HomeMy WebLinkAboutPermit Plumbing 1988-1-25
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I INSPECTION LINE
726-3769
.
CITY Of SPRINGfIELD
COMBINATION APPLICATION/PERMIT
A ubecl- ~~~~GY SOURCES:
\~ater Heater
Range
ValuE. of Work:
.
INfORlIATlON L1Nl
726-3753
Sq. Ftq. I.Iain
~q. Ftg. Access.
Sq. Ft9. Other
flew Add Alter Rep.
-Fence Demo Change/Use
Other - -
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10
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Job Address If) 1] O. ~{1)uJ--11
Legal Description \'1 6:3 BI", 3.:l.
01 "inDO
Owner Q; ~ E !<,p.M.ird h...J
Address 1'5 '10 ~~ A
Phone'7.9i,--IKII
BuildinQ Permit Info: Describe Work(i.e., Build Single
Family nesidence With Attached GaraQe)
-1(~ 1-"'" ~ {<'-,,?VU'_,,-- ~.~
~ S(}J' 1J u.. \CLtUV ~
4.-,,/ 1I1"\"k' 4'- ~Lu_1~
v (lies. no. 1 (exoiresl ~hone no.
Construction lender
Address
DESIlJN H.AI"
{namel
Phone
(address)
Primary
Structural
CJ2.(,." \2,1)0
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(1 ics. no. \
(\J.c."'t'I' (O~'-I,)
(~xnirps) (DhQn~ no.)
General
Pl umbi no
'- \i'I~. '\-l.... (111-"'.lUl")
3/+05 f2A'taofl ((j.
~t;l:()~(lJl)""..
n 1<./.<,/Q() 0
'7/r,) K'7r
i I
)_-u1_
'It'
Electrical
M~~"anical
PLUflBI NG
NO. FFF rHARr,.F' NO
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
OUplex (I bath) each
Additional bath
I ~Iater servi ce l~ I'fr~
fD
Sewer
Storm Sewer
ELECTRICAL
MECHANICAL
J:'J:'J:' rl-l~.lW
m,_1 LIlARliE
SQ. FT.
furnace/burner to
BTU's
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Soace heater and vpnt
Of
amps.
Appliance vent
S~Darat~
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.r:.
Mechanical exhaust
hood <lnd duct
Temporary Construction
Change in existing
res'; cl..e.nce
multifamily, comm. or
TndlJstri<ll
COMfl. IIND. FEEDERS
Install/alter/relocate
dic;trib. feerierc;
Wood stove/heater
Of
amps.
'Je\
I SSUANCE OF PFR!IIT
TOTAL CHARGES I$<t'- TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,"~ REQUIRES that the Electrical work be done by an'.Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I 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 oerformed s ne in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the Sta te of Ore(]on perta i ni ng to e work desc . ed herei n. and that rm OCCUPAHCY wi 11 be made
of any structure without the permission of the Building Division. I further cert y that my registration with the Builder's
Board is in full or and effect as required by ons 701.055, that' exempt the ba . -fo exemp.' is oted hereon, and that
only subcontrac ors a d employees who are i~mPliance with OP.S 7Ql. S will be s on t is oj ct
/!ff~ \r ~a./Js. S~E(
Fon OFn CE USE OIlL Y /
So. Ftg. rIain
Sq. Ft9. Access
Sq. Ftg. Other
IWIE(please prin
/.
ATE
:{J.~,f'-
Zone
Type/Canst.
Bedrooms
Stories
Units
x
Value
Value
Value
Fire Zone
Occy Load
Occy Group
x
Flood Pla i n
x
TOTAL VALUATIOh
BUILDING PERHIT
Charges and
Surcharges
Plan Ck. Comm/lnd
__ __ _ __ __ _ _ _ 6S1;/81do Pj'r F~~
Plan Ck. Res
30t/BI do Per Fee
_____J9-~___ Fence
.15 DfIIlIO
Sidewalk
syste.ms Development
Charoe (1.5~)
PLUl1B ING PERMIT
Charges and 5
Surcha rges
ELECTRICAL PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
A/C Paving
Total Comb. Permit
I TOTAL
~ I:) '15
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
1/ oj 43
2. exam~]e- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electr;cal/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 pennit information:
1. examole - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exa~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. 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 ANO
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.
Ill. Applicant to Si9n 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 OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
v ~ . ()I<!-
- CfJ ilL
Permit
!'J51.5
/-0:(5 - 8"'6'
Clerkd(~ 1?~p..>
.if
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date