HomeMy WebLinkAboutPermit Plumbing 1987-3-10
Job Address
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CITY U~ SPRINGFIE,O
COMBINATION APP,ICATION/PERMIT
EilERGY SOURCES:
Heat
t~ater Heater
Range_
.
INFORllATION LINt
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
--Fence Demo Change/Use
Other- -
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I INSPECTION UNE
726-3769
.
legal Description
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Owner' ~ 1nd
Address '/ /\ c- r LJ
/"-U~ J .::::., / I
Phone
I
BuildinQ Permit Info: Describe Wark(i.e., Build Single
Fam1).v nesidence With Attached Garaae)
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ValuE of Hark:
Construction lender
Address
Ut::>ll:iN TE.Af1
(name)
Phone
(address)
(lics. no.l
fexoires)
(ohone nn.l
Primary
Structural
L. \ t1~"'l! l.)-W)
El ectri ca 1
Mechanical
CONTRACTORS
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(name)
(addressl
(l i~s. nn.)
(pxni rpc;. \
(ohnnp nn.)
Genera 1
Electrical
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P1umbinq
"lechanical
P,UIIBING
E,ECTRICA,
MECHANICA,
NO.
FFF r.HARGf f.,In
~~~ rI-lAIH:'~ "In
~~~ rI-lA~r.~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(] bath I
Duplex (1 bath) each
INew circuits alts.
or extensions
ISERVICES
I
Floor furnace
and vent
Recessed wall
So~rp hp~tpr ~nrl vpnt
Sewer
!TempOrary Construction
IChange in existing
rp~ j qf'nl"'P
Imultifamily, comm. or
Tnrlllc;tri~l
! Of amps.!
ICO~j./IND. FEEDERS I
IInstall/alter/relocate I
r1;c;.tr;h_ fpprlprc;.
10f amp~1
Appliance vent
seoa ra te
Stati onary evap.
r.oo 1 er
I Vent fan wi th
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood and dur:t.
! ~Jood stove/heater
I
I
I
,
Additional bath
Water servi ce
Storm Sewer
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ISSUANCf OF PFR!IIT
TDTA, CHARGES , TOTA, CHARGES . TOTA, CHARGES
WHERE STATE ,,'1/ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali~ 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 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 ons 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 th~Oject.
NAf.1E(please print) hA!IIk (1)')"./oA/14A/ SIGIIATUR~AV"","~'~A~ DATE~/P7
FOr. OfF I CE USE OI.U
Sq. Ftg. t1ain
Sq. Fta. Access
Sq. Ftg. Other
Zone
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
x
Value
Val ue
Value
Fire Zone
x
Flood Plain
x
TOTA, VA,UATlOII
BUI,OING PER/lIT
Charges and
Surcharges
PW!jBING PERMIT /_
Charges and ~
Surcharges
I Plan Ck.
65%/Rlda
------------ Plan Ck.
30%181 do
js aV fence
----- --;'--0o-ID6mo
I'Sidewalk
I A/C Paving
I Curb Cut
I
COIl1T1/Ind
Ppr Fpp
Res
Per Fee
ISystems Development l-
Charoe tI.5~) .
E,ECTRICA, PERIHT
Cha rges and
Surcharges
Total Comb. Permit
TOTA,
/5 (00
I
MECHANICA, PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
~
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100. Lane County Map Reference
11 03 43
2. examp-le- lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceil;nqJor forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examp'le- if new project. check-new - if addition,
chee k add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examele - 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 jab 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
1 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
signa ture.
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.
e 0 1(91 &
9~ /~/f 1
V. FOR OFFICE USE ONLY
'Permi t Cl erk
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.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Adgitional Project Information:
/
/
,
/
,
PLANS REVIEWED BY:
/
name
signature
date
.