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HomeMy WebLinkAboutPermit Backflow Test 1988-2-23 .----:'"'Jf", ~'-" --'-',~ ..;;::: ..-.- . "I INSPECTION LINE 726-3769 - CITY Uf SPRINGFIElD COMBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater . INFORltATION LlNt 726-3753 Sq. Ftg. ',Ia i n ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use -Other- - Job Address tfl'-{cf-f) fYla4v Legal OescriPtio'n / '1 0 _:1 3 ~ L( d. <1-~ fb~IfJ.u/2~7' Owner' ~ ~fH\) Address gY:3 7 t..J;ei~ Construction ~ Lender Phone '1 rLf, ooc(7 BuilciinlJ Pennit Info: Describe Work( Leq Fam~ nesidence Hit~ Att. aCh~d ,.raoe I '.fI-:'A /' h.ll\r'l 'j--WI'J t:%///'1-/r/ ~;;..- -= / Build Single QI) C\) C) --.., ~ --Z fjU ro / Range ValuE. of Work: Address UtS IoN I EAI~ (name) Phone (address) nics. no.) (exoiresl , (ohone no ~ Pri ma ry Structura 1 ? Ct...G1 , CS ~oCl Electrical 11echanical ::::::~TORS n (na("~ _ . la;pssl, Plumbino !//~ t1-.'::,~i: ---/VJrJ~,J Electrical 1/ f1 ics. nIL) (~xnirp<;' (I)honp no &(/0-:1001 ./ --y--F ~1echanical PLUIIBI NG ELECTRICAL MECHANICAL -1!Q.1 Each single fixture I FFF I rl-IIl.Rr;f rm J Residence of 1 ITLI..c.I:IARG.E. NO I I FH" I rl-lAWi[ furnace/burner to SQ. FT. 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 SERVICES Recessed wall ~n~rp hp~tp~ Ann vpnt ?OJ ITemporary Construction IChange in existing ~ps. i rJp"nrp ImultifamilY, comm. or Tndllc:.tri~l 10f ' amps,1 ICO~~./IND, FEEDERS IInstall/alter/relocate dic:.trih. fpptip~c:. IOf amp~1 I Appliance vent se021~~tFl Stationary evap. coolH Vent fan with sinole duct Vent system apart from heatinq n~ A.C. Mechanical exhaust hoor! <Inri tiur:t. Additional bath Water service Sewer Storm Sewer Wood stove/heater ISSUANCF OF PFRmT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\\~ REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical rortion of this pernit shall not be vali1 until the 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. an that NO OCCUPAr~CY will be made of any structure without the permission of the Building Division. I further certify that my gistration with the Builder's Board is in full force and effect as required by OR$ 701.055. that if exempt t y asis for mption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7Ql.055 wi e used t project. Zone Fire Zone Flood Plain Tvpe/Const. Bed rooms Stories Units Occy Load Occ.y Group SIGNATUR < FOP. OFFICE USE ONLY Sq. Ftg. rlain Sq. Ft~. Access Sq. Ftg. Other .1%-' DATE ~ -..2- HAME(please print) Cb~IL SAyot\J x Value x Va 1 ue x Value TOTAL V ALUA TI ON PLUMBING PERMIT Charges and SurCharges 5 Plan Ck. Comm/lnd 65%/Rldo Ppr Fpp ------------PTan Ck. lies ' 30%/Bldo Per Fee '"3 (), 00 Fence --n__n,-:&'J-I O~mo I'Sidewalk I AIC Paving I Curb Cut I syste. r.lS Development I Charoe (I.5~) BUILDING PERfIlT Charges and Surcharges ELECTRICAL PERr~lT Charges and Surcharges I I MECHANICAL PERMIT Charges and Surcharges ITotal Comb. Permit I TOTAL I 3/.&0 - ,. --C"-=:c - ---==-- ,.....---,~.-. . COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II oj 43 2. example- Lot 1, Block 3. 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examyle- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check:ruew - if addition, check add, etc. F. Building pennit information: 1. examole - construct single family house with an attached garoge 2. examole - remodel existing garage into family room 3. examole. 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, 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 permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ - ~ ,.~ . PERMIT VALIDATION /0 if 3;;L :J-:J-3-! t Permit Clerk c~ . . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature , date