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Home My WebLink AboutPermit Plumbing 1986-09-02Zc TISPECTIOIT L 26-37 69 ili.Y ON TIONc0HB I APPL I CAT I ERMIT -3753 Job Address J0 //{ rH EIIERGY SOURCES: Hea t Sq Sq Sq Ftg. l.lain l-egal Description . rtg. AcceF- Ftq. Other Ranqe 0 Va lue of l.lork: Owner /- surlt en""" /7p Buildinq Pernrit Info: -Describ.e-Uo*fi.e., AuiIO-Sngte_I!'xi l_f Qesj dence tii th Attached Garaqd ) 7 7st 4 7-/ Constructi nn Lender Addres s Phone I]L5IGN TEAI1 name address lics. no. )exD'res ohone no. Pri ma ry S tructura I E l ectri ca l l'lechani ca I name addres s I ics- no exoi res (ohonp no. ) Genera I Pl umbi nq EI ectri ca l tiechan i cal PLUIIB I NG ELECTR I CAL MECHAN I CAL ti0 FEE CHARGE iln FFF C HA ACF ilO. I I FFF HAAGF Each single fixture Residence of SQ. FT furnace/burner to BTLI' S Relocated bui lding (new fix. additional ) New ci rcu i ts a l ts.or extensions Floor furnace and vent S. F. Pesidence(l bath)SERV I CES Recessed wal I Snacp hcatcr and vonl Duplex (1 bath) each Additional bath Temporary Construct ion Apol iance vent seDa rate [.]ater service Change i n exi sti ng res i dence Stati onar.v evap coo I er Sewer multifami1y, conrn. or I ndustri a I Vent fan with s inole duct Storm Sewer 0f amps.Vent system apart from heatinq or A.C. 1 cor.fl.!./IND. FEEDERS Mechanical exhaust hood and drrr:f I nsta I I /a j ter/ re I ocate di <tri h fcpdpr<l'Jood stove/heater 0f amps ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I,JHERE STATE L.1N REQUIRES that ttre Electrical work be doshalI not be vali.l untiI the label has been signed by an E1 ne by an Electrical Contractor, the electrical portion of this pernitectrical Supervisor and returned to the Bu.iiding Division CAR EF UL L Y t completed apn that any and State of 0re, ssion of the c a t ,i o n for D ermi t and do hereby I ty t ha t a I I i n fo rma t i o n hereo n 'i s trueandandIfurthercertIfvall work oerformed shall be done in accordance with the Ordinances of the CityofSpringf'I e 1 d a nd the La ws of the o0n oerta 'i n 1 ng t0 t he wo r k de sc r 'I bed he re i n an d th a t NC 0cc UPAI,I CY wl 'I I be madotanystructUrew1thoutthepermiBudn9D ,|i i o n I fu rt her cert 'ify t basi s used ). ha t my req i s tr'a t i o n vll t h th e ut I deBoard is in full force and effect as required by ORS r s701.055, t ha t 'I f e xem0 t t he for e xemDt i on I s n0 ted hereon and t ha tonIvsubcontracto rs an d ernD I oyee s who a re I n comc 'I I an ce wl t h 0u S 701 055 I I I be 0 t h I s Proj e ct llAtlE(please print)/lrtlBt ..t tf,.) 1-32nuFr etD q-2-8L S ICiIATURE DA OF Zone / Cons t Uni ts Ftq. l'lain x Val Fire Zo Bedrooms Occy Load !q Ftg. Access x Va)ue Flood Plain S 0c c.y Group Sq. Ftg lue TOTAL VALUATION to ri es . 0ther BUILDIIIG PERT'IIT Charges anC S u rcha rge s Plan Ck. Corrn/Ind 65%/B1C'o Per Fcp Svs cha tens Deverqe ( 1.52 opment Plan Ck. Res 30%/81dq Per Fee PLUI,IBING PERMIT Charges and Surcha rges Fence Demo ELECTRICP.L PERI:IT Charges and Surcha rges Sidewalk A/C Paving IlECHANICAL PERNIT Charges and Surc ha rge s Curb Cut Tota l Cor-rb. l'ermi t TOTAL A,D F EC qqqq3L:a tlater Heater r/- Address .q S\D $ { :TOR S correct, COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job Adoress8. Legal Descriptionl. example- Tax Lot .l00, Lane County Map ReferenceTTlf-432. example- Lot l. Block 3, 2nd Addition toSFifli6Tietd Estatesq. Name, etc. of owner and construction lender9- Energy