HomeMy WebLinkAboutPermit Plumbing 1984-12-18
I INSPECTION LINE
, , 726-3769
Job Address
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
owner~' cl-,' ~f' X-~,' '~0-\-{) ,
, Address \. ~ \ 0 t-> LL) _ l't Jt\ll f\.n \ dfje
J.GK ; '14 rtY\~::1.4 '
Range
ValuE of Hork:
INFORl1ATION liNt
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Legal Description
Buildinq Permit Info: Describe Hork( Le., Build Single
Family Residence Hith Attached Garage)
Address
DES I GN TEAf.1
{name} ,
Phone
(address)
A.Q.~Q[)rn;t:(J,~)~
.1- f) ( YYUo. \,AJU) fLGe;
(lies. n1. i (exoires)
l
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
"'-.,
, (name)
-""
(address)
(1 i cs. no.)
(exoires)
(ohone no. )
General
Plumbinq
Electrical
~1echanicalIrj-WCU""
~1)1JL 1-'
PLur1B I NG
ELECTRICAL
MECHANICAL
NO. I
Each single fixture
I FEE I CHARGE NO, I I FFF I rHAR(;F NO. I
Res i dence of furnace/burner to
SQ. FT. BTll' s
I FFF I rHARGF
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath)
IAdditional bath
~Iater servi ce
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
SaneR heatpr and vpnt
each
Sewer
Temporary Construction
IChange in existing
residence '
Imultifamily,'comm'. or
Industrial
10f
ICOMr1./IND. FEEDERS
Install/alter/relocate
distrib. feeders
amps.
Appliance vent
seoarate
Stationarv evao.
cooler' ,
Vent fan with
sinole duct
I Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and duct
I Hood stove/heater
I
I
I
I
I
I
I
I
I. _
I IV,Ol
TOTAL CHARGES /0.00 TOTAL CHARGES
WHERE STATE LAH REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an El'ectrical
I Storm Sewer
I
I I
1 Qro~J.L
-'EJ.Lluw,
Of
amps.
\.l<<\~ ~
UJ 10l'M)
I .J,R1)(~
I -
ISSUANCE OF PFRrHT
/().aJ
TOTAL CHARGES
I HAVE CAREFULLY EXA~1INED 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 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 NO OCCUPAliCY will be made
of any structure without the permiss'ion of the Building Division. I further certify that my registration vlith 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.
IJ, 1~eA-P S"NATU~_pR 0Q-.-^-
FOR OFFICE USE ONLY
Electrical Contractor, the electrical portion of this permit I"
Supervisor and returned to the Building Division
:NAME(please print)
I
1-eJ)
DATE/?-//6'/~ '
I
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
Sq. Ftg. r1ain
Sq. Ftc]. Access
Sq. Ftg. Other
x
x
Value
Value
Va I ue
x
TOTAL VALUATION
PLUI1BING PERMIT
Charges and
Surcha rges
l:- 00
----9to
__f~~
Plan Ck.
65%/Bldo
Plan Ck.
30%/Bldq
,I Fence
I D!]R1o
!Sidewal k
I A/C Pavi ng
I Curb Cut
I
Comm/Ind
Per Fee
Res
Per Fee
I Systems, Development
Charge (1.5%) ",
I
I
I
I
BUILDING PERNIT
Charges and
Surcharges
ELECTR I CJl.L PERr~IT
Charges and
Surcharges
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
I TOTAL
({f) gO
I
COMBINATION APPLICATION/PERMIT (CAP)
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
t. ' Name, etc. of owner and construction lender
D. Energy Sources '
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square {ootage 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
O. 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 d~e and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
PERMIT VAll DATION
~,. \~I~{
{p '-to \ <0
Permit Clerk~~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date