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Home My WebLink AboutPermit Plumbing 1985-8-16 . , II}.. ,. OF SPRINGFIELD City Hall Springfield, Oregon Department 01 Public Works ".'~."j>t.'.":,',;:I' ".: "',"""" .,' ,'; ',' OFFICIAL RECEIPT,.' ""r ;",," ,...,~" ':,';. : o (' \ '; , COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100, lane County Map Reference 17 03 43 2. example- lot 1. Block 3, 2nd Addition to Springfield Istates" " C. Name, etc. of owner and construction lender D. Energy Sources <" " " 1. example- heat/electrical ceilinqior forced air c, 2. example- waterheater/electrical/or solar .( "" E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garac' 2. example- if new project, check new - if additior check add, etc. C' F. Building permit information: 1. example - construct single family house with an~ attached garage" " '2. example - remodel existing garage into family rc "':( 3., example - convert single family residence into - restaurant (change of 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, Co' . the applicant need fill-in only the No. Boxes adjace to the appropriate 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 schedul have been abbreviated 2. "If the item(s) to be installed are not covered 0 the abbreviated schedules you should consult the "( fu 11 schedu 1 es 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 ~opy 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. "'. ( . . No. B "Date~. 19~ . ' , ('" R~c'd From ~ ~e>~~ ' , '2t:3 ~ C::~rlf ~Iow ~ " Address ~U4'# ~_ ~":>~~ .. r - - 65145, , " (' Received For: t'J~# ~:>6>< Gt; ';C.~ :;r~_, -:25-: c::r_ _' I.. c:r-.e:> I~"~ 7~_ 4~ ,." I '" .' ~~.~~ ( ; .. '. 'i Amount Received :z6- C.$ " !L( ~../ ~ '" / AU'HORIZED S~NlIl"l'"URE ,...... 1,'" ". ..... , -' FnnItIer BUSINESS FORMS, INC, (5031342.8149 6353 V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: I..:, '-Additional -Project Infonnation: PLANS REVIEWED BY: name Li!:'H## 1i..f!ii;.~" signature d ,~ r-' ' -> ~L;,'" '- . v , , - date B ~"-#r-~ ;' It i 'f - '~ 'l . WSPECTION LINE 1726-3769 Job Address 6 3 d, ::z .. CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ErlERGY SOURCES: Heat t~ater Heater ~ Owner J) ON '6~f /e"j-OrJ Address~s <"...9 ~-4/"Sf; Phone cYV'e. A "/1?- 7tf{::l.. Ranqe' Val UE of Horle S-~_ ~.. BuilGino Permit Info: Familv nesidence With INFORtlATlDN ll.''ll:. II 726-3753 Sq. Ftq. f.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter ~ep. Fence _Demo _Changel.~lJ.se, Other . % ~ OG N 6\ C~/)7~~ v.t. "5 f . Legal Description Describe Work(i.e.. Build Single /l,ttached GaraQe) UIV~" Con~ruction Lender Address DESIGN TEAI~ (name) Phonf! .. (address \ /H'S~~( '7 C> 5--~~ ~~~:I"'~ (lics, no,) €C.Fc.//Y/~c. ~~<"4iF ~ .",/A' Zlft& E .. . (exnires) (ohone no,) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (] i cs, no.) (exoires) (ohone no. ) General PlumbinQ Electrical ~Iechani ca 1 I PLUrlB I NG ELECTRICAL MECHANICAL NO.' I FEE I CHARGE NO. ~~~ rHARGI NO. ~~~ rHA Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wa 11 Soa~p heatpr ard vpnt Sewer Temporary Construction Appliance vent seoarate Change in existing Stationary evap. residence cooler multifamily, comm. or I Vent fan with Industrial sinole duct / Of .-:2 ese> amps. 1<$ A Vent system apart from I I heatino or A,C. COMM./IND. FEEDERS I Mechanical exhaust I hood and duct I Install/alter/relocate I Wood stove/heater I di~trih" fppder~ IOf amps. I I I I I I I I I I I I ISSUANCE OF PFRr1IT Hater service Storm Sewer TOTAL CH~RGES TOTAL CHARGES WHERE STATE L/\t~ REQUIRES that the Electrical work be done by an shall not be valid until the label has been signed by an Electrical :< S~ TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the'Building Division' I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true' and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAIlCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. Zone MAl. Fire Zone Flood Plain Type/Const. Bedrooms Stori es Units Occy Load Occy Group S IGIlATURE -f 'l} .ptrzf.~) FOP. OFFICE USE OIlLY I / ..... Sq. Ftg. 11ain Sq. Ftg. Access Sq. Ftg. Other~~ Dh6/~s rWIE(please print)3t:1 V't"JIPr (-1 D, B Y".....lAj A./ DATE x Value x Value ~V'/'<::~ Value S~ TOTAL VALUATION - ... ~ BUILDING PER~1IT Charges and Surcharges I Plan Ck. 65%/Bldo Plan Ck. 30%lBl do I Fence I D6mo '2:S: .. I Sidewalk -------/ ~~ I A/C Paving '. ., I Curb Cut - - - - - - - - - ---, ------------ CommlInd Per Fee Res Per Fee ISystems Development Cha rqe (1. 51:) ~.A-. PLur~BING PERMIT Charges and Surcharges ------------ I I I I ELECTRICAL PERfHT Cha rges and Surcha rges ITotal Comb. rermit I I TOTAL. <G:~~ HECHANICAL PERMIT Charges and Surcharges .