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HomeMy WebLinkAboutPermit Plumbing 1986-12-10 . " 'CITY OF SPRJrlGFIELD COIIBIIIATlON APPLlCATlON/PERMlT E!IERGY SOURCES: Heat Ha ter Hea ter . RanrJe - IIISPECT 1011 LlIIE 726-3769 . Owner -:s 30 S- fY1()~ Legal De"ription 11 (J;2 ~ I ~ J thJL~ -~ecLd '\~drcss! 0L/31 ~...//1 Phone 1l(J / ,~ / Od- II ro<) ~ o ~ Built';inq Penllit Info: Describe \.jork.(Le.. Build Single I~ Fami1 v nes 1 dence 1.lith /'l.t tathed r.a raae) \::::) az;a-.2A.i- rJ.. Y-1--t.J() ~t:, I INF0R11ATION UI'lt 726-3753 Sq. Ftq. Hain ~q. ~tg. Access. Sq. Ftg, Other Uew Add Alter ~eD. --Fence Demo Change/Use Other - - Job Address ValuE of ('Iark.: Construction lender Address [Jt.~llirj rtAr-1 ( name) Phone (address) f 1 ics. no.) (exnires) (ohane no. Primary Electrical L.ll"l /;... ,t-.n .... 1""1.- I A ~(I!t ............ --... J.YJ'i'y.:::- p-- ~ Structura 1 ~. r1echanical CONTRACTORS {name l (address) (lies. no.) fexnirE's) (nhnnp nn.) Genera 1 Plumbina DtJJI1P/V , Electrical A't tJ.ll pv- N' -.....t, \, t.lechanical PLUlIB JrlG , FFF 'rHARr,F I Nn ELECTRICAL MECHANICAL 110.; lEach single fixture I Relocated building (new fix. additional) IS,F. Residence (I bath) IDuplex (1 bath) each IAdditional bath I I Residence of SQ, FT. I New c;rcu~ts alts. or extenSlons I SERVICES I H'~ I rJ..jll.Rr.~' t.J() I I rU!lQr.t"" furnace/burner to BTU's I t"n= I Floor furnace and vent Recessed wa 11 Sn~~p hp~tpr nnd vpnt ::J ~Co IOf ICOI~'I./IND, FEEDERS I Install/alter/relocate rlic:.trit-L fppdprc; amps, Appliance vent seoarate Stationary evao. cooler ~ , Vent fan wi th sinale duct Vent system apart hell. t i no or A. C. Mechanical exhaust hnnd and dur:t from ~!ater service Temporary Construction Change in existing reo;. i dpnl'p multifamily, COI1ll11. or lnduc:.tri<il Sewer Storm Sewer YeS-DO I I I I I I TOTAL CHARGES IS. &01 TOTAL CHARGES TOTAL CHARGES WHERE STATE L'H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division Wood stove/heater o L//I> ",", Of amps. I~ I I S"7 15 tJ7J (PD I tl16 L(.,~ -;/1\ ISSUANCf nF PFR!11T /6-,60 thi s pernit IIAI.IE(please print) DA lG- I HAVE CAREFULLY EXArlINED the completed application for ~ermit. 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 1m OCCUPArlCY 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 and employees who are in comoliance with OP.S 701.055 will be used on this oroject. ~ lZlL au I { SIr,!IATURE [j FO~ OFF I CE USE miL Y Sq. Ftg. f1ain SQ. Ftn. Access Sq. Ftg, Other D~TE/2.-/O-g, Zone Fi re Zone Type/Canst. Bedrooms Stories Units x Value Value Flood Plain Occy Load Occy Group x x Value TOTAL VALUATION BUILDING PERIIIT Charges anG Surcharges Plan Ck, CommlInd 65%/Blda Ppr Fpp --------------p:j"dn Ck. R-es 30%/Blda Per Fee -' //--. Dr? I Fence ______0_____ ,&0 D~mo Syste~s Development Charqe (1.51,) PLUt1BING PERMIT / C1111 rges and l:J Surcharges ELECTRICP.L PERI:IT Charges and Surcharges Sidewalk I A/C Pavi ng ( S. 00 I Curb Cut --------~Z~-I ITotal Comb. rermit 11ECHAN I CAL PERM IT Cha rges and \ 1\ Surcharges '.f' I I iOTAL ~(.20 , - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100, lane County Map Reference 11 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. example- heat/electrical ceilinq/or forced air qas 2. examyJe- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. . example- if new project, checkfl"ew - if addition, check add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 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 OIVISION STAFF WILL FILL OOT ALL FEES ANO CHARGES ON THE SCHEOULES 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 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: . I , PERMIT VALIDATION . J \1 ~ , : g{o~53d--- , 17/ (o,f{o Permit Clerk Cc ~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature J date I i~