HomeMy WebLinkAboutPermit Plumbing 1987-4-24
Job Address
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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
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I HISPEOIDII LHll
726- 3769 .
(name)
Phone
(address)
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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~
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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:
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PERMIT VALIDATION
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BG~( 00
L( -d,Lf- ~ 1
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Permit Clerk
CL
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
~
date
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