HomeMy WebLinkAboutPermit Plumbing 1985-5-9
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I INSPECTION LItlE
726-3769
Job Address c2 50 N, 'A
J< fr-..u.F
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
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INFORt1ATION L1I'H:
726-3753
Sq. Ftq. 1.lain
:q. Ftg. Access.
So. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
-Other-- --
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CV)
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legal Oe5cription
Address
J r"->-J.rl.->le.JrO ~ &,,^-y
..:250 N'U~ $.:f^~ I Phone
A pl!'o.
Ranqe
Valu€
of Hark.:
Owner
BuiloinQ Permit Info: Describe Work(;.e.. Build Single
Familv nesidence I-lith ,lI,ttached l'iaraae)
'l'-lf.-'i'lss/
Address
UeSiG" iEAl1
(namel
Phone
(addrp'is)
r:J r&u..LfoU} ~".,~-t; ~ ~~
Construction Len~er
(lies. no.)
(exn; res)
(ohane no. I
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrf'~s )
(l ics. nn. \
(plmirf's)
(ohnnp M.'
Genera 1
Plumbina
-(~-
$:-~
Electrical
f.lechani ca 1
PLUI1BING
ELECTRICAL
MECHANICAL
Each single fixture
I FFF I rHJ\Rr.E NL1 I ~n:
Res; dence of
rl-l8.RG..E.. .llJh.1
I 1="1="1=" I r
---1:ill.:.1
SQ. FT.
furnace/burner to
BTU's
Relocated bUlldlng
(new fix. additional)
New clrcuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
11 baUd
Ouplex (1 bath) each
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Apo 1 i ance vent
~eoari'ltp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd and duct
Additional bath
Hater servi ce
Temporary Construction
Change in existing
rpS; rl.f'nc~
multifamily, comm. or
Tnnu<;;trii'll
Sewer
;).. ~..,,-,kU~
f~_
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S.oP'iO.nO
COMM./IND. FEEOERS
Install/alter/relocate
ni<;;trih. fppdpr<;;
Wood stove/heater
Of
amps.
I SSUANCr OF PFRIHT
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be vali1 until the
/0.00 TOTAL CHARGES
that the Electrical work be done by an Electrical
label has been signed by an Electrical Supervisor
TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Divlsion
I HAVE CAREFUllY EXMlINED 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 rw OCCUPAr~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 DRS 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.
IJAl.1E(please print) .it?,lJ O~ "15:164 SIGlIATURE Q",,^ rnA~ OATE ;-
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FOR OFFICE l.r~~ Oil! v '"
Zone Type/Canst. Units Sq. Ftg. riain / x Value
Fire Zone Bedrooms Occy load Sq. Ft~. Access x Value
Flood Plain Stories Dcc'y Group Sq. Ftg. Other x Value
TOTAL VALUATION
PLUt1BING PERMIT
Charges and
Surcharges
, Plan Ck. Corrm!lnd
65%/Bl do Ppr I="ee
------------ Plan Ck. Res
30%/Bldo Per Fee
10.. () b Fence
------------
. '-fa Demo
lSystems Development 1
Charae (1.5~)
BUILOING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Charges and
Surcharges
Sidewalk
A/C Paving
ITotal Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
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,I" . . _
5'/0. '"Zio
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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
1/ uj 43
2. examDle- Lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterneater/electrical/or solar
E. Square footage or valuation, etc. -----
1. examole- 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
attached gar~ge
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
Oivision 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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. ~ll other fees and charges are due and
payable when the permit is issued.
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V, FOR OFFICE USE ONLY
Permit Clerk
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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
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