HomeMy WebLinkAboutPermit Plumbing 1986-1-29
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I I SSUANCE OF PFRr1IT
I TOTAL CHARGES
Contractor, the electrical portion, of this permit
and returned tQ the Building Divisio~
\l"-'-;d~
'INSPECTION LINE
726-3769 '
Job Address 3:;2 ft;
I NFORl1ATION LJ Nc
726-3753
Sq. Ftc). f.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
Legal Description
CITY OF SPRINGFIELD
CDr1BINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
~nA.oJ}
Owner ,~C~ flkcf~
Address 3..."> to ~. ~ '
~;[tJ rrf
Phone 12 h-
3;;; 7'1"
Range
ValuE of Hork:
Construction Lender
Buildina Permit Info: Describe Hork(i'.e., Build Single
Family Residence With Attached Garaae)
!0t!(i;~~ d,fr>1I-1V
n7A~
"-lr
Address
DESIGN TEAr1.
Phone
(address)
(name)
(lics. no.)
(exoires)
Primary
Structural
i Electrical
; Mechani ca 1
, CONTRACTORS
(name)
(address)
(lics. 'no.)
(exoires)' ','
General
Plumbina
~unIAJ
; Electrical
, ~lechanical
PLUf1BING
ELECTRICAL
MECHANICAL
NO.
I' FEE CHARGE NO,
FFF r.HARGF NO.
Each single fixture
Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated building
(new fix, additional)
, Is.F. Residence
(1 bath)
I Duplex (1 bath)
IAddii:ion~l bath
,I ~later servi ce
New circuits alts.
or extensions
Floor furnace
and vent
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TOTAL CHARGES
HHERE STATE L~W REQUIRES
shall not be valid until the
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I; I ITemporary-construction
I' '/ IChange in existing
residence
,',' I I multifamily, comm. or
Industrial
I', 1 I Of ' amps.1
I, (S I 00 I COt~r,1. II ND. FEEDERS I
I " I Install/alter/relocate I
distrib. feeders
I I~o ,IOf amps.1
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I s; too I TOTAL CHARGES
that the El ectrica 1 work be done, byan,El ectri ca 1
label has been signed by an Electrical Supervisor
ISERVICES
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LlO( c>
I Reces sed wa 11
Soace heater and
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'I App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
'I Vent' system apart from I
heatina or A.C. '
I Mechanical exhaust
hood and duct
I Hood stove/heater
vent ,I
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each
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Sewer
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Storm Sewer
'1"1~ fu~
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--
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-....
(ohone no:)
(ohone no. )
I FFFI r.HARGF
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I HAVE CAREFULLY EXNlINED 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 \~ork performed shall be done in accordance with the Ordinances of the City
of Springfield.and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAr~CY wi'l be made
of any structure without the permission of the Building Division. I further certify that my registration ~Jith 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.
NAI.1E(please print) -fIOWf\ R D M~'r-r;-o rJ SIGNATURE~./~ ~ DATEI-29- ~h
FOr. OFFICE USE Oi~L Y L
Zone
Fi re Zone '
Flood Plain
Tyoe/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
Sq. Ftg. t1a i n
Sq. Ftc]. Access
Sq. Ftg. Other
'x
x
Value
Value
Value
x
"
TOTAL VALUATlmJ
BUILDING PER~lIT
Charges and
Surcharges
Plan Ck.
~___________ 65%/Blda
Plan Ck.
, 30%/131 da
/5. ()t? I Fence
--------~~o-I D6mo
I'Sidewal k
I A/C Paving
I Curb Cut
I
/ r;;; to ()
CommlInd
Per Fee
Res
Per Fee
ISyste,ms Development '
Charqe (1.S%)
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ITotal Comb. Permit
[ TOTAl
PLur~BING PERMIT
Cha rges and
Surcharges
ELECTRICJl.L PERrm
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
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 1. Block 3, 2nd Addition to
Springfield Estates
C. Name~ etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceiling/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 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 singl~ 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 si,te
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 schedul es
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 ~s ,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 ~nd charges are due and
payable when the permit is issued.
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V. FOR OFFICE USE ONLY
Permit Clerk
ev
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt 'from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
name
signature
date