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Home My WebLink AboutPermit Plumbing 1985-8-23 JOb Address :Y~7? Legal Description NO .,-A-x A4, , /'/4'/;' [ r toT , ~ Ao-/ ~. CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater Range ValuE of Hork: r~....... ihone~'(-l~.J? ~~~l~~n~e~~~~~eInf~~ A~i~~h~~eG~~~~~l.e., Build Single - fl., A..Lln1 t'1 /U'Z ~\ (J~(,(tj ~ /,.Ji7!:. i /)hJ!f'/l) d- 1l.~.hli1J /~ _ 1),0 ~ () a.-rL ./2.K. c:at;)., ~ u-.JL- (lie's. no.) -Pexoire!fl I (,:,hrynp' nr:' \ . ~. I INSPECTION LINE 726-3769 . INFDRtlATlDN LINt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Dther- - ~ ~ ~ * Owner . fldA U;-",A;~.:>n, 1''1' ~tJ ;?';Iv/J/b.. ,,!'/ "!f.?'I.? j' a.6 / \. Address ~./ Construct1on lender Address DES I GN TEAr1 (name) Phone (address) Primary ~~~ ~ y ~ Structural Electrical Mechanical CONTRACTORS (namel rijddress) "ice;. no.' (pxoirpc;) (ohnop nn , Genera 1 Plumbina Ot.0V1.QA ) Electrical ~1echani ca 1 PLU'IBING ELECTRICAL I """ I r"A,"J Nn MECHANICAL NO. FFF r.HARGE Nn I t:"t:"t:" I r~.ll.Qr.t:" 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 (] bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p hp~tpr ~nrl ~pnt ~Iater service ITemporary Construction Change in existing rp~ i qp"n~p multifamily, comm. or TnrllJ,tri~l (rJ 0 '0 tin / n . <Ie TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical IOf !cOMI'1. /I NO. FEEDERS I Install/alter/relocate r1i,trih. fpprlpr, IOf I I I amps. Appliance vent SPI)i\r~tp Stationary evap. ~onler I Vent fan wi th ,inole duct I Vent system apart heatinq or A.C. I Mechanical exhaust hood and dud I ~.lood stove/heater I I I from Sewer Storm Sewer iJ (~~(>.. ne ri- (~ . --' 91:::( sic":" sewo. \- \Alder: i\- /110 l' "VI r\~ I t./y~ -.J TOTAL CHARGES . WHERE STATE L~H REQUIRES shall not be valid until the amps. ISSUANCE OF PFR'1lT 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 gertaining to the work described herein, and that NO OCCUPAHCY 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 compliance with ORS 7nl.055 will be used on this project. IW1E(please print) ;,t:JAP ',;7;;.A;.~b'" SIGIIATURE L~ FOP. OfFICE USE DIllY Sq. Ftg. t1ain Sq. FtlJ. Access Sq. Ftg. Other ~- DATE 1f-~':>,,!J"> Zone Tvpe/Const. Bedrooms Uni ts Occy Load Occy Group x Value Value Value Fi re Zone x Flood Plain Stories x TOTAL VALUATION BUILDING PERfllT Plan Ck. COIl1l1/1 nd Charges and ----------- 65%/Bldn PprFpp Surcharges Plan Ck. Res 30%161 do Per Fee PLU11BING PERMIT . (D.oo Fence Charges and --------:~6- Surcharges Demo ELECTRICAL PERIHT 'Sidewalk Cha rges and ------------ Surcharges A/C Paving 11ECHANICAL PERMIT I Curb Cut Charges and ------------ Surcharges I Systems Development Charqe (1.5~) '. Total Comb. Permit .. TOTAL 10:.0/0 . - COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. examRle. Tax Lot 100, Lane County Map Reference 17 03 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. examole- waterheater/electr;cal/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, cneck 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. exam~le - 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. OESIGN 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. --- 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. I ~ ~~d ~~ V. FOR OFFICE USE ONLY Permit Clerk uV . ] PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: / PLANS REVIEWED BY: name signature date .