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HomeMy WebLinkAboutPermit Plumbing 1988-2-26 ..... , ~ .... I INSPECTION LINE ~ 726-3769 . CITY OF SPRINGFIELD COMBIIIATION APPLlCATION/PERMlT EilERGY SOURCES: Heat l~ater Heater Ranqe ValuE of Hork: c:J.>-C_<>-Q Bul161nQ Permit Info: Describe Work{i.e., Phon"M_~t"" Farnilv Residence Hith Attached Garaoe) . INFORlIATION LiNE 726-3753 Sq, Ftq. '.Iain ~q. Ftg. Access. Sq, Ftg. Other New Add Alter Pep, --Fence Demo Change/Use Other- - Owner R /l,-L pJ/ Addross 1'1' L. - t.., <; />.1/f"r I? c "'/ "" Build Single ~ ~ \Jl Legal I lis- AOAla:-g,,~,;>#~~6"~ De<cription /7- tJ'l. "3y-::2,/ /.l6.~0C> Job Address . tte../..c.e.. 1.....1 L SA. ............,0 f\..-I~ ..".~ fLu ,,-I,',,; (..,.,4 oJ t" --. L I ,I P (lies. no.) (exoiresf (ohone no. \ Construction lender Address DES I GN HAI1 {namel Phone (address) J&'Jo,d'IJ 1 f.I<...., Primary Structura 1 Electrical <()/) I __ ....1'1 .:::> ?V,j ~ 'P' v Mechanical CONTRACTORS (name) (addressl (1 ic:s. no.) (pxoirpc:.l (ohnllP fln Genera 1 f"\i-L,.( '\ AL: l. ..,M'EEh " ,.., Cc ~ fr= h.fiL/.<' R,.;-v/.c-'-' ~r"':- #''2'") , Plumbina Electrical ~1~~h~ni~,~1 PLUltBING ELECTRICAL MECHANICAL NO, FH r.HARGF NO ~ n.~ I rl:iARG..E.. Nn I ?-2> 37.. 9:: SQ, FT. furnace/burner to STUts I !:'!:'!:' I rl:iARG.E. ~ 1) Each Single fixture Residence of Relocated building (new fix, additional) ./ New circuits a1ts. or extens.lQns '"2 ,.T~ ,,;~~.'7''-; ~:<,_Si! . Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wa 11 ~n~rp hp~tpr ~nrl vpnt ~Ia ter servi ce ITemporary Construction IChange in existing res j rjeJlcP Imultifamily, COrTIn. or Indu<:;triill 10f amps,l ICO~1,/IND, FEEDERS I IInsta11/alter/relocate I rli<:;trih. fppdpr<:; Of amps.! Appliance vent I o;;.~oariltp Stationary evap. I I cooler 7 Vent fa"n wi th 13....1 6.-' sinal~ duct Vent system apart from I I heatino or A.C. Mechanical exhaust I hood ilnd durt Wood stove/heater I I I I ISSUANCf nF PFRPlIT Sewer Storm Sewer TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be vali1 until the "3'7~S'O TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical -::?"Z-SC> TOTAL CHARGES M-_ /~s..- Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I . I HAVE CAREFULLY EXM1INED 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 accordan~e with the Ordinances of the City ". ,:~ Springfield and the laws of the" State of Oregon pertaining to the work described herein, and that NO OCCUPAllCY will be made of'~~y structure without the permission of the Building Division. I further certify that my registration with the "Builder's Board i~ in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon, and that only subcuntractors and employees who are in compliance with ORS 7Ql.055 will be used on this project. ~~./~ tlM.IE(please print) "RcJ n ~ c;: Med Zone C:C Fire Zone Flood Plain Type/Cons t, Becrooms Storfes 5"-10/ Units' Occy Load Occy GroupJ?-2 (j) Coriin/lnd Ppr Fpe Res Per Fee SIGIlATURE FO~ nFF I CE USE QIIL Y So, Ftg, Sq, Ftg, Sq, Ftg, DATE 2-h, -~ I / I r1ain ,'I( Value Access )( Va 1 ue nthe~,4.,,,, ~1F~~c.. Value ::;('S"~_-- TOTAL VALUATION ELECTRICAL PERrHT Charges and Surcharges ~ --_./~~-- _ 5'0 ____2.-;z-=;:!f~ Fence /. :?~ 1 Demo .___~_?.:~'?J Sidewalk L. /? _ A/C Paving IS. =e> ------------ .75" Plan Ck, 65%/Bldo Plan Ck, 30%/BldQ ;pc~ #'/~9Ch ~ syste,rns Development 6.:::.0fW' ~~ CharQe (l.m ## BUILDING PER/lIT Charges and ?- Surcharges PLU'1BING PERMIT Charges and /" Surcharges S 11ECHANICAL PERMIT Charges and SurCharges Curb Cut I I I ITotal Comb. rermit ~ I I TOTAL 87'.7te;; . . ~, ~ \' COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I, Applicant to furnish A, Job Address B. Legal Oescription 1, example- Tax Lot 100, Lane County Map Reference 11 U3 43 2, examp-le- Lot 1, Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examp'le- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project, check new - if addition, cneck add, etc. f. Building pennit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family foom 3. example - convert single family residence into restaurant (change of use) G, Value af 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 infonmation or jOb site corrections9 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 ta 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 an the abbreviated schedul~s you should consult the fu 11 schedu 1 es C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 0, 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 possible9 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. (IO(~ f 9--~(o -~ V, FOR OFFICE USE ONLY Permit Clerk o --. . 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 / ___~.!".!:-=..P<:: ~~Signature::::.. ?,-?""".---,.L'~~--:"" date -;;? -::? 2- B':!S I I ~ .. "quired Inspect.ns .. IT IS THE RESPONSIBILITY OF TIlE PER-'lIT HOLDER TO SEE TIlAT ALL INSPECTIONS ARE MADE AT THE PROPER TUlE, TIlAT EACH ADDRESS IS READABLE FROII TilE STRF:ET, AND THAT TilE PERHIT CARD IS LOCATED AT TilE FRONT OF THE PROPERTY. BUILDING DIVISION APPROVED PLANS MUST BE ON JOB SITE AT ALL TIllES, PROCEDURE FOR REQUF:STING INSPECTIONS: Call 726-3769 (recarder) state yau CITY DESIGNATED JOB NUMBER, job address. type of inspection requested and ~lhen you will be ready for the inspection. Contractors or owners name and phone number. Requests received before 7:00 am,will be ~~de the same day, requests received after 7:00' am will be made the follawin~ work day,. Yaur City DesiRnated Job Number Is: B8c:x::> 5>? Job Address: /7"~ ~~~ R:..~-w..-.A-_ 7- """'ii)/ Owner: ;?~.PH ~~~=- .., Phone:_ ?9'~' ~.2";:r3' Contractor: ~~",~~ Phone: o ~ D D D SITE INSPECTION: To be made after excavation, but prior to setup of forms. ~ 0 L4 t UNDERSLAB PLlJ)ofBING, ELEtrRICAL & MECHANICAL: To be made before Bny work is covered. CONCRETE SLAB INSPECTION: To be made after all inslab building service equipment. conduit, piping. accessories and other ancillary equipment items are in place but before any concrete Is poured. D (, ~ o fOOTINGS 6 FOUNDATIONS: To be made after trenches are excavated and forms are erected, all steel in plnco. but prior to pouring concrete. D UNDERGROUND: Plumbing, Electrical, Gas, Sanitary Sewer. Storm Sewer, Water and Drainage lines. To be made prior to covering or filling trenches. D ~ \0 D UNDERFLOCR: J Plumbing. Electrical, Mechanical. To be made prior to installation of floor insulation. decking or floor sheathing. POST 8 BEAM: To be made prior to installation of floor insulation. d~cking or floor sheating." FLOOR INSULATION & VAPOR BARRIERS: To' be made prior to installation of decking or floor sheating. ~~SONRY: Steel location, bond beams grouting or verticals in accord,ance D with U.B.C. Section 2415. D D D D D o rg] ROOF SHEAllHNG AND NAILING: Prior to installing any roofing. a' I &..I1.fI ROUCn PLUMBING, ELECTRICAL & ')-'!i, .,.u ~IECHANCI^L: No ,,"'ork is to be covered until these inspections have been made and approved. ?-""'l I xl FINAL PLUMBING Vl I ~I FINAL ELECTRICAL ilY111 ~ FINAL ~lEOIANICAL D 1"'1 o ATTIC DRAFT STOPS & CURTAIN WALLS, SPECIAL INSPECTIONS: In accordance with Section 306 of the Building Code a specinl inspector shall be employed by the Ownerl Contractor during construction of the following work. A copy of the special testing reports shall be furnished to the Building Division. FIREPLACE: Prior to placing facing materials and before framing inspection. INSULATION & VAPOR BARRIER: To be made after all insulation and required vapor barriers are in place but before any lath or gypsum board interior wall covering is applied. FRAMING: To be made after the roof, all framing. fire blocking and bracing are in place and all pipes, chimneys and vents are complete and the rough electrical, plumbing and heating wires, pipes and ducts arc approved. =:J =:J =:J STRUCTURAL CONCRETE: 'In excess of 300 P,S,I, (306 a,l) STRUCTUR\L WELDS: Preformed on the job, (2722 f) HIGH STRENGTH BOLTING: During all . bolt installation and tighting operations (306 a.5) =:J LATIl AND/OR GYPSI~1 BOARD INSPECTION: --, To be made after all lathing and ~ g)~sum board, interior and exterior, is in place but before any plastering--, is applied or before gypsum board ---3 joints and fasteners are taped and finished. WOODSTOVES: After installation is completed. SIDEWALK 6 DRIVEWAY: Required for all concrete paving within street right-of-way, to be made after all excavating complete 6 form work 6 sub-base material in place. CURB AND APPROACH APRON: After forms are erected but prior to pouring concrete, SPRAYED ON FIREPRooFING: Standards 43~8) SPECIAL GRADING, EXCAVATION AND FILLING: During earthwork. (306 Ii Chapt'er 29) FIRE & SEPARATION WALL: Located & constructed according to plans, (U,B,C, n.l1 GLU-LAM BEAtlS: Inspection Certificate, by an approved agency. furnished to the City's Building Division before beams are placed. (2501.U.B.C. STDS. 25-10,11) . =:J PARKING LOT: After gravel place but prior to placing or concrete. *In addition to the inspections specified hereon, the Building Official may make or require other inspections of any construction work to ascertain compliance with the Building, City or Zoning Codes. is in asphalt CITY'S SITE PLAN REVIEW BO.\RD INSPECTION: Must be requested 2 days in advance of the date YOI' wish inspection. All project conditions such as landscaping. parking lot striping etc. must. be completed before requesting this inspection. FINAL BUILDING: Must be requested after the final Plumbing. Electrical, Hechanical and Fire Department inspections are made and approved. No Occupancy of the premises can be made until a Certificate of Occupancy has been issued by the Building Division and posted on the premise~ i~ FINAL FIRE DEPARTMENT SIGNATIJRE DATE .ALL MANHOLES AND CLEANOUTS ~lUST BE ACCESSIBLE. ADJUSTfolENT TO BE MADE AT NO COST TO TIlE CITY, Job Address . (l(5 r P F f15T CITY Uf SPRINGfIElD COMBINATION APPlICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Work: . INfORltATlON LINt 726-3753 Sq, Ftg, 1.lain ~q, Ftg, Access, Sq, Ftg. Other lIew Add Alter pep, --Fence Oemo Change/Use Other- - o(l ~ D a ~ ....:::t I INSPECTION lINE 726-3769 legal Description Owner 1Zalut- ~i /7 (/) /, (1/ S:b,J7ff' Address Phone 7 t/ h t;,;;Q3 BuildinQ Permit Info: Describe Work{i.e.. Build Single FamiJ neSi~~n;;;ith 2)ache7:;;~ ~ 1/' Construction lender Address Ut~ tliN ItAf1 (name) Phone (addressl Plumbina (name I 1/_.1 .. I C--tUAfM- u (address' ( lies. no. ) (exn;resl (ohone na. <('),00 ~lf",> \ In '" -1,- (1;re;, M. \ (pxoirpc;) (ohnnp nol Primary Structura I Electrical Mechanical -CONTRACTORS Genera 1 r I 6' VYt.mY Electrical ~'echan;cal PlUl,lBlNG ElECTRICAl MECHANICAl NO. Each single fixture FFF rHARGE Nn I liL,I..cJiAIlG.E. ...llil....1 Res; dence of furnace/burner to SQ. FT, BTU's ~~~ rU;&{iE Relocated buildin9 (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath I Duplex (1 bath) each Additional bath SERVICES Recessed wall ~"~rp hp~tpr ~nrl vpnt ~Ia ter servi ce ITempOrary Construction I'Change in existing r~c;.jdrJ1CP_ [multifamily, comm. or Indll<;.tri~l [Of amps. I COMfI.IINO. FEEDERS [Install/alter/relocate rlic:trih, fpprlprc: IOf amps. I I I Appliance vent ~.~oa ra tp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from I heatinq or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Storm Sewer ISSUANCE OF PFRI1lT TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES WHERE STATE l,'lj REQUIRES that tile Electrical work be done by an. Electrical Contractor, the electrical portion of this permit shall not be vali~ until the 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 oerformed 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 OCCUPAr~CY 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 7n1.055 will be used on this project. IvtJflJ~e/ OATE ?-f.-rg ! KAlPl-l SMHD IlAI-lE(please print) Zone Tvpe/Const. Bedrooms Stories Units Occy load Occy Group SIGIIATURE FOP. OFFICE USE OIIL Y Sq, Ftg, f1ain Sq. Ft~. Access Sq, Ftg, Other x Value Value Value Fire Zone Flood Plain x ,x TOTAl VAlUATION Plan Ck, 65%/Bldo ------------ Plan Ck. 30%lBldo ~~~~:~~Ga~~RMlT t""" __n_~Q.:~_ Fence Surcharges'::> I .50 Demo ElECTRICAl PERIHT ['Sidewalk Charges and ------------ Surcharges I A/C Paving BUIlDING PERNlT Charges anC: Surcharges Corrm/lnd Peor Fee Res Per Fee syste,ms Development Charoe (J,5~1 I I I ITotal Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut I I TOTAl 5-( .Sf) . l . . '. ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A, Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2. exam~le- Lot 1. Block 3, 2nd Addition to ~Prl ngt,i el d"Es ta tes C. Name, etc. of owner and construction lender D, Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. exa~le- waterheaterjelectrical/or solar E. Square footage or valuation, eft. - 1, examole- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project. check-n€w - if addition, cneck add. etc. F. Building permit information: 1. exam~le - construct single family house with an attached gar~ge 2. exam~le - 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 TE~l 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 schedul es C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES DN 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 when the permit is issued. \\()t~& tJl& /~ V, FOR OFFICE USE ONLY Permit Clerk [t/ 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 . . COMBINATION APPLICATION/PERMIT (CAP) I, Appticant to furnish A, Job Address B, Legal Oescription I, examp.le- Tax Lot 100, Lane County Map Reference 1/ 03 43 2, examEle- Lot I, Block 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction"lender D. Energy Sources 1. exa~le- heat/electrical ceilinq/or forced air aa 2. exa~le- waterheater/electrlcal/or ~ E. Square footage or valuation. etc. I. examele- 1250 sq, foot house. 500 sq, faot garage 2. examDle- if new project. check new - if addition, cneck: add, etc. F. Building pennit information: 1. examole - construct single family house with an attached garage 2. examEle - remodel existing garage into family rool 3. exam~le - convert single family residence into restaurant (change of use) G, Value of wark as defined in Section 303 (a) of the Structural Specialty Code H, DESIGN TEM4 AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design infonmation 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 8. 