HomeMy WebLinkAboutPermit Plumbing 1985-5-10
IIIISPECTIOII LItlE
726-3769
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Job Address
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CITY Of SPRINGfiELD
COMBliIATION APPLICATION/PERMIT
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E!IERGY SOURCES:
Heat
l~ater Heater
Owner ill""" J L..J~
Address /4,." It':" , A' 'i.--Q.
construct~J~:? (f) f!
Ranqe
ValuE of Hod:.:
INFORllATlON L!:il:.
726-37S3
Sq, Ftq, 1.la i n
~q. Ftg. Access.
Sq. Ftg, Other
r~ew Add Alter P.ep.
-Fence Demo Change/Use
Other- -
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V)
00
Legal De$cr;ption
Phone ?'17'?'5Z.
BuilcilnQ Penllit Info: Describe Work(Le.. Build Single
Familv nesidence With Attached r,araQ~)
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Address
DI:.SUjN TEAr1
(name)
Phone
{address 1
(1 ics. no.)
(eXD; res)
{ohone no. i
Primary
Structura 1
El ectr; ca 1
Mechanical
CONTRACTORS
(name)
(address)
(l ies. no.
(exo;res)
(nhonp no.)
Genera 1
Plumbino }lh"'jz cJ:L~(dJ1~i
ElectricaV
IL-"s/CD
--Ad.O () .
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~:""'olD
3/JJhl.D
~'echanical
PLUIIB I NG
ELECTRICAL
MECHANICAL
SQ. FT.
furnace/burner to
BrU's
F'F'F fHAf./r,F ~
tlo.
FEF CHARr,F NO
~FF fHARr,F NO.
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence .;.'
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Soaee heater and vpnt
Storm Sewer
Of
amps.
App 1i ance \lent
seoarate
Stationary e\lap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinQ or A.C.
Mechanical exhaust
hnnrl and rllH":t.
Additional bath
Sewer
Temporary Construction
Change in existing
rp,?idcnce
multifamily, comm. or
lnrlustrial
\>/ater servi ce
a,M~~''i,
10.00
COMI.!. IINO. FEEDERS
Install/alter/relocate
rl;c;trih. fppdprc;
Wood stove/heater
Of
amps. I
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
10.00 TOTAL CHARGES
that tile Electrical work be done by an,
label has been signed by an Electrical
ISSUANCf OF PFRtIlT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM11NED the completed application for permit, and do hereby certify that all information hereon ;s 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 rm OCCUPArKY will be made
of any structure without the permission of the ~uildin9 Oivision. 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 ;s noted hereon, and that
only subcontractors and employees who are in cornDliance with QRS 7nl.055 will be used on this Droject.
HArIE(please printl-IS';:::l ~h 1/ JI Z<.-7J 1'eA./ SIGIIATURm~ ~m$,-/tJ..?S
'FOR OFFICE I1SR OIJI YI v
S~:'h<( Ilain
Sq. Ft!J. Access
Sq. Ftg. Other
Zone
Fire Zone
Tyoe/Const.
Bedrooms
Units
Occy load
Occy Group
x
Value
Value
Value
x
Flood Plain
Stories
x
TOTAL VALUATION
BUILDING PERHIT
Charges and
Surcharges
. Plan Ck.
____________ 6S%/Bldo
Plan Ck.
30%/Bldo
I Fence
I DfJRlo
I Sidewalk
I Ale Paving
ConmlInd
Ppr Fpp
Res
Per Fee
Isystems Development
Cha roe (1. S1,)
I
I
I
I
ITotal Comb. rermit
I TOTAL
IO.'~D
PLU'1BING PERMIT
Charges and
Surcharges
___L0..:p_Q___
, C(O
ELECTRICAL PERI:lT
Charges and
Surcharges
11ECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
.
,
..
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Legal Description
1. exa~Ele- Tax lot 100. Lane County Map Reference
17 UJ 4"
2. examole- lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilinq/or forced air Qas
2. example- waterheaterjelectrlcal/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 addition,
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 TEM1 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.
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
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,~ authorized
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be used a5
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.
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.
II.
I I I.
IV.
v.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
'1
PERMIT VALIDATION
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Permit Clerk
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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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