HomeMy WebLinkAboutPermit Plumbing 1987-3-26
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I INSPECTION LINE
726-3769 '
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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-- --
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ConstructiomVLe~der
Phone 726
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Bui1dinq Permit Info: Describe Hork(i,e., Build Single
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Address
DESIGN TEAI~
(name)
Phone
(address)
(1 ics. no.)
(exnires)
(Dhone no.)
Primary
Structural
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Electrical
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. CONTRACTORS
(name)
(address)
(1 i cs. no.)
(exoires)
(ohone no. ) , ..
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: Genera 1
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, P1umbinq
Electrical
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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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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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