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HomeMy WebLinkAboutPermit Backflow Test 1987-8-12 BU11<;lnQ Pennit Info: Describe \'!ork(i-.e., Build :6;d~7;;)~i'~~/~ , UfA/tc ...u I I I I I I I I I I I TOTAL CHMGES I TOTAL CHARGES that the Electrical work be done by an Electrical Contractor. the electrical portion of this perr.lit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED the completed aprlication 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 Soringfield and the Laws of the State of Orel]on pertaining to the work described herein, and that IlO OCCUPAllCY \'/ill 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 701.055 will be used on this project. SIG'IATURE I.//Jn t) /Ja:A 1 IrISPECTIOtl LItlE 726-3769 . CiTY Of SPRINGFiELO CorlBiilATION APPLlCATION/PERMlT EilERGY SOURCES: Heat Ha ter Hea ter Ranqe ValUE of l'/ork: . Ii /fls JYl tJ/.4f, Legal Description Jif() "13 (/') -=? / () 1tj()( Owner fh,i//;/J Ibj-o il'ittd Address jirsd m tLt~ Job Address Phone Construction Lender Address OESIGrI rEAl1 Phone (address ) (name) (1 ics. no.) ; Primary Structura 1 Electrical !1echanical CONTRACTORS (name) (address) (lief;, no.' Genera 1 Plumbina I Electrical I d ~G ELECTRiCAL ,11. / . /7 If(t?dt~ ;20 - '/s-;u6 ~lechanical 1m, I FFF Each single fixture Relocated building (new fix. additional) rHARr,f ~)(\ I IResidence of SQ. FT, New circuits alts. or extensions ~n n-lARr.~ rm S. F. Residence (1 bath) Duplex (1 bath) SERVICES each Additional bath I ~Iater service Sewer Temporary Construction Change in existing rp~;1pnrp Imultifamily, camm. or Inrluf;tritll I i I I } I I I I ~fD 10f ICor~II./IND. FEEDERS I Install/alter/relocate rlif;trih_ fpprlpr~ Of amps.1 Storm Sewer amps.1 4) V TOTAL CHARGES WHEnE STATE L~W REQUIRES shall not be valij until the ilAr'lE(please print) \1/ /I). J2 AIl....[:y' v.!. Zone Fi re Zone Flood Plain Fon OfFICE USE QillY Units Sq. Ftg. riain Occy Load Sq, Ftg. Access Occy Group Sq, Ft9' Other Tyoe/Cons t. Bedrooms S tori es BUILDING PERI.IIT Charges an':: Surcharges Plan Ck, Comm/Ind 65X/Bldo Ppr Fpp Plan Ck. Res 3D%/Bldo Per Fee Fence ~~~~;~~G a~~RM~/ _ n __ j Q-'. ~~_ Surcha rges -, . '6 ELECTRICP.L PERI~IT Charges and --------____ Surcharges Demo \ Sidewalk I A/C Pavi ng I Curb Cut I I I I 11ECHANiCAL PERMiT Cha rges and Surcharges i1IFORtIA TI ON WI< I 726-3753 Sq. FtQ. I,lain ~q. Hg. Access. So. Ftg, Other rle\~ Add Alter ~ep. --Fence Demo Change/Use -Other - - Single D<,1 c5 ~ '~ II,~ (exnires) (ohone no, I 4 <1<"1 ~~ "(l~ (pxoirpf;) (ohnnp nn, \ '1t.:b\lLf I() -,.) c/ - '(~ MECHANICAL H'~ njAI?r.~ furnace/burner to BTlI's Floor furnace and vent Recessed wall ~otlrp hptltpr tlnn vpnt Apoliance vent ~f'oartltp Stationary evap, cooler Vent fan wi th sinale duct Vent system apart heatina or A.C. Mechanical exhaust hood and duc-_f. from Wood stove/heater ISSUANCF OF PFRtlIT Dm~J;2~,\'->- v x x Value Value Value x TOTAL VALUATION Systems Development Charge (1.5~) Total Comb. Permit I IS: 7S I iOTAl . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Appl icant to furnish A, Job Address B. legal Descriotion 1. examole- Tax Lot 100, lane County Map Reference J/ 03 43 2. example- lot J. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources , " 1. examole. heat/electrical ceilinQ/or forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - J. examole- 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. example - construct single family house with an attached gar~ge 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 TEAI.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 Mechani~al 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 ha've 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 ANO 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. 'Bfr;?ft 3 g ~ ( 2- -f 1 V, FOR OFFICE USE ONLY Permit Cl erk cu PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , Permit applicant exempt from registration with thiBuilder's Board becaus~: Additional Project Information: PLANS REVIEWED BY: I name signature date