HomeMy WebLinkAboutPermit Plumbing 1987-11-3
1-0
'; IIISPECTIOII LIIIE
, i 726- 1.'69
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CITY OF SPRINGFIELD
COMBIIIATlON API1ICATION/PERMIT
) VI\ r f' Jj' - /)- E'IERGY SOORCES
() lJ l) LO AA V I)/Yl nA oJ/ Heat
Legal Oe'crlptlOn 17'()'7'25' 3'1, O~7~ Hater Heater
( - ~ , " i1 \ ::~:: of Wfk //7 ~9H
Owner df-rur.-cl G.A 0/ ~<UUt~ <i1 I' ~(j / ,
- BUllGwd/Pernnt'Info Descrlbe l~orkl' e 1 BUlld Slngle ~
Phone Farnlv n.esldence Ihth flttached GaraQe)
IIP./J'M M/P () a-1, iJ-1 ,lu Y-- j VJ
C...-/JA} A' Jl ~ if (/ I( f')() .s~ If. --0
;:;;;/r;,N/4'T Jl/'5/~/Y 'c~~
(lles no) (exnlres) (ohone no J
INFORllATlON UNt .1
726-3753
Sq Ftq 11a10
~q C'tg Access
Sq Ftg Other
liew Add Alter Pep
--Fence Demo Change/Use
Other - -
0<:)
c?
Job Address
Address
ConstructIon lender
Address
LJt::illiN TI:.lJ1
(nameJ
Phone
(address)
,Prlmary .h1/CU.eLL:E' /;?;-h' /!,,;rr /H~/-=-~'
Structural
Electncal
'l)'-k
--J)
(,,5"''-'
t1echamcal
CONTRACTU~S (oa.el
(/\ ')f1jJ(J 4
d\ l, U]th_
Y,j-d
Plumblncl
() t ~ddrJP:2s)
(=~J~
r;~h7;,.//./
(1 lee;. no)
I J -=; q tf'ofJ
(PXOlres)
(ohone no )
Genera 1
Q-30 - ~1-::z=''I37
Electncal
{;}I{)I(II,
~lechan1cal
Pll'e1BUtIS
ELECTRICAL
MECHANICAL
NO
FFf I !}'ARr" NO
I=H ~ nlAR~1=" NO
1=1="1=" rI-lARr.1="
3
Eac~ s~ngle fixt9re
ReSldence of
7-5" 22'.;2:
SQ FT
furnace/burner to
BTU's
Relocated bolldlng
(new flX. additlonal)
~ New ClrcUlts alts
V' or extenSlons ,~
'7 L>i'e .N1.t>7?e.
SERVICES
~,,(.=
Floor furnace
and vent
S F lJl'es'ldemce
(1 ba~~J
I Duplex (1 bath) each
I Addltwnal IraU
I ~Iatef" serlll(:e
I Sewer
1 Stam Sewer
Recessed wall
SOn~P hp~tpr nod vpnt
ITemporary Constructlon
IChange In eXlstlng
rp,? 1 d~.ncp
Imultlfamlly, COIJ1T1 or
Jndustnal
IOf ampsl
I COMII II NO FEEDERS
Install/alter/relocate I
rll~trlh. fppdpr~
Apollance vent
seoaratp
Statlonary evap
cooler
Vent fan loll th
slnole duct
I Vent systel'l apart from
heatlno or A C
I Mechanlcal exhaust
hood and dud
I Hood stove/heater
Of
amps
I ISSUANCF OF PFRP11T
TOTAL CHAPElS -;(7.50 TOTAL CHARGES "22 .s&:> I TOTAL CHARGES
WHERE STATE l-U1 iRfQUIRfS that the Electncal work be done by an Electncal Contractor, the electrlcal port1on of th15 perlint
shall not be va]11 until the label has been slgned by an E1ectrlca1 Supervlsor and returned to the BU11dlng 01v1slon
I HAVE CAREfUllY [XAMl~ED t1e completed app11catlon for oerm1t, and do hereby cert1fy that all lnformatlon hereon 1S true
and correct. arJd I further cert1fy that any and all work oerformed shall be do accordance w1th the Ord1nances of the Clty
of Spnngheld and the laws of the State of Oregon oerta10lng to the work de rlbeij hereln, and that HD OCCUPAIlCY wlll be made
of any structure ~tbout the perm~SSlon of the BU11dlng D1v1Slon I furth certjfy th y eQlstratlon w1th the BU11der's
Board lS 10 f~11 force and effect as requ1red by ORS 701 055, that lf exe t the~as x mptlo 1S noted hereon, and that
only SubcO~Lractcrs and ~loyees who are 1n comollance w1th QPS 701 055 w;ll b s d on DrOJ t
:1
IWIE(please pr,"~) DAf I \ U~.A1..c'l~_ SIGIIATUR,
""' ~ FO" OFFICE USE
Tyoe/Const 5-/#.R' UOlts Sn Ftg
Bedrooms Oeey Load Sq Ftg
Starl es / Occy Group .g- Z Sq Ftg
USE LODE #' gz '-/
