HomeMy WebLinkAboutPermit Plumbing 1985-4-9
j IIISPECTIOtl LIIIE
726-3769
.
CITY U, SPRlflGFIELO
COMBINATION APPLICATION/PERMIT
WERGY SOURCES:
Heat
Hater Heater
.
(name)
Phone
(address)
INFORfIATION l1Nt
726-37S3
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Ranqe~ ~'h;:~-- -Fence Demo Change/Use
ValuE of I./ork(:.)j-A '. . Other--
Builcilnq Permit Vnfe: Descrlbe Workl Le.. Build Single
Famil v l1es i dence IH th ......,ttached Ga rane)
r!J' \ J~n ('lrIJ ()( L ) ,
L] )Jl -0 J lVlll'(1JY\ (t? 1 )( f'f f)
\ l/
(lies. no.)
(exn; res)
~
I
I
\
no. )
Job Address
L\ Y S [11, 1\,,400 x,
legal Description
Owner \\ )\\0..l')\C\l I ~\Jffi\)(\lllJy
Address' C\ C\ ~ C"'f'-" .. r-:A "I;\-- ) \ Ph-;'n\j
CO:-~~i~~e~1 ,~ crn-r7 f)
Address
Ut::'lur~ Il:.Af1
(ohane
Primary
Structura 1
Electrical
t1echan;cal
CONTRACTORS
(name)
{addr~c;<; 1
(l ice;. nn.)
rpxo;re,,)
(ohonp no.)
Genera 1
Plumbin\' ~J\ ffif) U l. ^ - \ 1.')\ tTO > 0 ill
Electrical U
4\()ri. \;({i' t\ CO i 1\ ) l-\llY'l \ h fA .
IJIVI::" fJ!f7!l\c;
~1echaJ1ical
PLUIIBIIIG
ELECTRICAL
MECHANICAL
-1!Q...
FEF f.HARGE NO
~IT-..QiARG.E.. tIn
eEL LllARli.E.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
$.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
SnnCP hPntpr nnrl vpnt
Storm Sewer
.!1 U"'iY rr..j1 (){~I .
l'iJ^O t). log Q). l~cD f(),G. I
Of
amps.
App 1 i ance vent
seoariltp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.L
Mechanical exhaust
hood and duct
Additional bath
Sewer
Temporary Construction
IChange in existing
rP<1 i dr.ncp
Imultifamily, comm. or
Tnrlvstrinl
~/a ter servi ce
COMM./INO. FEEDERS
Install/alter/relocate
rli~tr;h_ fppdpr~
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L1W REQUIRES
shall not be va1i1 until the
I
I I SSUAtlCf OF PFR'lIT
!f) . OG I TOTAL CHARGES I TOTAL CHARGES
that -the Electrical work be done by an .Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED 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 Derformed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the Sta te of Oregon pertai n i ng to the work descri bed herei n. and that UO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard 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.
IW1E(please priW -n-!oJ1o'7A<1 3. m (r;;-~/l/SIGfjATURE ~ J Jrl't>@...aA-..
i\
om -I/7'k
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories.
FQR QFF~G: IISE DIlLY
Units Sq. Ftg. riain
Occy load Sq. Ftl]. Access
Occy Group Sq. Ftg. Other
x
x
x
Value
Value
Value
TOTAL VALUATION
BUILDING PER~lIT
Charges and
Surcharges
I Plan Ck. Comm/Ind
65%/Bldo PE'r I=~e
------------ Plan Ck. Res
30%/BldQ Per Fee
_JO_;..C!J__h Fence
. 40 Demo
----1
'Systems Development r
Char~e l1.5~)
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRlO.L PERI'.!T
Charges and
Surcharges
Sidewalk
------------1 A/C Paving
____________1 Curb Cut
I
ITotal Comb. rermit
: TOTAL J /0 .40-
I
11ECHANICAL PERMlT
Charges and
Surcharges
.
,
..
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ce;l;~or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 SQ. foot garage
2. example- if new project. check new - if additi.on,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted on the CAP. the labe1 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
..
.
PERMIT VALIDATION
~.\ C\ \ctCOS
~'(IJ0 \
19AA~~
~J ,,'oY
CJi\\~uJL~r
Permit Clerk
fh\~(l )
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date