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Home My WebLink AboutPermit Backflow Test 1983-6-17 , (, I I INSPECTION LINE 726-3769 ~e, 9.: . LITY Uf SPRINGFIELD COMBINATION APPLICATION/PERMIT E!lERGY SOURCES: Heat 14ater Heater Range~__~_.___ ValuE of Harle INfDRllATION UNt 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add A,ter Pep. -Fence Demo Change/Use Other- - a() LN - ..J .J C<l I " Job Address 5'70 I mAJ,y _ --:7 .Legal Description \I)(),;\:\'~ \ ()~.:jU -llwM<; l-€SY -0 0 -AmQ..S L, [bC?:.Q([j~ AddressOr> ^ ,If)' n ,1, Pho BuiIciino Pennit Info: Describe Work(Le., Build Single OM "'--......II<-S UW~ ."'~:~i~(-Fami1V nesidence lH.th ,o,ttachped GaraQe) po. (3~ 10;+.(.., 0f-fw O(L /c:r...,"Ci.l-1 hA(j-( - f-ww {L~ueNi,tJN ~VKoC Construction lender Address Phone UI:.::iHiN ftAr1 lnameJ (address) Primary Structural Electrical Mechanical - ,CONTRACTORS (name) (address 1 \ CtI/-L.. General LillI-<.. Plumbina Electrical Hechanical (l;es. no.l (exnires) (ohane no. ~ V l1ir:s. no.l (exoires) (Dhon~ no. ) PLUIIBIIIG ELECTRICAL MECHANICAL, ....llih' Each single fixture I ~FF 1 nMRr..F ~(l I ~~~I-.C..I:iARG..E. NO. I Res i dence of furnace/burner to sq. FT. BTU's I ~~~ I r1:iAR.G.E. / ; ,l:i,OO I'New circuits alts. or extensions I SERVICES I ITempOrary Construction IChange in existing res.i q~nce Imultifamily, comm. or TnrltJ~triill IOf amps. ICOMM./IND. FEEDERS I Install/alter/relocate rlid.rih. fpprlpr~ IOf amps. I I I Floor furnace and vent Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (I bath) each Additional bath Recessed wall Sn~rp hp~tp~ ~nrl vpnt Sewer Appliance vent seoarate Stationary evap. cooler Vent fan with sinale duct Vent system apart from hea t i no or A. C. Mechanical exhaust hood and rlu('t .Iater servic;e , -L t:nLt+lOIA.)~ I Storm Sewer Wood stove/heater , \ ISSUANCE OF PFRIHT TOTAl CHARGES WHERE STATE l~W REQUIRES shall not be valiJ until the ~,()o ...rOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an. ".Electrical Contractor, the electrical portion of -this perrnit label has been signed by an Electrical 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 OCCUPAIKY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors a~loyees who are in como:ianc~ith ORS, 7~I.055 w~ uC\ed~~!~,~ect. 1lA/1E(please print)...... J A.'yn.QS L, ~&1U'J SIr,IlATURE ~ ~'tv-\)~ DATE L III k3 FOn OFFICE USE OIlLY \ ~v \ , Zone Type/Canst. Units Sq. Ftg. r1at1J:. ,x Value Fire Zone Bedrooms Occy Load Sq. Ft9. Access x Value Flood Plain Stories Occy Group Sq. Ftg. Other x Value TOTAL V ALUA TI ON " BUILDING PERflIT Charges and Surcharges Plan Ck, Comm/lnd 65%/Rlrlo Per Fpp ------------""Pian Ck. Res 30%/Bldo Per Fee .c:-[b Fence -------'.....:_--- .W O!,mo Sidewalk Systems Development Charoe (1.5%) PLUl~BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Cha rges and Surcha rges A/C Paving I Curb Cut I Total Comb. Permit MECHANICAl PERMIT Charges and Surcharges I I TOTAL -'If 5 ;20 J . . COMBINATION APPLICATION/PERMIT (CAP) t. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100, lane County Map Reference II OJ 43 2. exampJe- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilin~/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example- 12SD sq. foot house, 500 sq. foot garage 2. 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 - remodel existing garage into family room 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 TEM4 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 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. --- Ill. 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 signa ture. 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 penmit is issued. V. FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . I PERMIT VALIDATION (pil\O 'tlLulL \~,5 Pennit Clerk (1~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name signature I date II .- \~ ~ .. .uired Inspecttns .. :---< IT IS THE RESPONSIBILITY OF TilE PER.'!IT HOLDER TO SEE TIlAT ALL INSPECTIONS ARE MADE AT THE PROPER TIllE, TIlAT EACII ADDRESS IS READABLE FROII THE STREET, AND THAT THE PER1'1IT CARD IS LOCATED AT TilE FRONT OF THE PROPERTY. BUILDING DIVISION APPROVED PLANS MUST BE ON JOB SITE AT ALL TIllES. PROCEDURE FOR REQUF.STING INSPECTIONS: Call 726-3769 fr~~?rder) state you CITY DESIG~ATED JOB NUMBER, job address I type of inspection requested and \olhen you will be re.::.dy for the inspectlcn. Contractors or o~~ers name and phone n~~ber. Requests received before 7:00 am,will be reade the same day, requests received after 7:00-am will be made the following work day. Your City Designated Job Number Is:~J 77B Job Address: S 70/ /YJA/JV 57=' Owner: r )A/?7 ~ c.., B~7.:5. Phone:J:U;. .