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Home My WebLink AboutPermit Plumbing 1984-9-7 1 INSPECTION LIIIE ]726-3769 t . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range INFORllATION liNt . 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Pep. -Fence Demo Change/Use Other - - eX: ~ '-.Sl ~ ~ bo Job Address j 5< 9 q ((Xj/~ /J~ P' '/ . Legal oe'criPtion/'J~~2t;"YO I 077tJO Owner tu/--/;t.~/. ~p~ /l~~JL//.J i Valul1;;~c)_ai) Addre" l-nn ~ /J 'Pho~~ -;;, BUilG;na Pennit Info: Describe Work(Le., Build Single / ,#,..,.; ~~.....-??1 k1/../', 71-...."'-: k;;;~ence lHth Attached Garaael _ _'~L.P.t~ IJ#9N7'7 7701Jl '.-P/~~f /0' ~,_ndAJ Constructi;6 Lender 1/ /, ,,,",,, ~ IA .A.fJfQ U .. ./ / Address Phone UtSJuN rEAM (name) (address) flies. nn. l {exl1ires1 (ohane no. Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (address) nies.nn.) (F!xnirpo:;,' (ohnl'lp !'In. \ General n PI"mbinoJ?lo/~1ti<-.~~ r/)hd..tJ,. J7/0JM~~;/ ;-,. A ~, b,>,"d-.. Electrical c...- ~ I htW- 4'~ I ~1echani ca 1 PLUIIBING ELECTRICAL MECHANICAL NO. FEF rHARr,E' Nn I ~I' Res i dence of SQ. FT. INew circuits alts. or extensions CLL J:IJARlil Nn I..EEL J:IJARlil Each single fixture furnace/burner to BTU's Relocated building (new fix. additional) Floor furnace and vent S.F. Residence 11 bath 1 Duplex (1 bath) each Additional bath I SERVICES I Recessed wall ~n~rp hp~tpr ~nrl vpnt ITempOrary Construction IChange in existing rp'i i Itp]lrp Imultifamily, comm. or Inrluc:;t.ri<l.l IOf amps. I COMI.I./ I NO. FEEDERS 1 Install/alter/relocate n;c:;trih fpprlprc:; IOf amps. I I I TOTAL CHARGES 10 ~ TOTAL CHARGES WHERE STATE L,\lJ REQUIRES that the Electrical work be done by an shall not be vali~ until the label has been signed by an Electrical Sewer ~ l Storm Sewer I/J gO Appliance vent seoar<l.tp I' Stationary evap. cooler I'Vent fan with sinole duct I'Vent system apart from I heatino or A.C. I Mechanical exhaust hood and rlurt I Hood stove/heater I I I ~Ia ter servi ce ISSUANCE OF PFRllIT 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 1 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 NO OCCUPArKY 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 ons 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. I~AI.1E(p1ease print)Rob~ b-J, ~y~:. SIGIIATURE~.-?1 k , FO~ OFF I CE USE DIlL Y .R' Units Sq. Ftg. t1ain Occy load Sq. Ft~. Access Occy Group Sq. Ftg. Other OATE 7'- 7-?V Zone Tvpe/Cons t. Bedrooms Stories x Value Value Value Fire Zone Flood Plain x x TOTAL VALUATION BUILDING PER/lIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldo Ppr Fp~ ------------PTan Ck. Res 30%/Bl do Per Fee Syste,ms Development Cha roe (1. 5~) PLUI1BING PERMIT Charges and Surcharges ______.!().L~_ Fence 4/D I O/lRlO I Sidewalk ------------ I A/e Pavi ng I Curb Cut I ITotal Comb. Permit iTOTAL /0_ LlO I '1/J /{J, ij'O ELECTRICAL PERrm Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges - R1./ (J!o~ x- COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax lot 100. Lane County Map Reference 1/ 03 43 2. examp]e- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilin~/or forced air Qas 2. exam~le- waterheaterjelectrlcal/or ~ E. Square footage or valuation, etc. I. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an a ttached garage 2. example - remodel existing garage into family room 3. example - 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 TEAr~ 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. --- Ill. 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 whenithe permit is issued. V. FOR OFFICE USE ONLY , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . .. PERMIT VALIDATION ~ ^ '1 \ 0\ ~L\ ~L. ) lo 06\4 P,rnit C1 ",r:4 ~-' Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date .