HomeMy WebLinkAboutPermit Plumbing 1990-8-17
'.
DZr? L/q 59
Eureka. Ca1. 95501
Phone 707
445-9601
INFORf1ATION LINt
726-3753
Sq. Ftg. f'lain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter Rep.
Range -Fence Demo Change/Use
ValuE of Work: -Other- -
$12,000 'L -G
BulldinQ Permit Info: Describe Work(!.e., Build Single.... 1\.' ._J
Family nesidence With Attached Garaqe) ~
Construct new driveway access to
'1 INSPECTION LiNE
726-3769
Job Address
663 W. Centennial Blvd. .
Legal Description 17-03-27-43 Ds <;5()C)
CITY OF SPRINGFIELD
Cm1BINATION APPLiCATION/PERMIT
EflERGY SOURCES:
Heat
Water Heater
Tax Lot 585
Owner Fravcis Rea1tv. Inc.
Address P.O. Box 1328
Construction Lender
center from Centennial R1 wL
Address
DESIGN TEAM (name)
Primary Branch EnQ'ineerinQ
Phone
(address)
(lics.no.l
(expires)
(phone no. I
Structural
212 '0' St.
Spfld. OR
P.E.
8450
746 -,0637
Electrical
Mechanical
CONTRACTORS
(name)
(address'
11 ics. no.)
Cexoiresl
(phone no. )
General
Plumbina
Electrical
~'echani ca 1
PLUf1BING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
~FF r.HARr.F NO,
I FFE CHARliF
SQ. FT.
furnace/burner to
BW's
Each single fixture
Residence of
I Relocated building
(new fix. additional)
New circuits alts.
or extensions
Fl oor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Space heatpr and vent
amps,
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatinQ or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re~idence
multifamily, comm. or
Industrial
Additional bath
~Ia ter serv ice
,
'\~ Storm Sewer
20 .;H-;-OO
Of
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps,
ISSUANCE OF PFRrlIT
TOTAL CHARGES -::?~. _.t> TOTAL CHARGES TOTAL CHARGES
WHERE STATE U\W REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAmNED the completed appl ication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed 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 HO OCCUPAflCY will be made
of any structure without the permission of the Building Division. I further certify that my registration ~lith 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 701.055 will be used on this project.
NAt'lE( please pri nt) .:k.V\!>
S... ....J
SIGNATURE ~ 12..
FOP. OfFICE USE or~d j
v
Sq . F t g. ria i n x
Sq. Ftc]. Access x
Sq. Ftg. Other b W.#~ x
m i(lJ ~''!Jq () #-(714tJ.JAL VALUATION
,- ' Systems DeVelopment
f,JLJ ~ Charge (1. 5';)
DATE 3 - 1- '10
Zone~
Fire lone
Flood Plain
Type/Const.~I~~units
Bedrooms ' Occy Load
Stories Occy Group"
Value
Value
Value/2 _t:..-- '--'
,
BUILDING PER~1IT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65%/Blda Per Fee
Plan Ck. Res
30X/Bldq Per Fee
PLur~B ING PERMIT
Charges and
Surcha rges
____ ZQ...QQ____
1.00
Fence
D6mo
ELECTRICAL PERfm,Sldewalk
Charges and - --- -- --- ---
Surcha rges A/C Pa vi ng
92.50
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
II~.~C)
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 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 n~ed 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 b~ 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.
,j
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V. FOR OFFICE USE ONLY
Permit' Clerk
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0&~Mte1': \-1-~O /:
~~ In" ~ \ eJ1Y
~_\)\(l.l! IJ.,___~ 1 ~A
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applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name L.::,/f#~ 7} ,JCC~/'i' Signatur;e~,~
~ date JJg-/7-~C>