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Home My WebLink AboutPermit Plumbing 1984-12-14 ~" Owner - "/ A '" If a ) Addres On~ r'S,f>J ~QO q{ \. ~ l,.j'/l/l ()~-97~7 P constructiod'~~ I INSPECTION LINE 726-3769 Job Address Legal Oe5cr;ption Address DESIGN TEAI1 Primary Structural Electrical Mechan; ca 1 CONTRACTORS Genera 1 . -~ . CITY UF SPRINGFIELD COMBINATION APPLlCATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Ranqe ValuE of Hork: INFORlIATION LINL 726-3753 Sq. Ftg. I-lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Rep. --Fence Demo Change/Use Other- - L;-7 ij '2; 7'J1/P./.d. f'- ~ (J ~ O<:J U/)/ J Phone 7<1/- 61:2,~ Builtiinq Permit Info: Describe World Le.. Build Single Famil"{, R.esidence I~ith Attached Garaae\ aljpc! :1 MJlh) .,cV~jJ,A) {name) Phone r address) (ohone no. (1 ics. no.) (exoires) ~ l... In"'lIe1 r"rlr!rp.ss) (p')(r)i,...p~ \ (n"nn'" nn -, (lire: nn. \ IV (I . if2A :;~:::;:al ~ J~~Mt ) fJj{ If ~1echan;cal NO. 7'//- JT?,(/:J PlllllllING ELECTRICAL MECHANICAL FEF rHARr.F Nn~1 I "L J:IJARG.E. 'In Residence of furnace/burner to SQ. FT. BTU's I '!I-IJ:IJARG.E. Each single fixture Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath\ Duplex (1 bath) each Additi ona I ba th ISERVICES I Recessed wa 11 ~o~rp np~tpr ~nrl vpnt Temporary Construction Change in existing rpsiqp..nrp multifamily, comm. or TndlJo;.trial 10f amps, I COlil.I./lNO. FEEDERS I Install/alter/relocate rtic:.trih. fpprlprc;. IOf amps. I I I TOTAL CHARGES J('J _ CJi) TOTAL CHARGES WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an. shall not be vali1 until the label has been signed by an Electrical ~Iater servi ce Sewer Storm Sewer/) J.-~'.M.Lj Appliance vent seoarate Stationary evap. cooler Vent fan with sinnle duct Vent system apart from heatinq or A.c. Mechanical exhaust hood "nn rllJ~t Wood stove/heater ISSUANCE OF PFRllIT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Oivision I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information hereon is true and correct. and T further certify that any and all work performed 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 lW OCCUPArKY will be made of any str~cture without the permission of the Building Division. I further certify that my registration with the B~i'der'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 and employees who are in compliance with OP.S 701.055 will be used on this project. NN1E(p1ease print) Zone Fi re Zone Flood Plain BUILDING PERflIT Charges an~ Surcharges PLU!iBING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ,( /J.t!J/J SIGNATUR~~~ FOR"OFFICE us! ' y Sq. Ft . Hain Sq. Ft9. Access Sq. Ftg. Other O~.TE /1f~. ~L1S0,c/ (-' Type/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value x x TOTAL VALUATION Plan Ck. Comm/Ind 65%/Blrl~ Ppr Fpp -- -- - -- -- - - - Plan n. R.es 30%/Blda Per Fee __n_./J2.M_ Fence . L./ rJ D~IIIO ______ ___ __-'-Sidewalk I AIC Paving . Curb Cut syste.rns Development Charoe 0.5%) I I I ITotal Comb. Permit I I TOTAL/6_ ~ I 1//0 C/D - r .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examele- Tax Lot 100. Lane County Map Reference II UJ 43 2. examEle- Lot I. Block 3. 2nd Addition to Spnngtield Estates. C. Name. etc. of owner and construction lender D. Energy Sources 'I. example- heat/electrical ceilinQ/or forced air oas 2. example- waterheater/electrical/or ~ E. Square footage or valuation, etc. I. examp.le- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check add. etc. F. Building permit information: 1. exa~le ~ construct Single family house with an attached garage 2. examele - 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 TE~I 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 fu 11 schedu 1 es 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . PERMIT VALIDATION . ~# frP Permit Clerk {;.;o 0 3 I ({tv fty / 497) ~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date .