HomeMy WebLinkAboutPermit Plumbing 1989-1-11
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I I NSPECTI ON LI liE
726-376g
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Legal Deseriptio~ \ ~ 1l'32<::::, r;}.,,? \9' )"f' n ,Y~: lIeater
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Address Phone U -\ - - - . \
UESlliN rEAI~ '(name) {address' (lies. no.' (exn1res) lphone no.
Primary \tC)~'<"t"b\\n\ \..") :"oSC\.Q S~ I h JoY-flO. y1\40\ 1~4;L2{-JrA
Structural D
. CI1Y III' SPRINGFIELD
COI1BllIATlON APPLICATlON/PERfIlT
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INFORltATlON LINE
726-3753
Sq, Ftq, I"a i n_""Ll"1'2
~q. Ftg. Access.
Sq. Ftq, Other
r~ew Add Alter P.ep.
--Fence Demo Change/Use
Other -- --
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Electrical
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CONTRACTQRS (na~e\l ' .
General \'\QDc{, ~ ~f\T\f\-hf'(\
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Plumbina
(address\ (lics. no.1 (exoirec,l
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{ohooe no. 1
Electrical
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PLUl1BING
ELECTRICAL
MECHANICAL
NO,
FEF CII^Rr,F Jill~
_EEL _CHARGE.. NO
~~ r J:llARG.L
SQ. FT.
2
furnace/burner to
BTU's
/6"
Each single fixture
Residence of
S.F. Residence
(l bath)
Duplex (1 bath) eaeh
INew circuits alts.
or extensions
!SERVICES
Floor furnace
and vent
Relocated building
(new fix. additional)
Recessed wall
Soacp hPntpr and vpnt
Additional bath
t/ ~rater service
y- Sewer
Temporary Construction
Chan~e in existing
res i (h~n(f>
multifamily, conJlT1. or
Indllstrial
L/
Appliance vent
seaa ra t.e
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hoorl <lnd rluc:t
I ~Jood stove/heater
~ Storm Sewer
Of
flmps.
C0I11'1. /I NO, FEEDERS
Install/alter/relocflte
rli~1,rih_ fppdpr<;
Of
flI11PS_(
I SSUAt!CF OF PFRt1IT
TOTAL CHARr,FS I TOT^L CII^Rr,ES
WHERE STATE L.\H REQUIRES that the Elecl.riCfll work he done by an Elcctrici'll
shall not be valH until the label has beell siqned by an Electrictll ~;\lpcrvisor
, TOTAL CH^RGES
Contractor. the electrical flortion of this permit
,lnd returned to the Guilding Division
I HAVE CAREFULLY EXAmNED the completed aprlication for permit. find do hereby certify that all information hereon is true
and correct, and I further certify that any find all work nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the Stflte of Ore!)on lJertainin~ to thp. work described herein. and that 110 DCCLJPAliCY will be made
of any structure without the permission of the [luilding Division. I further certify that my registration ...lith the [luilder's
Goard 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 O~S 701.055 will be used on this project.
UAltE(please printL~~_g:A~A.~~'IAllr.nmE~A'.z: +AA;(q/l,drj-~ /f//~7
_ . . ~~7o.. OfFICE IISE O.IL Y 9'
Zone G L TYOe/Const'-"'~/~~ t;;';{s SQ. Fl.,!, liain ?"p Y':2.
Fire Zone Bedrooms Occy Load ~/ Sq. Ft~. ^ccess
Flood Plain Stories ~ Occ,V Grou,'~-:? J'~~~q. Ftg, Other
x
Value
Value
x
x
Value
TOT^L VALU^TiOfl
BUILDING PERI,IIT
Charges and
Surcharges
, d' ' Plan Ck,
----R------ 65%1Bldo
Plan Ck_
30%lBl do
____0'______
1
Cor1111/ I nd
PH Ffle
Res
Per Fee
/)
(-
Isystems Development 1
Charoe (1. 5%)
PLUtmlNG PERMIT
Charges and
Surcharges (
Fence
Damo
ELECTRICAL PERI~lT
Cha rges and
Surcharges
Sidewal k
11ECftANICAl PERlHT
Cha rges and
Surcharges
, . _.' Ale Pa-:jng
. f1 I Curb Cut
----, ------1
Total Comb. Permit
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ITOTAL6~":7-~~\ #tJ? f ...;.--.:.-
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIT VALIDATION
If.
t. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100. lane County Mop Reference
II U3 43
2, example- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ccilinq/or forced air qas
2. examyle- waterheater/eJectrlcal/or solar
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-nfw - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. exam~le - remodel existing garage into family room
3. examyle - 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, DES I GN TEAM AND CONTR^CTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonllation or job site
corrections, etc.
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
electrical contractor for signature
supervisor. The general contractor
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.
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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[\GlJ \I~q
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be delivered to the
by his electrical
is .!!El authorized
111.
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IV,
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V. FOR OfFICE USE ONLY
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Permi t
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
name L..<?h'A/e n~~
/"'? ~ ~
signature /" /.~~
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d ate "7- 7....8"'7
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