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Home My WebLink AboutPermit Plumbing 1980-10-2 " I INSPECTION LINE . CITY OF SPRIN.1,tLD 726..3769 COMBINATION A~ATION/PERMIT Job Address ZD 7 '3 (j ( VVrYI .ill r ) I ~~;~r,y SOURCES, legal Description 0 ' r Hater Heater Range ValUE of Hark: . INfORllATION liNt 726-3753 Sq. Ftq. ',lain ~q, Ftg. Access. Sq, Ftq. Other New Add Alter Rep, Fence_Demo _Change/ Use _Other dJ 0> o ...j ---.. '-J:\ , Owner t::iut \ ;1- vO kt ~ ~ Address 0- Phone Buildinq Pernlit Info: Oeser be Work(i~6.. Build Single A~~n~periY-ttt1~);;lj) 0 =-rn J I fL+ -=frJ ...sv ~ Construction lender Address DES J oN TEA"I (name) Phone (address) (lies. no.) (exn;res) (ohane no. j Primary Structural Electrical l1echanical CONTRACTORS (namel (address) (1i(':~. nn. \ (pxoirps) (ohonp nn. \ Genera 1 Plumbino Electrical ~lechanical PLUIIBIIIG ELECTRICAL MECHANICAL NO. FEE CHARGF NO ~~~ r~A~r.~ NO. ~l='l=' rUl\.lU:l=' 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 I S. F. Res i dence (1 bath) Duplex (1 bath) each SERVICES Recessed wall ~n~~p np~tpr ~nrl vpnt I I I I I I _ t5UO Temporary Construction Change in existing rpc:iden~~ Imultifamily, COIl1Tl. or TnrllJc:tri~l 10f ICOMM,/IND. FEEDERS I Install/alter/relocate rlic:trih. fppdprc: 10f amps.1 Appliance vent SE'oarate Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from I heatinq or A.C. Mechanical exhaust hood ~nd du~t Wood stove/heater Additional bath I ~Ja ter servi ce ')GISewer I Storm Sewer IIE)l~ I I amps. " ISSUANCF OF PFR!\lT I HAVE CAREFUllY EXN1INED the completed apr1ication 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 1m OCCUPAIKY 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 f exe~Pt~~~ is notjd hereon, and that only subcontractors and employees who are in comoliance with OP.S 701 5 will be used 0 tn. P\l~t. l1 ~ IlA!IE(please print) ~S 1::/'fJl./-Iu SIGrlATURE . ~...u.J; '--LDAT(O-;:ro I FOr. OFFICE USE enLY /1 Sq. Ftg. r1ain x Value Sq. Ft~. Access x Value Sq. Ftg. Other x Value Zone Fi re Zone Flood Plain Tyne/Const. Bedrooms Units Occy Load Occy Group Stories TOTAL VALUATlOrl BUILDING PERfllT Charges anc Surcharges I Plan Ck. COITlTl/Ind 65~/Bldo Pyr Fpp ------------ Plan Ck, Res 30%/Bldq Per Fee 'Systems Development Charqe (1.5~) PLUI~BING PERMlT Cha rges and Surcharges 15JX~ -nu7nn-- __[O~~~ , <-rD Fence Demo 'if>/oJoci I ~/.R .ZD ELECTRICAL PERI~lT Cha rges and Surcharges Sidewalk A/C 'Paving I Curb Cut I Total Comb. rermit MECHANICAL PERMIT Charges and Surcharges I TOTAL ZCo .20 f . "'." . ~ ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN ~ I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II oj 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. examole- heat/electrical ceilinQ/or forced air qas 2. examyle- waterheaterjelectrical/or solar E. Square footage or valuation, etc. - I. example- 125D sq. foot house, 500 sq. foot garage 2. examp.le- if new project, check-new - if addition, check. add, etc. F. Building pemit information: 1. example. construct single family house with an attached garage 2. examEle - 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 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. V, FOR OFFICE USE ON~Y Permit Clerk ~ I 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 . Job Address 207:=) n I ,qm\ L'J!f' J legal De5cription - 0 ' - , Owner (;:iQ..r\ \ :1- vG YL ~ ) Address 0- FEF r.\IARr,E I'm I I Res i dence of SQ. FT, New circuits alts. or extensions I I I I I I I I I TOTAL CHARGES /~ ~J~ I TOTAL CHARGES WHEnE STATE LW REQUIRES that tile Electrical work be done by an Electrical shall not be valii until the label has been signed by an Electrical Supervisor I HAVE CAREFULLY EXNlItlED the completed apfllication for r>ermit.. and do hereby certify that all ;nfonnation 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 Oreqon pertaining to the \...ark described herein, and that flO OCCUPAflCY will be made of any structure without the permission of the 8uilding Division. I further certify that my re9istration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exemot the baSiSfjexe Otl0 is not d hereon, and that only subcontractors and em~loyees I<ho .are in c~mOl1ance with OP.S 7n~ be use..d 0 tn' ,~O o~e t. 'I IlAIIE(please print) ~ftl2fYc::, t:1.pl~1 SIC,II^TURE J7h..)},}-..