HomeMy WebLinkAboutPermit Plumbing 1989-10-30
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INFOR/1ATION liNE
726-3753
Sq. Ftq. Haln
~q. FtlJ. Access.
Sq, Ftq, Other
Hew Add Alter Rep,
-Fence Demo Change/Use
-Other- -
I J
:B
I INSPECTION liNE
726-3769
Job Address
Range
ValuE
,-
-
,-
ll"Sor\Q \oC> aU
Build Single
I;-.J
I
(1 ics.
no. '
(exnires)
{ohone no.1
Primary
Structural
Electrical
Hechanical
~:::::~TOR~ (ffi ~ Nt, ,-\\r\-r~ nnO, t;d{)~ rJ
(1 ics. no.'
{exniresl
(ohone no. ,
Plumbino
Electr;cal(~ :::,
~'echanical
PLUIIB I NG
ELECTRICAL
MECHANICAL
NO,
FEF CHARGE NO
r-r-r rfJARr.r: NO.
r:H rPARr,r
SQ, FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Res; dence
(1 bath)
Oup1ex (1 batb) eacb
SERVICES
Recessed wa 11
Sn~ce heater nod vent
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood i1nd duct. .
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rps.i de..nCf;
multifamily, conJII. or
Industrial
Add it i ana 1 ba th
\<Iater service
COMH,/INO, FEEDERS
Install/alter/relocate
rli"trih_ fpprlprs
Of
amps.
I SSUANCF OF PFRtIIT
TOTAL CHARGES \ TOTAL CHARGES
WIlERE STATE LW REQUIRES tbat the Electrical work be done by an Electrical
shall not be vali~ until the label has been signed by an Electrical Surervisor
TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Division
I HAVE CAREFULLY EXM1INED the comrleted 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 rw OCCUPAI~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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7~1.055 will be used on this project.
i1V(r0J;<J
IWtE(p1ease print)
Cyrv~ f~)1l0
,
SIGIIATURE f, ""^ '-1l.- I '^
OrFICE USE ~-'="~~
DATE ,0 - ~'W1
FOr.
x
x
Value
Value
Value
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sf'!. Ftg. t1ain
Sq. Ft~. Access
Sq, Ftg. Other
x
TOTAL VALUATION
BUILOING PERMIT
Charges and
Surcharges
. -J?k . Plan Ck. Conm/Ind
___ ______ 65%/Blda Ppr Fee
. t1?f Plan Ck. Res
y~ 30%/Bl dq Per Fee
'Systems Development 1
Charqe (J.5~)
PLU'1BING PERMIT
Charges and
Surcharges
Fence
D6mo
ELECTRICAL PERI~IT
Charges and
Surcharges
(j) I Sidewalk
----(:2)-----1 AIC Paving
I Curb Cut
I
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL ~C3 \~ 0
1
.
.
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
]) 03 43
2. example- Lot 1. Block 3. 2nd Addition to
Sprlngfield 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. examole- 1250 sq. foot house. 500 sq. foot garage
2. example~~ew project. chec~lncw - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family Ilouse with an
attached garage
2. example - 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, DES I GN 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 011 THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contl"actor 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. ~Jhere possible, Building Division Staff
will prepare a type written copy and rctur'n 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.
J 0 . 30 fsCj
(SdL14
V, FOR OFFICE USE ONLY
clerkrAffi)
Permi t
PROJECT CONDITIONS TO BE SATISFI ED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
5 i gna ture
date
.