HomeMy WebLinkAboutPermit Plumbing 1985-8-1
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CITY OF SPRINGFIELD
COMBINATION,APPLICATION/PERMIT
-'f-- - . --n-:-' . - . cJ) . ErIERGY SOURCES:
~y11 Heat
t~ater Heater
Range
I INSPECTION LINE
726-3769
Job Address lto d... I
Legal Description
NFORl1ATlON u,
726-3753
Sq. Ftg. r.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other - -
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\'1 O~?~t) ~L\ ~~1 ~r- ValUE of I-lork:
Owner rQA~VlUJ) V-Jt1~ )~llSJ Jrt___~
Address \ ~ ~ I rnK\1 O'Ah \1 f () f) Phone L/gq~ ~~~~~~nHe~~~~~e Inf~~
7:2L(to -J)A~
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Construction Lender
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Describe Work(i,e., Build Single
Attached GaraGe)
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Address Phone -I.
DESIGN TEAt~ (name) (address) (Tics. no. ) (exllires) (ohone no. \
Primary
Structural
Electrical
Mechanical
CONTRACTORS (name) (address) (]ics. no.) (exoires) (ohone no.)
General
Plumbinq Clh,~ ~~ 35!"d -:3 ( .:<.~ 3 ~ 8S'
'-'-
Electrical
~lechani ca 1
PLU/1BING
NO.
Each single fixture
Relocated building
(new fix. additional)
IS.F. Residence
(] bath)
IDuPlex (1 bath) each
IAdditional bath
IHater service
I Sewer
IStorm Sewer
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I ~evd='-flo L0 I
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TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
I FEE CHARGE NO.
ELECTRICAL
Residence of
SQ. FT.
New circuits alts.
or extensions
SERVICES
MECHANICAL
FFF I rHAR(;F' NO.
FFF rHAR(;F
furnace/burner to
BTU's
Floor furnace
and vent
1-
I Recessed wall
Soace heater and vent
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Itll 00
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I Apo 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinoleduct
I Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and duct
I Hood stove/heater
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ISSUANCE OF PFRMIT
I TOTAL CHARGES
ITempOrary Construction
Change in existing
residence
multifamily, comm. or
Industrial
IOf amps~
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders
10f amp~1
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10 ,~ J TOTAL CHARGES
that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAt1INED the campleted applicatian for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed 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 OCCUPANCY will be made
of any structure without the permission of the Building Divisian. I further certify that my registration with the Builder's
Baard is in full force and effect as required by ORS 701.055, that if exempt.the basis far exemption is noted hereon, and that
only subcontractors and employees who. are in comoliance with OP.S 701.055 will be used on this project.
rm.1E(please print) A U Gu S\
SIGNATURE,,^(l.,(4A/~ / 4..........-
FOP. OFFICE USE QijL Y 1/ I
So. Ftg. 11ain x
Sq. Ftg. Access x
Sq. Ftg. Other x
F\ RPS,
Plan Ck.
65%/Bldq
Plan Ck.
_ 30%/Bl dq
It)~ DO I Fence
--------~LlD-1 D6mo
____________, Sidewalk
I A/C Paving
I Curb Cut
------------1,
Zane
Fire Zane
Fload Plain
Tyoe/Const.
Bedrooms
Stori es
BUILDING PER~1IT
Charges and
Surcharges
PLU~~BING PERMIT
Cha rges and
Surcha rges
ELECTRICJl,L PER/HI
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Units
Occy Load
Occy Graup
Comm/Ind
Per Fee
Res
Per Fee
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DATE 'X"-l- ?.s-
Value
Value
Value
TOTAL VALUATION
Systems Development I
Cha rg€ (1. 5%)
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!Total Comb. rermit
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I TOTAL
lo-:tfo
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 I. Black 3, 2nd Addition to.
Springfield Estates
C. Name, etc. of owner and constructian lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage ar valuation, etc.
1. example- 1250 sq. faot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit informatian:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family roam
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 af the Mechanical and Electrical Schedules,
the applicant need fill-in anly the No. Boxes adjacent
to. the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Divisian
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to. be installed are nat covered an
the abbreviated schedules you should cansult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As nated on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general cantractor is ,not authorized
to. sign the electrical label. ---
III. Applicant to sign and date
Whenever passible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written capy 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 af 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
signature
date