HomeMy WebLinkAboutPermit Plumbing 1990-1-4
~~
-I INSPECTION LINE .
726-3769
; Job Address /,~ ~,/e-d~4 ?7~,
CITY Uf SPRINGfiElD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Ueater
Ran!1e
ValuE of Hork:
Owner V~LL.<7.47.e"rr-e- VC>XAe-#-<: &~ ;> ~,,~ ~
Add Y1 ';t::... Ph . BUll(ilnQ Pe",lit Info: Descrlbe Work(Le.. Build Single
rcss I' ~~ ~ I'y .~;;--. onc Familv nesidence With Attached Garaoel
-?ft:1FCD. d-;;:;J. /9E~~-C: /....r/~/__~ ~
L~.r/~cF d/,Q7 C,.c:- ....-5?-~c::::--.
.
INfDRHATION LINt
726-3753
Sq. Ftg. Main
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Al ter Rep.
-Fence Demo Change/Use
Other - -
t
~
legal Description
Construction lender.
Address
UI;,16N IlAH
(name)
Phone
{address}
(1ies. no.1
(exoires)
(ohone no.
Primary
Structural
Electrical
Mechanical
CONTRACTORS
General ~~/'~
(name)
r~"~"~'"/7)7"-.6~ .
7
(addrp....l
(1 ir::... no.l
Cexoire51
(ohone no.)
7%-5"?:75
Plumbina
Electrical
Mechanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FEE CHI182L Jln
~~F rH~ NO.
~FF r"'\8GE..
i
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
7..5''''' ?&>.-
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
Recessed wall
Snar::e hp~ter ~nd vent
Storm Sewer
Of
ICOHM./IND. FEEDERS
I Install/alter/relocate
di..trib. feedP~~
10f
c1::' c:c.T . La",," ~ ~
~.c, c:::P3779/ ~ ./ ~
. 4~//'?"~/~""''''''7-.
"?~ -. TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor. the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
amps.
Appliance vent
s_eoaratf!
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood ~nd du~t
from
Water service
Temporary Construction
Change in existing
rec; j ~eJl("e
multifamily, comm. or
Indu..trial
Sewer
Wood stove/heater
amps.
ISSUANCE OF PfRl1lT
TOTAL CHARGES
WHERE STATE L\I/ REQUIRES
shall not be vali1 until the
TOTAL CHARGES
1 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel)on pertaining to the work described herein. and that UQ OCCUPAHCY 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 Or.S 701.055 will be used on this project.
Units
Occy Load
Occy Group
S lGrlATURE
FOr. OfFICE USE OIIL Y
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
pf'_~/LtJJL
DATE /' /4'A;:>#
IWIE(please print)
/(/,
\/'"IIp'lAr
/ ,
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
t1ain
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERIIIT
Charges and
Surcharges
I ~ ~6 I Plan Ck. COIllll!lnd
____~!!!?-=~--- 65t1Bldo p.pr Fep
8= Plan Ck. Res
;<'- -' 3D%/BldQ Per Fee
:::2'6 - Fence
----~-~----
/ .So D~mo'
'Sldewa I k
ISystems Development I
CharQe tl.5~) ,
PLUHBING PERMIT
Charges and
Surcha rges
~'-'
ELECTRICAL PERlllT
Cha rges and
Surcharges
, ,
A/C PavIng
Total Comb. rermit
11ECHANICALPERMIT
Charges and
Surcharges
Curb Cut
I,
1'0.83
TOTAL
~' J:
.
, -
COMBINATION APPLICATION/PERMIT (CAP)
!
'I. Applicant to furnish
:":' A. Job Address
'. ) B. legal Description
1. examp.le- Tax lot 100, lane Co~nty Map Referenc
II OJ 4J
2. example- Lot I. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
. D. -;Energy Sources . -
.1. example- heat/electrical ceili~Q/or forced air
2. exam~le- waterheater/eiectrlcal/or solar
E, Square footage or valuation. etc. ------
1. example- 1250 sq. foot house. 500 sq. foot gal -~
2. exam~le- if new project. check new - if addit~
check add. etc.
F. Building pennH information:
1. exam~le - construct single family house with;
attached garage
2. example - remodel existing garage into family
3. exameJe - convert single family residence inti
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of tho
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriat
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedu s_
A. Except where blank spaces occur in the descriptio
portion of the Mechanical and Electrical Schedule
the applicant need fill-in only the No. Boxes adj
to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical. and Electrical Schedul
are available at the Building Division
1. To conserve space on the permit form the schE
have been abbreviated
2. If the item(s) to be installed are not coverf
the abbreviated schedules you should consult
fu 11 schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES M
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered-l."'--1;l''''
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
r"l
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CITY OF SPRINGFIELD
. City Hall
Springfield, Oregon
Development Services
OFFICIAL RECEIPT
15694
Dater ~f"- q
Rec'd From r rl?<:::':
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Add,as.? 7~ g.!:: ,!>~......",..c>
Received Fo'j .b~~~6 ker~ .
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7 AUTHORlZEO S1G RE l-- - -
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~mount Received
4
Frantler BUSINESS fORMS. INe
lSOJI:Ml....
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Pennit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
','
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Pennit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
.
name / JiT/Y,d: ~~E?)
signature
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