HomeMy WebLinkAboutPermit Plumbing 1988-5-11
INFORllATION LINt:.
726-3753
Sq. Ftg. r.1a i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Range --Fence Demo Change/Use
Val UE of Hork~ b1) D Other----
Buildinq Permit Info: Descrlbe Work(i'.e., Build Single
Family Residence With Attached Garaqe)
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LI,NSPECTION LINE
726-37(-;') .
Job Address
537
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
l~ater Heater
jTempOrary Construction
IChange in existing
residence
Imu1tifami1y, comm. or
Industrial
10f amps~
ICOMM./IND. FEEDERS I
/Install/alter/relocate I
distrib. feeders
IOf amp~1
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1 I I I
TOTAL CHARGES / ':;-:oPbl TOTAL CHARGES TOTAL CHARGES
WHERE STATE L!\\~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion'of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
Legal Description 17-C~'':l?-Y'''31 c:> $""2'--?->
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ownerUk Fuif l~
Add;:.9~ lf1q- O~ .
c~ende~;'P- Vtltp.. ~)
Phone
Address
DES I GN TEAt~
(name)
Phone
(address)
Primary
Structural
Electrical
, Mechanical
CONTRACTORS
~~ (name) ~ ___ r (address)
bA- If flr,J-fl it/j/11 ~
{L11/tJ-- (1u4v}y~
General
P1umbinq
Electrical
~lechanical
PLUt1BI NG
ELECTRICAL
NO. '
FEE CHARGE NO.
'2
Each single fixture
~u~fir' ~/ A!b'A~
'Relocated building
(new fix. additional)
Residence of
7,.9> I$~
SQ. FT.
New circuits a1ts.
or extensions
IS.F. Residence
(1 bath)
IDuPlex (1 bath)
IAdditiona1 bath
IHater service
I Sewer
each
I SERVICES
I
Storm Sewer
~
~
,~
(1 ics. no.)
(exDires)
(Dhone no.)
j "}'-\
, '1/
~/\ "
(lies. no.)
~- ~
~xDires) (ohone no. )
( t f 1- ;;).K t/ / )
~ ~
MECHANICAL
FFF rHARGF NO.
FFF rHARGF t
furnace/burner to
BTlI's
Floor fu rnace
and vent
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I.
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Recessed wall
Soace heater and vent
I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
I Vent system apart from I
heating or A.C.
I Mechanical exhaust I
hood and duct
11'lood stove/heater I
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ISSUANCE OF PFRr11T
I HAVE CAREFULLY EXAt1INED the completed application for permit, and do hereby certify that all information hereon is'true --1
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 NO OCCUPAriCY 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 ORS 701.055 wi1 be used on this project.
rW1E(p1ease print) J)+(! IM}--l d ~ P L!!-,
SIGNATURE
FOR OFFICE USE
DATES-I/ -at(
/"
Zone <:: L:..
Fire Zone
Flood Plain
TYDe/Const. ~~~~nits
Bedrooms Occy Load
Stories / Occy Group .21- 2
Sq. Ftg. t1a in /y?e::s fA
Sq. Ftg. Access
Sq. Ftg. Other
x
x
x
Value -::::::z~~
Value
Value
o {{ -;;J.fc -~f .
~~~~~~~Ga~~R~1IT ____3':3:~~_ ~~~~B~~~ ~~~~~~ ~ I. (~ lJ3!lJ
Surcharges ') / ./ Plan Ck. Res '
. fa 3' ,30%/B1 dq Per Fee
PLU11BING PERMIT / ~- I Fence I
~~~~~:~g=~d 5' ----.{L2~~7?1 D6mo I
ELECTRICJl,L PERrHT ISidewa1 k I
Cha,rges and ----------__
Surc~arg,~~ ' . _ ' ' ,j-~/c Pavin,go I
t1ECHANICAL PERMIT ~ "',1 Curb Cut . I
Charges and ____________
Surcharges I I
TOTAL VALUATION
Systems Development
Charge (1.51,) ,
//:4.
I
I
I
I Tpta.l Comb,. Permi t, '
I TOTAL
.,~~
f/'9. 88.1
. ~ ""' k.'~ w.~-
-'
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
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/electricalior 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 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 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 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:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Boar~ because:
Additional Project Information:
PLANS REVIEWED BY:
name -L&>~&E.'7t c-~~
signature
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