HomeMy WebLinkAboutPermit Plumbing 1985-4-10
~ InSPECTION LInE
1726-3769
1NFORr1ATION u,~E ~I
726-3753
Sq Ftq Ilaln
~q Ctg Ac.cess
Sq Ftg Other
~ew Add Alter Dep
_Fence_Demo _Change/Use
Other
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Job Address rJ q 75 ~ aO
Legal De'iCnptlOn ~/Vt1d aurO'rKd~
r100~\a~)
Owne~ ~I-L ~ 3<1'1-3(,,07
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Address /5'77 l:J()-dd.a~ ~ U~h3l''P_o
CJ!C 97<(0/
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Ranqe
ValuE. of lIark
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BUllcllnQ Pernllt Info
Farnly nesldence \~lth
Descrlbe Work(l e , BUlld Slngle
~ttached Garaqe)
P -'-L4./ ....-t-c.1J ~
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Constructlon Lender
Address
UESIGN ILAf~
(name)
Phone
(address)
"L^d.fI~ ~~
~ OA~{d-r' l)L<~
(llCS no) (eXlJlres)
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(ohane no 1
Pnmary
Structural
El ectn ca 1
Mechamcal
CONTRACTORS
tname \
(address)
Illes no I
(PXDlfP<;)
(ohonp no )
Genera 1
Plumblna - ~-
Electncal
,
~lechanlcal
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO I
lEach slngle flxture
Relocated bUlldlng
(new flX addltlonal)
FFF \ CHflRGF Nn I
Res 1 dence of
~I="I=" 1 rl-1.llRf,1=" NO
I r:l="l=" I rl-lf.Q(::l="
SQ FT
furnace/burner to
BTU's
New clrcu1ts alts
or extens10ns
Floor furnace
and vent
S F Pes1dence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wa 11
SOnrp hentpr nnrl vpnt
laLlO
Of
COMII /INO FEEDERS
Install/alter/relocate
(11 c;trl h fppoprc;
amps
Apol1ance vent
seoarnte
Stat10narv evao
coo1er ~
Vent fan W1 th
slnale duct
Vent syste~ apart from
heat1na or A C
Mechan1cal exhaust
hood and dud.
Addlt10nal bath
~Ia ter serV1 ce
Temporary Construct1on
Change ln eX1st1ng
rpc; 1 dpnrp
multlfam1ly. comm or
Tnrlllc;trlnl
Sewer
Storm Sewer
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TOTAL CHARGES ;0 c/D TOTAL CHARGES
WHERE STATE L1\, REQUIRES that tile Electncal work be done by an
shall not be val1j unt1l the label has been slgned by an Electr1cal
~Jood stove/heater
Of
amps
,LID
ISSUANCE OF PFRI1lT
TOTAL CHARGES
E1ectr1cal Contractor, the electr1cal port1on of th1S pe~lt
Superv1sor and returned to the BU1ldlng D1vls1on
1 HAVE CAREFULLY DAmNED t1e completed apnllcat10n for fJermlt. and do hereby cert1fy that all 1nforPlat1on hereon 15 true
and correct. and I further cert1fy that any and all work performed shall be done 1n accordance w1th the Ord1nances of the Clty
of SOrlngfleld and the laws of the State of Drenan oertalmng to the work descrlbed here1n. and that 1m OCCUPArKY wlll be made
of any structure w1thout the permlSS10n of the GU1ldlng DlvlSlon I further cert1fy that my reqlstratlon w1th the BU1lder's
Board 1S 1n full force and effect as requlred by ORS 701 055. that 1f exempt the basls for exemptlon 1S noted hereon, and that
only subcontractors and e~ployees who are 1n comollance w1th OPS 7nl 055 w1l1 be used on th1S DrOJect
NAIIE(please pnnt) TVhVl 1-1. )VJ e rYI'~ SIrlMTURF ~ ;4. -__ 0/
Fan OFFICE
Dm ,-/-/ZJ-85
Zone
Fl re Zone
Flood Plaln
Tyoe/Const
Bedrooms
Stones
Um ts
Occy Load
OcCY Group
!JWOiJL Y
Sa Ft<l
Sq Ft9
Sq Ftg
f1aln
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERNIT
Charges and
Surcharges
l Plan Ck CorrmlInd
____________ 65%/B1r1(1 Ppr J:QP
Plan Ck Res
30%/Bl do Per Fee
/ Q - 0 0 I Fence
__h___qO---j 06ffiO
jSystens Development '
Cha roe (J 5')
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRIUL PERIHT
Charges and
Surcharges
Sidewalk
A/C Pavlng
I Tota 1 COfllb
Permlt
IIECHANICAL PEPMIT
Charges and
Surcharges
~__h_h__h
Curb Cut
I
I TOTAL
dI ._
)O.VD
"
- ,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,
II
Appllcant to furnlsh
A Job Address
B Legal Descrlptlon
1 example- Tax lot 100. Lane County Map Reference
1/ 03 43
2 example- Lot 1 Block 3, 2nd Addltlon to
Sprlngfleld Estates
C Name. etc of owner and constructlon lender
o Energy Sources
1 examole- heat/electrlcal ce111nqlor forced dlr qas
2 eXdmole- waterneater/electr1cal/or solar
E Square footage or valuatlon, etc -----
1 examDle- 1250 sq foot house, 500 sq foot garage
2 example- If'Ilew proJect, check-nfw - If add,tlon.
check add, etc
F BUlldlng permlt lnformatlon
1 example - construct slngle famlly house wlth an
attached garage
2 examole - remodel eXlstlng garage lnto famlly room
3 examole - convert slngle famlly resldence lnto
restaurant (change of use)
G Value of work as deflned In Sectlon 303 (a) of the
Structural Speclalty Code
H DESIGN TEAM AND CONTRACTORS
To avold des1gn or constructlon delays, BUlldlng
Olvlslon Staff must be able to contact approprlate
persons regardlng deslgn lnformatlon or Job slte
correct1ons, etc
Abbrevlated Plumblng, Mechanlcal, & Electrlcal Schedules
A Except where blank spaces occur In the descrlptlon
portlon of the Mechanlcal and Electrlcal Schedules,
the appllcant need fl11-1n only the No Boxes adjacent
to the approprlate ltem{s) to be lnstal1ed
B Full Plumblng, Mechanlcal, and Electrlcal Schedules
are ava11able at the BUlldlng 01vlslon
1 To conserve space on the permlt form the schedules
have been abbrevlated
2 If the ltem(s) to be ln5talled are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be dellvered to the
electrlcal contractor for 51gnature by hlS electrlcal
supervlsor The general contractor 1S not authorized
to 51gn the electrlCal label -
Appllcant to 51gn and date
Whenever posslble, the lnltlal appllcatlon wlll be used as
a worksheet only Where posslble, BU11dlng Olv1510n Staff
wlll prepare a type wrltten copy and return lt to the
appl1cant at the t1me the actual permlt 1S lssued for h1S
slgnature
Fees and Charges
Plan check fees are due and payable at the tlme of the
appl1catlon, and no plans wlll be processed untll these
fees are pald All other fees and charges are due and
payable when the perm1t 15 lssued
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FOR OFFICE USE ONLY
Permlt Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because
Addl tl ona 1 ProJect Informatlon
PLANS REVIEWED BY
name
slgnature
date
.'