HomeMy WebLinkAboutPermit Plumbing 1987-12-5 (2)
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II INSPECTION LINE
q 726-3769
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CITY OF SPRINGFIELD. INFORl1ATION LINt
CDr1BINATION APPLICATION/PERMIT 726-3753
E!IERGY SOURCES: Sq. Ftg. I-lain
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
Ilew Add A Her P.ep.
Ranqe --Fence Demo Change/Use
V~Uw:\'J~~ Other- -
BU'lriino Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaoe)
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Legal Oe5cription /~_3~..:?:<...... .,:s.;;?_~
Job Address
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Owner p~<,- ~.7)~. r:~
Address gsB~S-) /:.z::. 57":
Ec-'?.i&;"?"C:; b/? _ 4~4"~
lhone ~
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Construction lender
Address
[)1:.~lliN H.Ar~
{namel
Phone
(address)
(l ics. no.)
(exn; res 1
(ohone no. I
Primary
Structural
c.., ,,/)
~?r')) - l~""
Electrical
Mechanical
CONTRACTORS
(namel
(address)
(l irs. nn.)
(pxnirpc:.'
(ohnnp nn.)
General
Plumbino?&"MS&,"7 ~~E .::::::...;. kc....
, Electrical
~'echani ca 1
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PLUI-1BING
ELECTRICAL
MECHANICAL
NO. -
Each single fixture
FEE r.HARr;F NO ~H' rl-IARr::r: NO.
Residence of furnace/burner to
SQ. FT. BTU's
~~~ I nIARr.~
I
Relocated building
(new fix. additional)
S.F. Residence
(] bathl
Duplex (1 bath) each
New circuits alts.
or extensions
Floor fu rnace
and vent
SERVICES
Recessed wall
Sn~~p hp~tp~ ~nn v~nt
Storm Sewer
Of
amps.
App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Additional bath
Sewer
Temporary Construction
Change in existing
rF'<;,;d~Jlc~
multifamily, comm. or
Tndu<;trial
~Iater servi ce
r:~F~-f2.~y.,~-.
COMM./INO. FEEDERS
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valij until the
I Install/alter/relocate
rtic;trih_ fM.rtprc;
IOf
I
I
I
?,. '5-=- --"'-. TOTAL CHARGES
that the Electrical work be done by an,:Electrical
label has been signed by an Electrical Supervisor
Wood stove/heater
amps.
I SSUANCf OF PFRr1IT
. TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 Derformed 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 OCCUPArKY 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 OP.S 7Q1.055 ~l be used on this proje~
NAI-IE(please print)~/A1 j j /l/"" /s'-'N_fhN 6" SIGII^TURE NJ.-6'v0,;t; ~ DATEP ~-?;:;
FO~ OFFICE USE DilLY (/
Sq. Ftg. t1ain x
Sq. Ftg. Access x
Sq. Ftg. Other x
Zone
Fire Zone
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Value
Value
Value
Flood Plain
TOT^L VALUATION
BUILDING PERfllT
Charges and
Surcharges
I Plan Ck. COlTll1/1nd
65%181 do PPf Fpp
------------ Plan Ck. Res
3D%!Bl do Per Fee
____t~C'"_j~- Fence
. 7~ O~mo
ISystems Development I
Charqe (J.5~)
PLUI1BING PERMIT
Charges and ~
Surcha rges
ELECTRICP.L PERI~IT -Sidewalk
Charges and ------------
Surcharges AIC Paving
Total Comb. Permit
11ECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAL
IS;;..)
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COMBINATION APPLICATION/PERMIT (CAP)
0'
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
II 03 43
2. examEle- lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinQ/or farced air Qas
2. examole- 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-nfw - if addition,
check add, etc.
f. Building permit information:
1. examole - 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. OESIGN TEAM ANO 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
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 lssued 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:
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PERMI1 VAlIDATION
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Permit Clerk
Permit applica.nt exempt from registOration with .the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
[~0'{/"C
Signature~~;~
, // . .
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~.:..:--? date
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