Loading...
HomeMy WebLinkAboutPermit Plumbing 1987-4-24 Job Address tfr;o Omription I r1 0:> .35' CITY uF SPR{ijGFIELD.\ JNFQR/IAT: .':1 U..:. COIIBIllATION APPLICATION/PERMIT 726-3753 I E!IERGY SOURCES: Sa, ,tq, I,\ai" Heat :q. ~ta. Access. ()t'f(ltJO !' !Iater Heater So, ,tg, Other flel... . Add P.h:er r.eo. Ranoe --Fence Demo Change/Use ~ ?f i Valu' of Hark: Other- - l//J U 1'1":/ r/' flHJ~ Pho nil iJ7 Buil':i"" Permit Info: Describe 1'lork( i,e.. Sui Id Single r (." I:; V 1-" "\ ne. (7 F3r.li) v rtes idence I'lith I\ttached r,a~~) ~ J 3371./ J-I'UJhJ/ A-:JT.I /f:i7/~hJ)J , i!/Jh;t//J1I/~ /)d-//;"O;?) 1\ (eXnlrt\ ~ '0,4- ~ :~ C/-;:; I HISPEOIDII LHll 726- 3769 . (name) Phone (address) II , dY ~ I~ .~ I f~ I I Legal Owner Address Construction lender Address OESJGH TEi\ll (1 ics. no.) (Dhone nO. J Primary Structura 1 Electrical !1echanical CONTRACTORS enamel (address) (1 ic<;. nO.l (pxnirpc;) (ohnnp no. ) Plumbina t!, Jcf - Wfh~ , - '~ d General Electrical t.iechanical PLUIIBItIG ELECTRICAL MECHAN I CAL no. FH CHARr,f f.J() err rl-lllor.r un SQ, fT, furnace/burner 'to 6TlI' , I ;:-r~ n-lAP(:r I i Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace" and \lent S.F. Residence (1 hiHh\ louP1e~ (1 bath) each Additional bath SERVICES Recessed wall ~~~iP hp~t~~ ~nrl vpnt Storm Se\>ler Of amps. Apoliar\ce Iler\t c;eoal'C1te Statlonarv evap. cooler ~ Vent fan wi th sinnle dud Vent system apart from I'. heatino or A.C. Mechanical exhaust hond C1nd durt ~'!ood stove/heater ~!ater service 1 Sewer Temporary Construction Channe in existing rec;idence mult{fami ly, camm. or lnnllc;frlCl1 C0I11.1. /I NO, fEEDERS Install/alter/relocate dic;trib. fppders. Of amps. ISSUANCE OF pmllT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES t-lHERE STATE LW REQUIRES that tile Electrical work be done by an Electrical Contractor. the electrical portion of this perr:lit shall not be valij unti1 the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXNlINED the completed apnlication for lJermlt. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City of SDri ngfi e 1 d and the Laws of the S ta te of Ore~on perta i n 1 ng to the work descri bed herei n, and tha t 1m OCCUPAfKY ,vi 11 be made of any structure without the permission of the ~uilding Division. I further certify that my re9istration with the Builder's Ooard is in full force and effect as required by O~S 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees \...ho are in comDliance with ORS 701.055 \.li11 be used on this project. IIMIE(p1ea,e print) 30~(\) AmOLD SlC,:lATURE tZt.--~ DATE I(-;!t/-Yl -<, FO~ OffICE USE(tlfIL Y Zone Tyoe/Const. Units Sq. Hg. f1ain x Value Fire Zone Bedrooms Occy Load Sq. Ftg. Acce s s x Value Flood Plain Stories Gccy Group Sq, ,tg, Other x Value TOTAL VALUATION BUILDI/IG PERl,lIT Charges al\~ Surcharges , Plan Ck. CommlInd ____________ 65VBldo Ppr FF'P Plan Ck. Res 30%/Bl do Per FPE' 'Sys ter.1S Deve 1 opll1en t \ Charqe (1.5') PLUtmlllG PERI~lT Charges and SurCharges . -00 __n..{Q=-..'__ - &0 I Fence D,;:mo ,ELECTRICP.L PERI:lT CharQes and Surcharges Sidewalk A/C Paving Total Comb. rermit TOTAL j -.- '-'-'1 (S.bv 11ECHANICAL PEPI1lT Charges and Surcharges ~--~-_.._---- Curb Cut . II COMBINATION APPLlCATIOII/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. examDle- Tax lot 100. Lane County Map Reference 11 03 ;.j.j 2. examole- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcalior 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 garage 2. examole - remodel existing garage lnto family room 3. 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, DES I GN TENl ArlO 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 OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES 011 THE SCHEDULES O. 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 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 cneck fees are due and payab7e 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 ~ Gb 'i ~D!P & rq r-SIJ BG~( 00 L( -d,Lf- ~ 1 , Permit Clerk CL J Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . ~ date a