HomeMy WebLinkAboutPermit Plumbing 1984-11-29
I INSPECTION LINE
726-3769
e
CITY UF SPRJNGFIE~D
COMBINATION APP~ICATION/PERMIT
re
INFDRllATION llNt
726-3753
Sq. Ftg. f~ain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A Her Rep.
-Fence Demo Change/Use
Other- -
I~
I~
\J
':j-
(X)
Job Address
760 ;V. Au
\ '\ D~ "-> ':) 4?_ O\'::a
EIIERGY SOUR~ES: ,
Heat l1.~ CV1"ve..51 """
l~atePHeater
Rangen
Legal Description
Address
PhO!!;t,'7_ 37,lG
Val.Jl' of flork:
0/1>/, sO-O
BuildinQ Permit Info: Describe Work(i.e.. Build Single
Familv Residence With Attached GaraQe)
/' ,
L.OI?J,hJf'....C III/
_JLd" hL:';j o(.Ea..a- ~
~O
OwnerS PVJIj,.. !t~/j
I .
.7/..0 N }1.,
.J,...pf.-.e.tfl 0 f.. q 7 <{ 7 7
(j)o>-t" Oa ; p
Construction lender
Address
UESIGN TEAr~
(name)
Phone
(address)
(l ics. no.)
(expires)
(ohone no.l
Primary
Structural
Electrical
Mechanical''''
CONTRACTORS
I/Vs:tlfl/n-t/~ d
(name) v
c: fJ-E; CO,'-' ,,'..Q.<J/ ,""'-
(address)
bi..AVllVe "'.
(lies. no.)
(exoires)
(ohone no.)
General
Plumbino
Electrical
~. -# 30595 1- /8.gS
f/ftG A A-' l-kfl..h',A.,'(;. rJ-It/c /000 $', '.8e';1'elr<,A.I f.l.t4-iz e~'l<?","-<?
:or ? '1-'/ ~.s'i'
~lechan;cal
P~UI\B I NG
E~ECTRICAL
MECHANICA~
NO.
FFF r.HARr,F NO
FFF rHARr,F NO,
FFF rHARr,F
SQ. FT.
furnace/burner to
.bOO,~~C Bru's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
So~rp hPntpr ~nrl ~pnt
Storm Sewer
Of
amps.
Appl iance vent
c;poaratp
Stationary evap.
cooler
Vent fan with
s; no 1 educt
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Additional bath
~Ia ter servi ce
Temporary Construction
Change ;n existing
res.i dJ>..nc~
multifamily, comm. or
lnduc;trial
Sewer
H,^~~~"
'D,OO
COMM./IND. FEEDERS
Install/alter/relocate
d;<;.trih. feeders
Wood stove/heater
Of
amps.
'110
-<(0
ISSUANCE OF PFRrlIT
TOTA~ CHARGES
WHERE STATE ~~W REQUIRES
shall not be va1iJ until the
o.H 10, <{O I TOTA~ CHARGES
tha t tile El ecUi ca 1 work be done by an
label has been signed by an Electrical
, TOTA~ CHARGES
Electrical Contractor. the electrical portion of this permit
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 performed 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 NO OCCUPAr~cY will be made
of _any structure without the permission of the Building Division. I further certify that my registration ...lith 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 ORS 701.055 will be used on this project.
1lAf.IE(please print) rJCobe..., E I.J fJ 6'flN
SIGIIATUR&L:t c Jy(~
I /
en.---
DATE //-'-.2,9-fY
FO~ OFFICE USE DilLY
Zone Type/Canst. Units Sq. Ftg. riain
Fire ZonE' Bedrooms Occy Load Sq. Ftl]. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
x
x
x
Value
Value
Value
TOTAL VALUATION
BUILDING PERHIT
Charges and
Surcharges
- Plan Ck. CorrmJInd
65X/Rlda PE'1" Fj:le
------------ Plan Ck. Res
30%/Bldo Per Fee
__!t2:..~____ Fence
if 0 D~.o
'syste. r.Js. Development '
Charoe (1.5~) .
P~U'1BING PERMIT
Charges and
Surcha rges
E~ECTRICP,~ PERI~IT
Cha rges and
Surcha rges
'Sidewal k
A/C Paving
Total Comb. rermit
TOTA~
J .11/0.1/0
,
11ECHANICA~ PERMIT
Charges and
Surcharges
Curb Cut
e,
.
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
17 uj 43
2. examole- Lot 1. Block. 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ce;l;n~/or forced air oas
2. examp'le- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. . exarrple- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. example - 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 OFFICE USE ONLY
Permit Clerk
i
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
.
.