Loading...
HomeMy WebLinkAboutPermit Plumbing 1987-3-26 :. " '" I INSPECTION LINE 726-3769 ' Job Address /fg'g ~cuLuJ~ Legal Oescription /7CJ3;;Z (..., ~~I ~_A~_,) ~~;_~ Owner ~ ~ Address 415 t? ;1J. -72/7 d CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat Hater Heater ()S/ Of) Range ValuE of Hork: INFORI1ATION LlNe. 726-3753 Sq. Ftg. r'lain :q. Ftg. Access. Sq. Ftg. Other Ne\~ Add Alter Rep. --Fence Demo Change/Use --Other-- -- Do -...J ~ N o ,()' . '- .)' ;LLl,C ri ConstructiomVLe~der Phone 726 6s c2 / Bui1dinq Permit Info: Describe Hork(i,e., Build Single Fa/Mi~en:Z;;~c;;a~ ,d/A-I.J-l A.,..J ~ I Address DESIGN TEAI~ (name) Phone (address) (1 ics. no.) (exnires) (Dhone no.) Primary Structural c; ,~,.~O C I t}3o, ()~OO Electrical : r1echani ca 1 . CONTRACTORS (name) (address) (1 i cs. no.) (exoires) (ohone no. ) , .. . I I I J I --I : Genera 1 PoJl!LA.JIJ , r nUUJ,{J '"--" .......-- ":::5 'S Ie (] L/ 1J'f) 1!J-3~rg1 , P1umbinq Electrical ~1echa n i ca 1 PLUI1BING ELECTRICAL MECHANICAL I NO. Each single fixture FEE CHARGE ~ NO, FFF rHARGF NO, Res i dence of furnace/burner to SQ. FT.' BTlI' s FFF rHARGF I Relocated building (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent IS.F. Residence I ISERVICES ; , I ,I I Recessed wa 11 'I I (1 bath) Soace heater and vpnt I Duplex (1 bath) each I I I I I I I I IAdditiona1 bath I ITemporary Construction I I 1 I App1 iance vent I I seDarate I Hater servi ce I I IChange in existing I I I I Stationary evap. ~ I I residence cooler I Sewer I/Dz:/ I ~,eX> I Imu1tifami1y, comm. or I I I Vent fan with I I Industrial sina1e duct Istorm Sewer I I 1 10f amps.1 1 I Vent system apa rt from,/ I heating or A.C. ' I I I I Cm~r'1.IIND. FEEDERS I I I I Mechanical exhaust I I hood and duct I @ I Install/alter/relocate I I I Wood stove/heater , I distrib. fpeders I 1 10f amps.1 I I I I I I I 1 I I ' , 1 I ,/ I '110 I I I. 20 I I I I I I I I I I I I I I I ISSUANCE'. OF PFRrlIT TOTAL CHARGES ~). 20 1 TOTAL CHARGES 1 TOTAL CHARGES WHERE STATE L~H REQUIRES that the Electrical work be done by an-Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA/1INED 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 s'ha11 be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPANCY 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 701.055 will be used on his pro.'ect. NAf.1E(p1ease print) --;(? ~ s If"" (Z./ I SIGNIITUREQ FOP. OFFICE USE DrIL'Y- DATE 5..6t.h -, . Zone Fire Zone Flood Plain TYDe/Const. Bedrooms Stori es , Units Occy Load Occy Group So. Ftc). flain Sq. Ftc). Access Sq. Ftg. Other x x x Value Value Value TOTAL VALUATION BUILDING PER~1IT Charges and Surcharges I Plan Ck. 65%/B1da ------------1 i6~~B~~~ _____;;?f),~ I Fence / . ZO I D@mo _ ___ _ _ ___ __-'Sidewalk I A/C Pavi ng ___________-' Curb Cut I Comm/Ind Per Fee Res Per Fee Isystems Development Cha rge (1. 5%) I I I I PLUMBING PERMI~ Charges and ~ Surcharges ELECTRICAL PERfm Charges and Surcharges ITotal Comb. Permit I TOTAl 31. 2() MECHANICAL PERMIT Charges and Surcharges 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 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-n€w - if addition, check add, etc. F. Building permit information: 1. example - construct single family house with an attached garage ' 2. example - remodel existing 'garage into family room 3~ exampl~,- 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. ()c~~ lJ~b6 ~/Z)P'K1 V. FOR OFFICE USE ONLY Permit Clerk C0 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