HomeMy WebLinkAboutPermit Plumbing 1984-2-2
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Job Address /80 l ai/1m LA
Legal Description \'103?-,ld."1) nnoc'i.)
CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
.
INFORt1ATION u('tt.
726-3753
Sq. Ftg. f.la;n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
-Other - -
.1 IrISPECTION LItlE
726-3769
Address
DESIGN TEArl
(name)
Phone
(address'
.~~
~r '~V~c;~.~
~. \)
1At'\
\\ - (l)hone
~
3
IcP
is-
I
no. \
Owner '\ b ~! (I UlYY) 1 nQ
Addr:;:-j80 'tFjct;) I~ qlu,bh~0b'7L/
constru~~der '
Range
Valu€ of 1,lark:
BuildinQ Permit Info: Describe Work(i.e., Build Single
Family Residence With Attached Garaqe)
Primary
Structural
El ectri ca 1
!1echanical
CONTRACTDRS
(name)
(address)
n.ies. no.'
(exo;rps)
(ohane no. )
Genera 1
Plumbino' ..t)o11'1.nt:f:)nI} j
~'5? 5s<7< M,dLQ.t (\.f\.If) f~
--
'?,obJ 10
R/lh/'?Jtj
~ ,
E1 ectrica 1
Mechanical
PLUI1BIrlG
ELECTRICAL
MECHANICAL
NO, '
I FfF I r.HARGF NO
I F'F'F' I rHIl.R(;F NO. I
I FFf." I r:HARGF
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~Onrp hPntpr nnrl vpnt
Of
amps.
Appliance vent
5i2Daratp
Stationaryevap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and duC'.t
Sewer kIf) /(J.CU
\
Storm Sewer
Temporary Construction
Change in existing
rp.:;,idp,:nce
multifamily, comm. or
Tnrlllc;,trial
Water servi ce
CO~~./IND, F5EDERS
Install/alter/relocate
r1ic;,trih. fppdprc:;
Wood stove/heater
Of
amps.
ISSUANCf OF PFR11lT
TOTAL CHARGES If). 00 TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H 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 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 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in cornDliance with ORS 7Ql.055 will be used on this project.
':a ;:' . 8 ed~~ ~.J L7 /-L2
HAI-IE(please ~I_ /./.1",1'..-...... SI(:;I^TU~ ~~ ~
~ \ FOP. OFFICE I!~~ QW.Y
Zone Type/Canst. Units Sq. Ftg. f1ain
Fire Zone Bedrooms Occy Load Sq. FtQ. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
DATE 2 -2 -if "I
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfIIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Rl do Ppr Ff!P
------------ Plan Ck. Res
30%/Bldo Per Fee
__jQ,_~~___ Fence
("(J Demo
Systems Development
Charqe (I. 5r,)
PLUt~BING PERMIT
Charges and
Surcharges
ELECTR I C~.L PER;~IT
Charges and
Surcha rges
Sidewalk
AIC Paving
Total Comb. rermit
/IECHANICAL PERMIT
Cha rges and
Surcharges
TOTAL
10,10
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
11 03 43
2. examp-le- Lot 1. Block 3. 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole. heat/electrical ceilinq/or forced air aas
2. examole- waterheater/electrlcal/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 pennit information:
1. example - construct single family house with an
attached garage
examole - remodel existing garage into family room
examole - 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 schedul es
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. ---
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.
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.
2.
3.
?
II !.
IV.
V, FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFlEO BEFORE OCCUPANCY:
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PERMIT VALIDATION
,
l;~f)8L{
'p' ro~'3s0
Permit
/r-----r-/ \
C'ler..JM,~
/
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date