HomeMy WebLinkAboutPermit Plumbing 1985-12-9
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I IrISPECTION LlIIE
726-3769
Job Address
Legal Description
Owner
Address 70,;(
Construction Lender
Address
UI:.SIGN II:.Ar~
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
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Plumb;no
Electrical
"lechanical
NO,
Each single fixture
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(name)
(name)
PLUIIBING
Relocated building
(new fix, additional)
S.F. Residence
(l bath I
Duplex (1 bath) each
Additional bath
~Iater service ~[f
Sewer
Storm Sewer
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CITY Uf SPRINGFIELD ~
COMBINATION APPLICATIONfPERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
Range
ValuE of Hark.:
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INFORlIATION UNt
726-3753
Sq, Ftg, I,'a i n
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter P.ep,
-Fence Demo Change/Use
Other- -
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Builciina Pennit Info: Describe Work.(Le.. Build Single
Family nesidence With Attached Garaae)
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Phone
(address)
(lics. no.)
(exoires)
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(address)
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ELECTRICAL
MECHANICAL
FEE r.HARGF Nn I
I-Residence of
SQ, FT,
INew circuits alts.
or extensions .
I SERVICES
I
~H I nlARh~ Nn_ I ~~~ rl-lARh~
furnace/burner to
BTU's ,/
Floor furnace
and vent
Recessed wall I
~o~rp hp~tpr nnrl vpnt
II) rJtJ
!TempOrary Construction
IChange in existing
rP'l j <1pn('p
Imultifamily, COl11T1. or
Inrlu<;tr;~l
IOf amps.
lCOMM,fINO, FEEDERS
I Install/alter/relocate
rl;c;trih. fppdprc;
jOf amp~
Appliance vent
SeD!lrate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent sys tern apa rt from I
heatina or A.C.
Mechanical exhaust
hnnd and durt
Wood stove/heater
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ISSUANCe OF PFRf1IT
TOTAL CHARGES ;.-:( 60 I TOTAL CHARGES I 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 valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 OCCUPAHCY 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 ORS 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.
SIGNATURE ~:P/~LA
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NAME(please print)
kOB8?-r ~H-EREI2'
DATE
FOr. OFFICE USE, DIlL V
Zone Type/Const. Units Sq, Ftg, t1ain
Fire Zone Bedrooms Occy Load Sq, Ft9. Access
Flood Plain Stories Occy Group Sq, Ftg, Other
BUILOING PERfllT
Charges an~
Surcharges
PLUI1BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERI:IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Value
Value
Value
x
x
x
TOTAL VALUATION
, Plan Ck, COIlIDf!nd
65%/81 do PI'''''' l=03p
------------ Plan Ck. Res
30%fBldo Per Fee
______~~_ Fence
.60 D6mo
'Sldewa 1 k
'Systems Development '
Charoe (1,5%) "
A/C Paving
____________1 Curb Cut
I
Total Comb. Permit
I
I TOTAL
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.
.
c.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Add'ress
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II oj 43
2. examele- lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources ~
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electnca (lor solar
E. Square footage or valuation, etc.
1. examele- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. checklruew - if addition,
cfleck add. etc.
F. .Building permit information:
1. example - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family room
3. exam~le - 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 schedules
C, BUILOING 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
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. All 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