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Home My WebLink AboutPermit Plumbing 1987-3-5 'I INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat I~ater Heater . INfDRlIATION UNt 726-3753 Sq. ftg. ','ain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - Job Address S-Sqo IYl t't&,0 Legal Description Owner. (/l 'or ~y~~ ~ M O./~ Phone Range ValuE of Work: ,~ ~\-Jv BuilriinQ Permit I~fo: Describe Work(;~e.. Familv nesidence With Attached Garaael ~ 'g//;J//~.K14z/c Build Single ~ ~ ............ ~ ---.:J Address Construction Lender. Address Ul:.~HiN fl:.Ar~ (name) Phone (addressl nics. no.) lexnires) (ohane no.' Primary Structural Itltle; I '* Electrical c.\ ~;' Mechanical CONTRACTORS (name) {addrp.ss 1 (lies. nn.' (pxoirp.s) (nhoop nn, \ Genera 1 Plumbina J::trA11A ..JWV P/;vvJu~ A- 6- Neif1z..-.~ (/ r \(j' -" )..~ I' Electrical ~1echanical PLUI,IBING ELECTRICAL MECHANICAL ....tllh I FEE r.HARGf Ij(l ~~L...c..t:tARG.E. Nn_ "'" r"~ 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 '(J bath) Duplex (1 bath) each Additional bath 1~later service I Sewer SERVICES Recessed wall Sn~~p hp~tp~ ~nrl vpnt @ Temporary Construction Change in existing I"P-s.jrlJ>J'u'p multifamily, COI11Tl. or Tnrtuc;,trial Of amps.1 ICO~1./IND. FEEDERS I l'Install/alter/relocate I dic;,trih. fPPdpl"c;, IDf amp~1 I I I Appliance vent seoarate Stationary evap. cQol~r Vent fan wi th sinole duct I'Vent system apart from heatinq or A.C, I Mechanical exhaust hoort ~nd c1urt I Hood stove/heater I I I Storm Sewer TOTAL CHARGES TOTAL CHARGES WHERE STATE LAI~ REQUIRES that the Electrical work be done by an' shall not be vali1 until the label has been signed by an Electrical ISSUANCE Of PfRrllT 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 OCCUPAI~CY 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 ORS 701.055 will be used on this project. NAf.IE(please print) SIGNATUR~~ R, ~ fOR OFfICE USE mIL Y · Sq. Ftg. rlain Sq. Ftg. Access Sq. Ftg. Other Dm3-S-~? Zone Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value Fire Zone x Flood Plain x TOTAL V ALUA Tl ON BUILDING PERNlT Plan Ck. Conm/lnd Charges and ----------- 65%1Bl dn PPI" Fpe Surcharges Plan Ck. Res 30%/Bldo Per Fee PLUMBING PERMITt; jS 00 Fence Charges and ----- ---=---- Surcharges .0{) D/IIl1o ELECTRICAL PERr~lT ISide,;al k Charges and ------------ I A/C Paving Surcharges MECHANICAL PERMIT I Curb Cut I Charges and ------------ Surcharges I / syste.ms Development Charoe (I.5~) , Total Comb. Permit TOTAL Is: 00 . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description I. ~xample- Tax lot 100, lane County Map Reference 1/ 03 43 2. example- lot I. Block 3, 2nd Addition to 5prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources "I. example- heat/electrical ceili~Q/or forced air Qas 2. examDle- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. example. 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached garoge 2. example - remodel existing garage into family room 3. example - convert single family residenc~ 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, the applicant need fill-in only the No. Boxes adjacent 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 schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WIll FIll OUT All FEES AND CHARGES ON THE SCHEDULES O. 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 copy 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. g &1fffJ ~--f1 V. FOR OFFICE USE ONLY Permit Cl erk GC-- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit appl i cant exempt from ,regi strati on with the Buil der' s Board because: Additional Project Information: PLANS REVIEWED BY: name signature date