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Home My WebLink AboutPermit Plumbing 1991-2-1 !INSPECTION LINE 1726-3769 Job Address Lega 1 Oeser; pt i on J'7~ ~ . .?~ Owner ..~ .l L Addr~ss ';;).~ Cons truct i on Lender . Address DESIGN TEAr~ Primary Structura 1 . Electrical Mechanical CONTRACTORS IO'l" .- mA.~\ ~T, . INFORl1ATION liNt 726-3753 Sq. Ftg. 11ain ~q. Ft9, Access. Sq. Ftg. Other Ilew Add Alter Pep. -Fence Demo Change/Use Other- - i:) - o - ~ CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat liater Heater ~/ Range tal UE. of Hark: '1,4'10 Buildinq Permit Info: Deser be Work(i.e., Familv nesidence With Attached Garaae) \ Build Single ~~ p., ,~.I\,," ~~. Phone l'-lb-'6'--l~ {name) Phone {address J (ohone no.} (lies. no.) (exo;res) ~ Genera 1 (address) {2?I\".J t:?l=-rr~ ('M,<\' ~ CJu'S1 \'f-, 0:~(,\( ~~\.~ ~(~I ~~& 1-1411-(')'331 <09...b - I ZJJO Plumbino Electrical ~lechanical NO. (name) flies. no.) (Dhone no.) \ (",xoirfl's) '1ILQ I<:'J \ {n~l (,,/432- 9--loIl..s () PLUI.lB I NG , .\ MECHANICAL ELECTRICAL FFF rHARhF NO ~~~ rHARG[ NO. ill- J:HARli[ Residence of furnace/burner to BTU's Each single fixture SQ, FL Relocated building (new fix, additional) I~~ ~ S.F. Residence f1 bath) Duplex (1 bath) each Additional bath ~ H.Jter service Sewer Storm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~p hp~tpr ~nrl vpnt Temporary Construction Change in existing rPsjde:n('p mult ifamily. COIlll1. or Industrial Appliance vent S~Darate Stationary evap. cool~r Vent fan wi th sinale duct Vent system apart from I heatino or A.C. Mechanical exhaust hnnd ~nd duct amps, I I I, f , 'I Of I COMfI./I NO. FEEDERS IInstall/alter/relocate rli~trih. fpprlpr~ IOf I I I I SSUANCf OF PERllIT Wood stove/heater amps. 'TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali~ until the -:20?~ TOTAL CHARGES TOTAL CHARGES that tile Electrical work be done by an,.Electrical Contractor. the electrical portion of this permit 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 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 HO OCCUPAfKY 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 ;s noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. Type/Const. Bedrooms Stories SIGI/ATURE ~ ~ EOP. orFICE USE OIlLY Sq. Ftg. liain Sq. Ftg. Access Sq. Ftg. Other DATE'd-\ \ \ '\. \ r-- NAI'1E(please print)'RoN ~!'r~ Zone Fi re Zone Flood Plain BUILDING PERIIIT Charges and Surcharges PLUI~BING PERMIT Charges and Surcharges ELECTRICAL PERllIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ~ a K'LA- I? , Units Occy Load Occy Group x Value Value Value x x TOTAL VALUATION b Q ~O Plan Ck, __ __i:?~ ___ ~/BldQ ~ ~ Plan Ck. ..-...:..--- 30%/Bldo 2:O~ I Fence / ..! .~ I O~mo I.Sidewalk ------------ I A/C Pavi ng I Curb Cut I Co"",/I nd P.rr Fe!? Res Per Fee #.S3 syste.ms. Development Charqe [1. 5~. . i{1A - I I I, Irota, Comb. Permit I I TOTAL /3 7. .:/6 ;.:','_! ---~.... . . COMBINATION APPLICATION/PERMIT (CAP) I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 11 uj 4J 2, exam~le- Lot 1. Block 3. 2nd Addition to 5prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examQle- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project, check-nfw - if addition, check add, etc. F. Building permit information: . 1. exam~le - construct single family house with an a ttached 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. 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. 11, 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 I es C. BUILDING OIVISION 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 lahel. --- I I 1. Appl icant to sign and date Whenever possible, the initial application will b~ 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: -. J PERMIT VALIDATION ., \0 )~~ ~ ff tq {q ( \ Pennit Clerk Q0 . Pennit applicant exempt from registration with the Builder's Board oecause: Additional Project Infonnation: , , PLANS REVIEWED BY: ., . M07))v; , R~~ ';1. , d~~e 12{// o/~/ ,. . .nam,e }),L, , signature