<.. /' "'.' o~T/O';:.ft) - FOP. OFFICe OSE cr:1LY" /J I, Units Sq. Ftg. 11ain x Value Occy Load Sq. Ft~. Access x Va 1 ue Occ,Y Group Sq. Ftg. Other x Value Plan Ck, Comm/Ind 65%/Bldo P~r Fpp ------------~n Ck. Res 30%/Blda Per Fee /5,00 Fence -----(oU--loemo --[O~9:.Q-- Sidewalk <--['0 A/C 'Paving I WSPECTlOII L1IIE 726-3769 . Construction Lender Address Ut~luN n.N1 {name} ; Primary Structural Electrical tlechanical CONTRACTORS (name) Genera 1 Plumbinq Electrical flechanic.ll PLU11B1IIG 1:0. Each single fixture Relocated building (new fix. additional) S.F. Residence {1 ~ath' Duplex (1 bath) each Additional bath I I I 16(:c) ~!ater service )( I Sewer IStorm Sewer Zone Tyoe/Canst. Bedrooms Fire Zone Flood Plain Stories BUILDING PERI,IlT Charges anc Surcharges PLUI1BWG PERI11T Charges and Surcharges ELECTRICAL PERI~IT Cha rges and Surcharges IIECHANICAL PERMIT Charges and Surcharges ,,' - INFORlIATlON LINt 726-3753 Sq. Ftq. ',lain ~q. Ftg. Access. Sq, Ftq. Other Ilew Add Alter Rep. --Fence Demo Change/Use Other-- - o CITY OF~~I"tFIELD COIIBlIlATI ON Al'PLI CA TION/PERMI T EIIERGY SOURCES: Heat Hater Heater c/J 0> o ~ ----. '-J.\ Ranqe ValUE of Harle Phone BuilC:inc Permit Info: Describe \~ork(i-.8., Build Single Far.1i 1 y nes i dence 1.lith Attached Ga race) ... (lnnn.pr j- J-11)kJU 0 . =rn J ( tP -+ ~ \.S.V .Lsce.r- Phone (address) (lies. no.l (exoiresl (ohona no.l (address) "ies. nn,) (pxolrpo:;) (ahonp no, \ ELECTRICAL MECHANICAL ~~~ r~ARr,~ NO. ~~~ rHllRr,~ furnace/burner to BTU's Floor furnace and vent SERVICES Recessed wall ~n~rp hp~tPr ~nrl vpnt !TempOrary Construction Change in existing rpsjcirncp multifamily, corrrn. or TndlJstriill I Appl iance vent spparat~ I Stationary evap. cooler Vent fan with s;nnle duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and duct Of amps. COI~'I.IIND. FEEDERS IInstall/alter/relocate di~trih. fppdprs 10f Wood stove/heater amps. -to ISSUAr:Cf OF PFmllT TOTAL CHARGES Contractor, the electrical portion of this per~it and returned to the Building Divis;on TOTAL VALUATIOII Syste~s Development Cha rqe (I. 5') ~ .r")' 1 ,1 Y [i/' L (}J.cJQ, I ~/eR Z.O Total Comb. rermit Curb Cut I I TOTAL ZCo.2O J ~ ~ 1,. ---.. . ..." ( I CITY OF SPRINGFIELD City Hall Springfield. Oregon Department of Public Work. OFFICIAL RECEIPT , . COMBINATION APPLICATION/PERMIT (CAP) I. PERMIT VALIDATION II. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Referl II 03 43 2. example- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinqjor forced 2. examoJe- waterheatertelectrical/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq, foot house, 500 sq. foot 2. example- if new project, check~~ - if add check add, etc. F. Building permit information: 1. examole - construct single family house wit attached garage ( 2. examole - remodel existing garage into fam~ .:, 3. examole - convert single family residence - restaurant (change of use) G. Value of work as defined in Section 303 (a) of (. Structural Specialty Code H. OES I GN TEA;-l AIIO CONTRACTORS To avoid design or construction delays, Buildir Division Staff must be able to contact appropr r persons regarding design information or job si . corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical 5ch A. Except \./here blank spaces occur in the descrip ,if portion of the Mechanical and Electrical Sched \ the applicant need fill-in only the No. Boxes to the appropriate item(s) to be installed B. Full Plumbing, r'lechanical, and Electrical Sehe IC~ are available at the Building Division \ 1. To cODserve space on the permit form the s have been abbreviated 2. If the item(s} to be installed are not CO\ u the abbreviated SChedules you. should conSl (U" full schedules C. BUILOlliG DIVISION STAFF WILL FILL OUT ALL FW CHARGES 0:; THE SCHEDULES O. As noted on the CAP, the label must be delivel electrical contractor for signature by his elf supervisor. The general contractor is not au- to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will b a worksheet only. Where possible. Building Divis will prepare a type written copy and return it to applicant at the time the actual permit is issued signature. 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. ~ f ( (11.' Date~ ( 54779. No.8 10- 'l 19Y() ~n Rec'd Fram Wnr-r IS f\ If-? .1+1 /. Address ~t () nrrD~ 6 in Received For: yp (0 IO'.cJCJ . qCj(j , C\O -EP/ nJDpO./ 57?; .?o ~(j (6 pp iOln I / c=::, () 0 (n() () o (I Ct. - ~--._- Amount Received (!L.;. \. I I I I. ( ~~ rc, " I-b .?:O (1)J -- - "UT~ORIZII!:D SIGN...rURE ""ltlTo,,-rU"".ULL p"'..n"5' U'OItNIt 0" 8740' -~-;;: (, us"_,, ( \. IV. J- . V. FOR OFF! CE USE 0:11, Y Permit Clerk , . ,i j PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit' applicant exempt from registration with the Builder's Board because: Additional Project Information: , l I PLANS REVIEWED BY: name signa ture date . I