HomeMy WebLinkAboutPermit Plumbing 1997-7-27
Job Address
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- CITY UF SPRINGFIELD
. COMBIIIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
() h fo ()[) I~a ter Hea ter
-
INFORI1ATION lINC I
726-3753
Sq. Ftq. I.Ia;n
:q. Ftg. Access.
So. Ftg. Other
flew Add Alter P.ep.
--Fence Demo Change/Use
Other - -
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I INSPECTION LINE
726-3769
Ranqe
Value: of Hark:
Owner
Phone
Builuinq Permit Info: Oeser.be Workti~e.. Build Single
Family nesidence With Attached Garaae)
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CA'ld ro/(./(~ +c::L---7/J
flies. no.' '(exo;res) I
I
(ohane no.)
Address
. UESIGN TEAI1
(name)
Phone
(address)
Primary
Structural
Electrical
CJ2..n, 9..00
f1echanical
CONTRACTORS
(name)
(address)
(lir:<:.. no.)
(pxn;rp,,'
(ohnnp no,)
Plumbino
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Genera 1
Electrical
~'echanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
FFF CHARGF Nn
~~~ r~ARr,~ NO_
~~F rHARr,F
SQ. FT.
furnace/burner to
BTlI's
Each Single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~~P hp~tpr ~nd vpnt
Storm Sewer
Of
amps.
App 1 i ance vent
o::.l"o!!,ratp
Stationarv evao.
cooler J .
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood i'lnd durt
Additional bath
~Jater service
Temporary Construction
Change in existing
res i d_ence
multHamily, COIOO1. or
Tndustrii'll
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
distrib. fepdprc;
Wood stove/heater
Of
amps.
j\
ISSUANCf OF PFR!11T
TOTAL CHARGES . TOTAL CHARGES
WHERE STATE L,\I~ REQUIRES that ti,e Electr;cal work be done by an
shall not be valij until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED the completed application for ~ermit, 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 Ore~on pertaining to the work described herein, and that riC OCCUPArKY 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 t basis for exemption is noted hereon. and that
::,::::::':::::' "dv::'i:,~: ',"^'=' .m :::":::.:,,.m '"'/~:~,) ." 71, &;z
FO~ OFFICE USE OrjLY '/I I . / .
Zone Type/Canst. Units Sq. Ftg. riain x Value
Fire Zone Bedrooms Occy load Sq. Ft~. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
~__hh___
_____~~~~~I
,: 02 75
Plan Ck.
65% Blda
Plan Ck.
30%/BI dq
Comm/lnd
Ppr Fpe
Res
Per Fee
ISystems Development I
Charqe (1.51,)
PLU!~BING PERMIT
Char.ses and ~
Surcha rges
Fence
D~mo
ELECTRIC~.L PERtiIT
Cha rges and
Surcharges
Sidewalk
I A/C Pavi n9
L ~~ ~t
I -----------
Total Comb. Permit
t1ECHANICAL PERHIT
Charges and
Surcharges
TOTAL
'57; 7~
I
-
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
II U3 43
2. example- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ~
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example~ if new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examjle - 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.
V. FOR OFF! CE USE DNL Y
PROJECT CONOITlONS TO BE SATISFIED BEFORE OCCUPANCY:
~
PERMIT VALIDATION
.
~ bCGCC{
I~ 1-7-fl)
Permit Clerk
(:0
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
.
date