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 an the abbreviated schedules you should consult the full schedules C, BOILDING DIVISION STAFF WILL FILL OOT 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. --- 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. III. V, FOR OFFICE OSE ONLY r CITY OF SPRINGFIELD . City Hili Sprlng.oId, Oregon Office of Community and Economic Development OFFICIAL RECEIPT c , , ( .,. 11270 ( oate~fr~C -:; '9~ B ( Rec'd Fram l?ot..;::-S /It::?7'7~ "35"7<:> Ii;:' /y.:?Jk. "'l""-=:. Address ~^~ P., cP'~. " G. C Received Far;,)d'lS#~gCSO~7./ /' ~ (' 1<).: - .. - .'/5 ( /h 'Pc C/~ ( ~5'. ? S- 7 6~<- ( c ?~~Y70b i ( I. 1'5. 7 >___ .___ // ~' '/~. / (... Amount Received (I (I BY.' -\. IUSlNESSFORIoIS,INC. 16031:)42."" Permit Clerk 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 ~#C= /?~=-?T' signature ~ ~ /~ , ~ k=-v 1 /" date S'- 7-&'8. [ , l I INSPECTION LINE ~ CITY OF SPRINGFIELO 726-3769 COMBINATION APPLICATION/PERMIT D ENERGY SOURCES: Job Address J 'I.t:; r /L)N~ ;PA'7'?KlkA ,.. Gh.'7 - Heat Legal DescriptIon /:?....::>7-3'-~-,=?I-/->hS~b liater Heater Range ValuE of Hork: <7'~- -I> " Builriina Permit Info: Describe Work(i.eo. Build Single Familv nesidence With Attached Garaae) hv-6,?';;i!;)Lr TJ-v.-p ,"5"'~;s. ""_~,. '~.b ~A7/r ~"'=--~_'/ ~/'7A"~ (ohane no .~\ . INFOR/IATlON LINt .1 726-3753 Sq, Ftq. '.Iain ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Pep. --Fence Demo Changeluse Other- - . ~ ~ "'\l t"~~P# ~~ Address J'::>b L ,~; =- 4> 'T' .c:: '" ~ r Phone 5p~, ~. 7~-~3 Construction lender I' Owner Address DE:'IGN TtAl.I (name) Phone (address ) flies. no.l (exoi res 1 Primary Structural ElectrIcal Mechanical CONTRACTORS (namel (addrpss) (1 ire;. no.) (pxoil"'pc;) (ohnnp nn,l General Plumbino Electrical 'lechanI~al ?foLr3 #.c-A-nN~r. PLUllB I NG '";j ~:>c> C /"9'7'0 "57- ...,p~ I 77"/ ~a:::> <. ELECTRICAL MECHANICAL NO. I I FEf . rl-IMGF NO ~n. . rl-l~ NO SQ, FT, furnace/burner to BTU's ~~~ ru~ Each Single fixture Residence of Relocated building (new fix, additIonal) S,F, ResIdence 11 bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES -:2.. Recessed wal1,.~"2:> So~rp kp~tpr ~nrl vpnt 12- Storm Sewer Of amps. Appliance vent seoaratp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and durt. I I I ~.e>e I I ~Iater service Temporary Construction Change in existing rp~,i1E"nrp multifamily. comm. or Tnrlu,trial Sewer COMfI. IIND. FEEDERS Installlalterlrelocate rli,trih. fpprlpr, Wood stove/heater Of amps. ~ #/?'~ TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valid until the ISSUANCE OF PFmllT TOTAL CHARGES TOTAL CHARGES ~#, /,5 . - that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this peliilit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that UO 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 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. IlAHE(please print) 'ROLr t-\. \fo N ~ Zone ..:::L:::: Type/Canst. 