t ZO TOTAL CHARGES TOTAL CHARGES WHERE STATE LAli REQUiRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perr,rit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed application for permit, and do hereb.v certify that all information hereon is true and correct, and I further certif-v that any and all work oerformed shall be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State of 0reoon oertaining to the work described herein, and that NC OCCUPAI'ICY wiil be madeof any structure without the permiss'ion of the Building Division. I Board is in full force and effect as required by ORS 701.055, that if only subcontractors and employees who are in comcliance with ORS 70i.i ,, La(-lbt'lAt'lE( p1 ease pri nt)S I GNA' further certi fy that m.y reqi strati on vri th the Bui I der' s the basis for exemption is noted hereon, and that be used on this Droject. $ln.' REEb Ftg Ftg Ftg l,la i n Value TOTAL VALUATION- x x x5qFlood Plain Stories 0c c.y Group. itsnst Val ue Val ue Zone Acces s 0ther Fire Zone Bedrooms Occy Load Plan Ck. Comm/Ind 65%/81C'o Per Fee Svstems Deve Charqe (1.52 opmentBUILDING PERI'IIT Charges and Surcha rges Plan Ck. Res 30%/Bldq Per Fee FencePLUI^4BING PERMIT Charges and Surcha rges l"?D D6mo Sidewa.l k A/C Paving ELECTRICP.L PERIIIT Charqes and Surc ha rges Total Comb. Permit Curb Cut 3 t .-zo 14ECHANICAL PERMIT Charges and Surc ha rges TOTAL n CHARGE I COMBINATION APPLICATION/PERMIT (CAP) I . Appl i cant to furni shA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 ?. exampie- Lot 1. Block 3, Znd Addition to Springfield Estates C. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. 2.E. Squa exampl e- examp I e- re foota hea t/air gas water ge 0r F l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, EirecR--add, etc. Building permit information: a6g 1f1exampl e a ttac hed - construct single fami)y house with an garage 2. example - remodel existing garage into family room3. example - convert singie family res.idence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropr.iite persons regarding design information or job site (A ,V6 corrections, etc. Abbreviated Plumbing, Mechan'ical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Bui lding Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal1ed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF l^lILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the eiectrical label Applicant to sign and date Whenever possib)e, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapp)icant at the time the actuai permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapp)ication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY > q II III IV. Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s'l g nature date