The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 1985-01-25I NSPECT I 7?6-37 69 NEL CITY OF SPRINGFIELD COMBI NATI ON APPL I CATION/PERMIT Job Address !z,l ;: I'<'-*EIIERGY SOURCES Hea l,later Heater Ranqe. Sq. Fto. l'lain_ Sq. Ftg. Access._ Sq. Ftg. 0ther-- _!'lew___..Ad d__1A1 te r_Re p . _Fence_Demo Change/Use 0ther N) i \ Ln B- l-egal Description Value of l,lork 0wngr '.\tt i.a Address fr O /3r*vhoneTqtr.5{51o Builciino Pernrit Info: Describe Work(' Familv Residence llith Attached Garaqd :e.r Build Single SPt td Construction Lender 1^"U"^^l"-olJ; Addre s s Phone DESIGN TEAI.I name address (1 CS. nO ( exo i res ohone no- Pri ma ry Structura I E'l ectr i ca I MechanicaI n ame addres s I I ics- no. )(exnires)(nhonp no- ) P u a 1 ,* ectr I filechani ca l PLUIlB I NG ELECTRI CAL I'4ECHAN I CAL FEE CHARGE Nn-FFF CHA RGF NO FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTLI ' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. P,es i dence(t hath)SERV I CES Recessed wai l Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent sPnaratF [,later serv ice Change in existing res i dence Stati onar.v evap cool er Sewer multifamily, comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f Vent systern apart from heatino or A.C. cor.il.l. / IND. FEEDERS Mechanical exhaust hood and duct- Instal I /a1 ter/re1 ocatedistrib. feeders l'lood stove/heater 0f amps ISSUANCE OF PFRI,IIT TOTAL CHARGIS TOTAL CHARGES TOTAL CHARGES WHERE STATE LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon Dertaining to the work described herein, and that N0 OCCUPANCY wi'll be madeof 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 thatonly subcontractors and employees who are in comoliance with 0l?S 701.055 will be used on this Droject. llAl,lE(please print)P q/ m ,4r1/S I GNATIJRE 44?--\DATE Flood Plain S to ri es 0c c.y Gro Val ue TOTAL VALUATION-- Ftg. 0ther BUILDING PERI'IIT Charges and Surcharges Plan Ck. Conrn/Ind 65%/Bldo Per Fee Svs Cha tems Deverqe (1.52 opme-nt Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges qo Fence D6mo ELECTRICAL PERIlIT Charges and Surcha rges Si dewa I k A/C Paving Curb Cut Tota.l Cornb. Permi t I,IECHANICAL PERMIT Charges and Surcha rges TOTAL t6 v'o ]TORS Genera I Zone__Tyoe/Const. Uni ts Sq. FtS. l,lai n x Val ue_ FireZoneBedrooms0ccyLoadSq.Ft0.AccessxValue- /o-o o COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. exampie- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. exampl e-2. exampl e-E. Square foota heat,/el ectrical .l forced air gas WA ge r e ec or soiaror va I uat o[t II l. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- if new project, check new - if addit.ion, check add, etc.F. Building permit information:1. example - construct singie family house with an attached garage2. example - remodel existing garage into family room3. example - convert single family residence into iEsTiuFant (change of-use)G. Value of work as defined in Section 303 (a) of the Structura l Specia l ty CodeH. 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 sitecorrections, etc. Abbreviated Plumbing, Mechanical, & 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 avai lable at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electr.icalsupervisor. The general contractor is not authorizedto sign the electricai label Appiicant to sign and date lJhenever possibie, the initial application wilI be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wiII be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. Itl1 f,L .d 4 III IV. V. FOR OFFICE USE ONLY 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 i gnature date f. L SPRINGFI ELD UTI LITY BOARD 250 North "A" St. Springf ield, Oregon 97 477 BACKFLOW DEVICE TEST REPORT FIRM NAME ADDRESS FatuF) E = SIZE - MODEL LOCATION OF DEVICE New Parts and/or Bepairs Made lf Needed Final Test Af ter Repairs I CERTIFY THE ABOVE TEST HAS BEEN PERFORMED SERIAL # PASSED TESTEB CERTIFICATION ! 1+ DATE: TESTER # NAME DATE DOUBLE CHECKVALVES Check #'t Check #z Leaked ( I Closed Tisht ( ) REDUCED PRESSU RE DEVICES -lbs. Relief Valve Opened at Pressure Drop Across Check - lbs. Leaked ( ) Tisht ( ) Closed Check#1 Check#z Closed Tight() Opened at lbs. Relief ValveClosed Tight() BY (COMPANY OFFICER) \