~y~ '", Contractor: Phone: " o D o SITE INSPECTION: To be made after excavation, but prior to setup of forms. UNDERS LAB ~ P LUllS ING I E LECTRI CAL & ~IECHANICAL: To be made before any work is covered. CONCRETE SLAB INSPECTION: To be made after all inslab building service equipment, conduit, piping, accessories and other ancillary equipment items are in place but before any concrete is ,poured. D FOOTINGS & FOUNDATIONS: To be made ~fter trenches are excavated and forms are erected, all steel in place, ,but prior to pouring concrete. mJDERGROUNO: ~umbin~ Electrical, Gas, Sanitary ewer, torm Sewer, Water and Drainage lines. To be made prior to covering or filling trenches. 00 -0 UNDERFLOCR: , Plumbing, Electrical, Mechanical. To be made prior to installation of floor insulation, decking or floor sheathing. POST & BEAM: To be made prior to installation of floor insulation, decking or floor she&ting.'. FLOOR tNSULATION & VAPOR BARRIERS: To be made prior to installation of decking or floor sheating. o o o D o o o o o o o ~~SONRY: Steel location, bond beams grouting or verticals in accordance 0 with U.B.C. Section 2415. ~ FINAL PLUMBING ~ FINAL ELECTRICAL O FINAL BUILDING: Must be requested after the final Plumbing, Electrical, Nechanical and Fire Department inspections are made and approved. No Occupancy of the premises can he made until ~ :::: :.:::~,~ '''"'~::"''''~ ~-~~~,.~ '. ," ..":: "'.~(;~ ,.,~~ .., ."..." * ALL MM'JIOL~S AND CLEANOUTS ~T--!lE . CCESSIBLE, ADJUSTIlENT TO BE MADE AT NO COST TO TIlE CITY. o o ROOF SHEATIiI~G k~D NAILING: Prior to installing any roofing. ROUGH PLUMBING. ELECTRICAL Ii ~IECHANCIAL: No ",'ork is to be co\'ered until these inspections have been made and approved. o o ATTIC DRAFT STOPS & CURTAIN WALLS. FIREPLACE: Prier to materials and before inspection. placing facing framing INSULATION & VAPOR BARRIER: "To be made after all insulation and required vapor barriers are in place but before any lath or gypsum board interior wall covering is applied. ~ FRAMING: To be made after the roof, ~ all framing, fire blocking and ~ bracing are in place and all pipes, - chimneys 'and vents are complete and ~ the rough electrical, plumbing and ~ heating .wires, pipes and.ducts arc approved. ~ LATH AND/OR r,YPStm BOARD INSPECTION: ---, To be made after all lathing and ~ g}~sum board, interior and exterior, is in place but before any plastering ~ is applied or before gypsum board ---3 joints and fasteners are taped and firiished. FIRE & SEPARATION WALL: Located & constructed according to plans_ WOODSTQVES: After installation is completed. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right-of-way, to be made after all excavating complete & form work & sub-base material in place. CURB AND APPROACH APRON: After forms are erected but prior to pouring concrete. PARKING LOT: After gravel place but prior to placing or concrete. is in asphal t CITY'S SITE PLAN REVIEW BOARD INSPECTION: Must wish inspectio~. All project conditions such as be com~leted before requesting this inspection. ~\ SPECIAL INSPECTIONS: In accordance ,l'ith Section 306 of the Building Code a special inspector shall be employed by the Oh~er/ Contractor during construction of the - following work. A copy of the special testing reports shall be furnished to the Building Division. I~ excess of 3000 STRUCTURAL CONCRETE : P.S.I. (306a.l) STRUCTUR~L WELDS: Preformed on the job. (2722 f) HIGH STRENGTH BOLTING: During-all bolt installation and tighting operations (306 a.S) / SPRAYED ON 'FIREPROOFING: (D.B.C. Standards 43~8) ~PECIAL GRADINGt EXCAVATION AND FILLING: During earthlo'ork. (306 a.ll & Chapter 29) ~ GLU-LAM BEN-5: Inspection Certificate, by an approved agency', furnished to the City's Building Division before beams are placea. (2501-U:B.C.STDS. 25-ID,1I) . *In addition to the inspections specified hereon, the Building Official may make or require other inspections of any construction work to ascertain compliance with the Building, City or Zoning Codes. be requested 2 days in advance of the date you landscaping, parking lot striping etc. must