5;'# Units Fire Zone Bedrooms Occy Load Flood Plain Stories I Occy Group SIGNATURE 'FOR OFFICE USE mlLY Sq, Ftg, 11ain Sq. Ftg. Access "R - '2.. Sq, Ftg, Other K~ l{, ~~ ~ DATE4-7~ g3 /I II x x Value Value Value x TOTAL V ALUA Tl ON BOILDING PERMIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldo P~r Fpp ------------ Plan Ck, Res 30%/Blda Per Fee Fence Systems Development Charae (I.5~) PLU'1BING PERMIT Charges and Surcharges DC1A10 ELECTRICAL PERlm Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Sidewalk A/C Paving ___~~__ Curb Cut -75 Total Comb. Permit TOTAL /5'.7S- . COMBINATION APPlICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B. legal Description I. example- Tax lot 100, lane County Map Reference I! oj 43 2, example- lot I, 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. ----- I. example- 1250 sq, foot house, 500 sq, foot garage 2. examp.le- if new project. check:ruew - if addition, checl< add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. examole - 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 jab 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 an 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 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: . . PERMIT VALIDATION Permit Clerk I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L:s.~#<E: ~ ~ =-;?i" signature ~-'Ca /6/ ~~ date SI- 7-:::G r , r " INSPECTION LINE . CITY UF SPRINGFIELD 726-376g COMBINATION APPLlCATIONIPERMIT 1"l""" I EIIERGY SOURCES: Job Address ILlE;" /-'/L>/(.:z:.~:L:l:}<-'-A .,~Z - Heat Lega I Oescri ption / :?-rt:>"3r 3'_"-.=?/- ~~-S-6D lIater Heater Range ValuE of Hork: =<7".:::?O. "I> BuildinQ Permit Info: Describe Work(i.e., Familv nesidence With Attached Garaae\ . INFORflATION UNe .1 726-3753 Sq, Ftg, I.lain ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Rep, --Fence Demo Change/Use Other- - . ~AP# ~.D Address '';";;t:;; W~;... .2: '" < r Phone 5p~_ ~. "7%~~3 Construction Lender " Build Single ~ I \l) \l Owner Address Ut,JuN TtAI,' ~~/"A>L:... T.u,..,p .-jc.->-6PE;.y~b . . 0/'7/'/ /~~/='~c,,/ ~?"';./'9A"~ (name) Phone raddressl nics. no.) lexoiresl (ohane no.- Primary Structural I), 1X".l.. \ e;;"l, ~ 0 Electrical Mechanical CONTRACTDRS (name) (addrpssl (1 ;cs. no.) (pxo;rpsl (ohOllP M.l Genera 1 ,-(.A \ Plumbino , Electrical ~'echanical ;HbtJ"3 #...c-#7./N~. ?f:>':>c> E /7".Ta~ ..-)p~ , . ". 7Y/~~<. PLUI1BING ELECTRICAL MECHANICAL -.llih FEf rHAor.F.JJO FFLI..cJJAB.Ii[ NO, ~~~ ru>1B.GL Each single fixture Residence of SQ, FT. furnace/burner to BTU' 5 Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath\ Duplex (1 bath) each Additional bath SERVICES -:2.. Recessed wal1,.~~= Sn~~p hp~tp~ ~nrl upnt 12- Storm Sewer Of amps. Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood and dur.t Wood stove/heater I ~ h'n-h=. I I I :<,. cooe ~Iater service Temporary Construction Change in existing rp~.idJI.r'r.P multifamily. comm. or IndlJo;.trial Sewer COMI,!. /IND. FEEDERS Install/alter/relocate ni c:trit'L fppnprc: Of amps. 6'1 ISSUANCf OF PFRruT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES ..-%-#, /1$ . ....... WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit shall not be valiJ until the 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 Derformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Orel.:lOn pertaining to the work described herein, and that UO OCCUPAUCY 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 701.055 will be used on this project. SIGrIATURE_K~ N, ~"1 FOr. OFFICE USE Q;iLY /I V ~ Sq, Ftg, l1ain x Sq. Ftg, Access x "R - 2. Sq. Ftg, Other x OATE4-7~ 88 IlAHE(please print) KOLr- t-\, 'J"O N Ct- Zone_ ~ Fire Zone Flood Plain TyoelCons t, Bedrooms Stories yh/ Units Occy Load / Occy Group Value Value Value TOTAL VALUATION BUILOING PERfIIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bld(l P..er Fpp Plan Ck. Res ' 30%/Bldo Per Fee Fence Systems Development Charoe (1.5~) PLU!1BING PERMIT Charges and Surcharges D~R1o ELECTRICAL PERIHT Cha rges and Surcharge.s MECHANICAL PERMIT " Charges and '^ Surcharges \fI Total Comb. Permit TOTAL I /5: 7S- I