HomeMy WebLinkAboutPermit Plumbing 1985-3-15
I INSPECTION LINE
726-3769
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CITY Uf SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
t~ater Heater
~
INFORflATION L"t
726-37S3
Sq. Ftq. r.lain
~q. Ftg. Access.
Sq. Ft9. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
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Job Address
CfYb ~ '/}_'
Description \I~?l~ ' 6()\cx)
RaMe
Valu€ of 1.lark:
Legal
Owner /}.I~ ~ t&.
Address (;9<::: ~ '/J_(
constru~R~ -IfJrf O)Q 971-/7 7
7..;7(" -/(/-;/
Phone
BuilGinQ Permit Info: Describe Workl;~e.. Build Single
Famil y l1esidence Hi th ,A,ttached Gara<}e)
J~d~~AJ/ ;;rk.JZ
~A -/1/i!,,"7 dj}-",~
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Address
UI:S I liN II:.Ar.,
(name)
Phone
(address)
(1 ics. no.)
(exoires)
(ohone no. I
Primary
Structural
Electrical
f1echanical
CONTRACTORS
(name}
(address)
(1 ;r.~. no.)
(pxoirf":;')
(ohone no.)
Genera 1
Plumbina,!-frJ/UI /J Ofj -
Electrical
(j)a.d:/g L/IOJ.. ~~>>~A- I.MdiEdtlUf,0!Zt)7cJo3 7db-76d3J ~
/
~1echani ca 1
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FFf CHARGE Nn
~FF fHARhF tlO_
FH fHAR(;F
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath]
Duplex (1 bath) each
New circuits alts.
or extensions
Floor fu rnace
and vent
SERVICES
Recessed wall
~n~r~ npntpr nnrl vpnt
Storm Sewer
:? f5acllfJow ~CW /~
Of
COMH./INO. FEEDERS
Install/alter/relocate
rlic;trih fppdprc;
amps,
Apo 11 ance vent
"eoarate
Stationary evap.
cooler
Vent fan with
~innlp duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
nnnrl nnrl duc-t.
Additional bath
Sewer
Temporary Construction
Change 1n existing
rfl,?id_enc-p
multifamily, comm. or
TndlJ"t.riill
~Iater service
Wood stove/heater
Of
amps.
ISSUANCE OF PFR'IIT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
,-1,; -
/0, ./'. TOTAL CHARGES , 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 EXM1INED 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 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 NO OCCUPArlCY 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 this project.
Zone
Fire Zone
Flood Plain
Tvoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
5 IGrIATURE vir ..('1...".')-]11$..
FO~ OFFICE USE DIlLY
Sq. Ftg. f1ain
Sq. Ftg. Access
Sq. Ftg. Other
DATE 3//SJsS-- .'
I
IWIE(please print) 7J.1om4S iJ1 ((;.jA$5 0/1/'
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfllT I Plan Ck. Conm/! nd
Charges and ------------ 65%/Blda Ppr Fee
Surcharges Plan Ck. Res
30%/Blda Per Fee
PLU'1BING PERMIT JS:::o-e. Fence
Charges and -------'- ----
Surcharges 100 D~R1o
ELECTRICP.L PERlilT S1dewal k
Charges and ------------
Surcharges A/C Paving
I1ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development I
Charqe (1.5~)
Total Comb. rermit
TOTAL ) j~ f!-
JiS'-~
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COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. example~ Tax Lot 100. Lane County Map Reference
17 U3 43
2. examp'le- Lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or 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.
cneck add. etc.
F. Building permit information:
1. example - construct single family house with an
attached gara.ge
2. exam~le - remodel existing garage into family foom
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. 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 ltem{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 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.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-
.
f(# Z~I~ ;IDATION
fJ ~);Jjl r
I
Permit C1 erk
4J#
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date