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Home My WebLink AboutPermit Plumbing 1986-01-10---- T INSPECTION LINE 7?6-37 69 CITY OF SPRINGFIELD COMBI NATiON APPLICATION/PERMIT TMORI1ATION {TNE 726-3753 Job Address ?bs- A/. &(rH lesar Description fl OZ 3 I OO IZEOZ EIIERGY SOURCES Hea t I'later Heater Ranqe Owne r Val ue of l.lork Sq. Ftq. l'lain_ Sq. Ftg. Access..-__- Sq. Fto. Other--_ _l'lew_Addal ter_Pep. _Fence_Demo_C ha n ge/ U s e 0ther PhoneAddressA6f /1./, Jfzrt q Pernrit Info: Describe l^lork(i.e., Bujld Single Residence l,lith Attached Garaqe) Bui I ri in Farn il y Construction Lender Addre s s Phone s0 $ C' D CA DESIGN TEAI{name addres s 'I ics. no.exD t res ohone no- Pri mary Struc tura I El ectri cal I'lechani cal CONTRACTORS name addrpss )lics. no.exDt res ohone no- ) Genera I ,?t /)/\Jo-/P8 r^).) El ectri cal 0/l.J l.lec ha n i ca I PLUIlB I I,IG ELECTR I CAL I'4ECHAN I CAL FEE CHARGE NO FFF I^ HA PCF NO FFF t'HARCF Each single fixture furnace/burner to BTLI' s Relocated build'ino (new fix. additioial ) New c i rcui ts al ts or extensions FIoor furnace and vent S. F. Residence ( I uat-tr)SERV I CES Recessed wal I SDace heater and vpnt Duplex (l bath) each Addi ti onal bath Temporary Construction Apol iance vent sepa rate l,later servi ce 'in exi sti ngC hange res i de nce Stati onar-v evap cool er Sewer multifami1y, comm Industrial 0r Vent fan with sinole duct Storm Sewer 0f Vent systern apart from heatinq or A.C.,r,fu-l /COI,lI.!. / IND. FEEDERS Mechanical exhaust hood and duct Z,rrr-L /Instal I /al ter/rel ocate di stri b- feeders l'Jood stove/heater -Dut-t),/ drrl,/,s ao 0f I (p,o ISSUANCF OF PFRI,IIT TOTAL CHARGES /5 co TOTAL CHARGES TOTAL CHARGES tlAl"lE(p1ease print)S IGNATURE TE L Ci ty made fo rce e permi effect H FULLCARE ae ted I c'I 'lat no rfo 'I tc0mppt)rehe CE Irt tha aL II nI tforma 0ntDermb.v re0nhe s1 trufy nda tc0rrec a Ind fu rrthe certi ttha a nda Ia 1^/0I I Irkfynysha be 'Idone a ccon anrd wlce ht ,loerformed0rdthe nance ofs the'I ,lf I d'f e a thend ofLaws het taSSorng ofte n'l nI to th0regon e kwor ,ldescr hebed Ire n dan hat tDe rta s NC CUPAI'ICYOC I beItstrtuucwlreLthouthIssoofnButheIi,ld 'I 1 1 ons I furth cr 'Iert tha t s ttra 0nI thu/1 Buthe Ii der sfym.y req iany rdBoa I n'|s Ifu I and ng 70tiuredORSasreq ha 'It f bathe 'ls forS It055byexempte o n noted re0he n nda tthaxemptonlbcSUtonanractorsdIvwhos'Iare n II anernp0yee thwl 70lts 10 505 'Iwl beI ousedcomc thi s ectproj be done by an El ectri WHERE STATE LAI,I REQUIRES that the Electrical workshall not be vali.l until the label has been signed by an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division Val ue ToTAL VALUATI0N=----- x xSq. Ftg 0the r e q. Ftg. Acce Group Zone Fire Zone Bedrooms Occy Load Val ue Val ue Flood Plain Stories onst. Units So. Ftq. l,lain Plan Ck. Comm/lnd 65%/8ldo Ppr Fpc Svsterns Cha rqe DeVe (1,.5x opmen tBUILDING PERMIT Charges anC Surcharges Plan Ck. Res 30%/B1dq Per Fee FencePLUI^4BiNG PERMIT Charges and Surcha rges 15"6) bc Dgmo Sidewal kELECTRICAL PERIIIT Charges and Surcha rges A/C Pavi ng Total Comb. Permit Curb Cut MECHANICAL PERMIT Charges and Surc harges TOTAL /sac Residence of SQ. FT. PERMIT VALIDATION z'-)5 .g (., Permit Clerk +% w ( nt r0 $u,s COMBINATION APPLICAT]ON/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. BIock 3, 2nd Addition to Spr-i ngTi el d Esta tesC. Name, etc. of owner and construction lenderD. Energy Sources 1. examp]e- heat/eiqctrical ceil_1tg/or forced air gas2. erdmple- waterheate/eTectrJcal r soTiF-E. Square footage or valuationl-GtE. - 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage 2. example - remodej existing garage into family room3. example - convert single fami'ly res.idence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Spec ial ty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriite persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanicai and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be .installed B. Full Plumbing, Mechan'ical, and Electr.ical Schedules are avai.lable at the Building Divisioni. 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 I schedul esC. BUILDING DIVISiON STAFF WILL 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 electricalsupervisor. The general contractor .is not authorizedto sign the electrical label,i1I. Appl icant to sign and date [,Jhenever possibie, the initial application will 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 hissignature.IV. Fees and Charges Plan check fees are due and payable at the time of theappiication, and no plans vri11 be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY Perm'it appf icant exempt from registration with the Builder's Board because: Additional Project Informatjon : ) S REVIEWED BY datenamenatures'l g PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: