HomeMy WebLinkAboutPermit Plumbing 1981-7-6
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INSPECTlO'N LINE
726-3769
CITY O'F SPRINGFIELD
CO'MBINATIO'N APPlICATlO'N/PERMIT
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Job Address 1+~6 --- C~A/7eA/AJ/;e; L
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Legal Description __
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O'wner~.D. noL_
Address/4.26 -- CeNT )3L 1/.lJ
n X (Y)C)
ENERGY SCURCES:
Heat
Water Heater
Range
Value of Work:
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INFO'RMATlO'N LINE
726-3753
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Sq. Ftg. Main
Sq. Ftg. Access.
Sq. r-tg. Cther
_New_Add_Alter_Rep.
_Fence_Demo_Change / Use
_Cther
'7/// rh/ ""3 Building Pe.rmit Info: Describe Work (i.e., Build Single
..... Phone/Tb-7~V F,amily Residence With Attached Garage)
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Construction Lender
Address
DESIGN TEAM
(nome)
Primary
Structural
Electrical
Mechanical
CCNTRACTCRS
(nome)
General
y.. Plumbing
/J;,/h~ /LIB;e.
Electrical
Mechanical
PLUMBING
NO'. I
FEE
, CHARGE
Each single fixture'
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
Duplex (1 both) each
Additional both
Water service
Sewer
Storm Sewer
I
TCTAL CHARGES ;f...0 k'c #.emjl-,
Phone
(address)
(address)
NO'. '
Residence of .
'q, ft.
New circuits, alterations
or extensions
SERVICES
\
Temporary Construction
Amps.
FEEDERS
Amps.
TCT AL CHARGES
(lies. no.)
.',
(lies. no.)
...,
ELECTRICAL
FEE
'CHARGE
(expires)
(phone no.)
~
~
~
~
~
FEE
I CHARGE
I
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I
I
I
I
I
I
I
I
I
I
I
(expires)
(phone no.)
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFUllY. EXAMIN'E'D the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I fur.ther
certify that any and 011 work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Cregan
pertaining to the work described herin. and that NO' CCCUPANCY will be mode 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 0 s required by ORS 701.055. that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with CRS 701.055 will be used on this project. '
Basis for Builder's Boord exemption:
X NAME (please Print,2::>..ezM A J)~ J3o,L'
Zonp
Fire Zone
Flood Plain
Type/ Const.
Bedrooms
c\'torip..,
BUILDING PERMIT
Charges ond
Surcharges
PLUMBING PERMIT
Charges and
Surcharges
elECTRICAL PERMIT
Charges and
Surcharges
I
I
I
---------,
MECHANICAL PERMIT
Charges and
Surcharges
"IGNATURE
FO'R O'FFICE USE O'NLY
'Inits
Occy Load
Occy Group
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per Fee
Fence
Demo
Sidewalk
A/C Pavin!!
Curb Cut
"q. Ftg. Main
c;q. Ftg. Accesr
Sq. Ftg. Other
'-
MECHANICAL
NO'.
furnace/burner to
BTU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
, Wood stove/heater
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000. CFM
ISSUANCE O'F PERMIT
TOTAL CHARGES
DATE7~g/
,/ ,/ ,
'(
Value
"clue
Value
x
'(
TCTAL VALUATICN
Systems Development
Charae (1.5%)
.1 Total Comb. Permit
I
I
I
I TCT AL
COMBINATION APPLICATION/PER^,- (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
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. examp,le-water heater/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 (0) 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 abbrevi-
ated schedules you should consult the full schedules
C. BUilDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
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 typewritten 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:
Additional Project Information:
PLANS REVIEWED BY:
namp
~ignaturf"
......
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....
lERMIT VALIDATION
Permit Clerk
date