Pl an Ck
.;l _nL"?$_?:.<e_ 65%IBldo
Plan Ck
6 '7':::> 30%/Bldo
7Z-S<P I Fence
5 _nn-T /3-1 D6ffiO
-Z"2-~ I Sldewalk
------;~n-I A/C Pmng
I Curb Cut
I
() Value
Access~ x Value
Other-2i',c-M~~ Value /~~ ~,
TOTAL VALUATION
DATE.....()r, 9 In
-(
20ne_K'- ~
Fl re Zone
Flood Plaln
BUILDING PERmT
Charges an~
Surcharges
\
Comm!l nd
Ppr Fee
Res
Per Fee
10-12.<6/1
00 r3 """^?'7? Systens Development
() :l ,0 '"/U'?C>L.- CharDe (! 5~)
, ~/ /f.
PLUP1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI'IT
Cha rges and LJ
Surcharges ,
ITota,
I
I TOTAL
1$2./9
I
Comb
rerm1t
11ECHANI CAL PERMIT
Charges and
Surcharges
..
..~
~
~
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
Appllcant to furnlsh
A Job Address
B legal Oescrlptlon
1 example- Tax Lot 100. Lane County Map Reference
-11 oj 43
2 examEle- Lot 1 Block 3, 2nd AddItIon to
Springfleld Estates
C Name. ete of owner and constructlon lender
o Energy Sources
1 exam~le- heat/electrlcal celllng/or forced alr aas
2 example- waterheater/electrical/or solar
E Square footage or valuatlon. ete ------
1 examole- 1250 sq foat house. 500 sq foot garage
2 example- If new proJect, check new - If addltlon,
check add, ete
F BU11dlng permlt lnformatlon
1 example - construct slngle faml1y house wlth an
attached garllge
2 exa~~le - remodel eXlstlng garage lnto faml1y room
3 examOle - convert slngle faml1y resldence lnto
restaurant (change of use)
G Value of work as def1ned 1n Sect10n 303 (a) of the
Structural Spec1alty Code
H DESIGN TE~I AND CONTRACTORS
To aV01d des1gn or constructlon delays, BU1ld1ng
01vls1on Staff must be able to contact appropr1ate
persons regardlng des1gn 1nformat1on or Job s1te
correct1ons. etc
II Abbrev1ated Plumb1ng, Mechan1cal. & Electrlcal Schedules
A Except where blank spaces occur 1n the descr1pt1on
port1on of the Mechan1cal and Electr1cal Schedules,
the appl1cant need f1ll-1n only the No Boxes adJacent
to the appropr1ate ltem(s) to be 1nstalled
B full Plumb1ng. Mechan1cal. and Electr1cal Schedules
are avallable at the BU1ld1ng 01v1s1on
1 To conserve space on the perm1t form the schedules
have been abbrev1ated
2 If the 1tem(s) to be 1nstalled are not covered on
the abbrev1ated schedules you should consult the
full schedules
C BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be del1vered to the
electrlcal contractor for slgnature by h1S electr1cal
superv1sor The general contractor 1S not authorlzed
to slgn the electr1cal label
III Appllcant to s1gn and date
Whenever poss1ble, the 1n1t1al appl1cat1on w1ll be used as
a worksheet only Where poss1ble, BU1ld1ng 01v1s1on Staff
w1ll prepare a type wr1tten copy and return 1t to the
appl1cant at the t1me the actual perm1t 1S 1ssued for hlS
51gnature
IV Fees and Charges
Plan check fees are due and payable at the t1me of the
appl1cat1on, and no plans w1ll be processed unt1l these
fees are pa1d All other fees and charges are due and
payable when the perm1t 1S 1ssued
I() & 55
(L-- _q_~1
V FOR OFFICE USE ONLY
Permlt Clerk
cv
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY.
Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because
,
.
Addltlonal Project Informatlon
.
PLANS REVIEWED BY.
name L..?.i9'H~ 7Z5Zi~Slgnatur~~~~~ date 1/- '5'-87