Sourcesl. elqlple- heat/electrical ceilinq/or forced air oas?. examo iE waterhEErEiTeTEEiirca7or soTa-i--E. SquaiE-76-otage or va I uation-E:- PERMIT VALIDATION II 1. examole- 1259 sq. foot house, 500 sq. foot garage2. ExamEte- jf n-new project, cneit-iEw - if aaOitioi,check add, etc.F. Building permit information:1. examole - construct single family house with an;ttacfr-ed garage?. example - remodej existing gaiage into family room3. ECmpIe - convert single iafriri'.esioence into ^ resii-urant (change of"use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI1 AND CONTRACTORS To avoid design or construction delays, Bui)ding0ivision Staff must be able to contalt appropriitepersons.regarding design information or job sitecorrections, etc. Abbreviated Plumb-ing, l,,lechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the I'lechanicaj and Electrical Scheduies,the app)icant need f.ill-in only the No. Boxes aOjaient - to the appropriate item(s) to be installedB. Fuil Plumbing, Mechanical, and Electrical Schedu.lesare available at the Building Div.ision1. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF l^lILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de.livered to theelectrical contractor for signature by his electricai - supervisor. The general contractor is not authorizedto sign the electrical iabelApplicant to sign and date l,Jhenever possible, the initial application will be used asa.worksheet only. Where possible, Bui lding Division Staiiwill.prepare a type written copy and returi it to theapplicant at the time the actual permit is issued for hissignature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no pians will-be processed until thesefees are paid. All other fees and charges are due andpayable vJhen the permit is issued. FOR OFFICE USE ONLY III Tlt Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit appljcant exempt from registration with the Builder's Board because: Add'itional Project Informat'ion : PLANS REVIEWED BY: da tenames't 9n ature 3PR!'t'(lF'ELf) FIHM NAME BAC CMY OF SPRINGI{ELD c1 Maintenance Division 201 S. 18th Street rll Ne- ?-as1., {lql,'ra o q rtr- L?osz PASSED FAI LED TESTER ,,r, 3" MoDELrlmc, aosP. senrar# / / 8-J Cz^ i f"t,n t ' *jt ftr-/Je CLa-k LOCATION OF DEVICE: ADDRESS: New Parts and/or Repairs Made lf Needed F inal Test Af ter Repairs I CERTIFY THE ABOVE TEST HAS BEEN PERFORMEO. Fo lrJF) Ez o CERTIFICATION# A);r DArE: 6'-l?'8L resren # NAME DATE DOUBLE CHECK VALVES Check #1 #z Check Leaked ( ) Closed risht lV )-l lLs Leaked ( I ' Closed' r4nt ifr atlls FEDUCED PBESSUBE DEVICES - lbs. Pressure Drop Across Check - lbs. Relief Valve Opened at Check#r Check#2 C losed Tight(t Closed Tight (l Belief Valve Opened at - lbs. BY (COMPANY OFFICERI I I SPFTtl.GFIELD CIIY OF SPRINGFIELD c1 Maintenance Division 201 S. 18th Street q7 No- ?-,.s1., llc.l,'ra Lqos 7 BAC FIRM NAME ADDRESS New Parts and/or Repairs Made lf Needed F inal Test Af ter Repairs I CERTIFY THE ABOVE TEST HAS BEEN PERFORMEO. r-th ,,r. -?'- M9DEL FEmo gqs P, seRrRu # / / E ';) Cu t i-s.r, b, n;'/ h,t-lJ4 O^e'oF'- LOCATION OF DEVICE: PASSED FAI LE TESTE R Fau,i- -l E = CE RTIF ICATION# A);r oArE: 6-t?'86 TESTER # NAME DATE DOUBLE CHECK VALVES Check #2 Check #t Leaked ( ) '{atlts Closed Tight BEDUCED PRESSU BE DEVICES lbs. lbs. Relief Valve Opened at Pressure Drop Across Check Leaked ( l C losed risht I V ).T \t,s Check#t Check#2 Closed Tight() Opened at - lbs. Flelief ValveClosed Tight() BY (COMPANY OFFICER}