HomeMy WebLinkAboutPermit Plumbing 1986-6-7
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Builc:inq Permit Info: Describe Hork(Le.. Bui ld Single
Family Residence With Attached ~araqe) _
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'"llrISPECTIOil LINE
726-3769 .
,
Job Address ~ ~~\ ~~
Legal De~cription 3tqoo CDIVlIYtEr'2r J A- L
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ow'''Orp%V\ (I r rLY!I~
. Address30f0 (Tpy\ V\,<a ~ 1_ '$"1,
Ranqe
ValuE of Hork:
",
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,
Construct inn lender
Address
DES I Gil TEArI
Phone
(address)
(name)
(I ics. no.)
~
. Primary
Structural
Electrical
11echan i ca 1 .
CONTRACTORS
(name)
(address)
(1 i cs.. no.)
Genera 1
S-hmsonv6b~ 12'1"10CR~~I~O
Plumbinq
Electrical
~'echani ca I
PlUf1B I NG
ELECTRICAL
NO.
FEE CHARGE Nn I I """
Residence of
'I
rHARh" flD.
Each single fixture
SQ. FT.
Relocated building
(new fix. additional)
IS. F. Res i dence
(l bath)
IDuPlex (1 bath)
IAdditional bath
New circuits alts.
or extensions
SERVICES
each
Temporary Construction
Change in existing
residence
Imultifamily, comm. or
Industrial
10f
I
I
I
~!a ter servi ce
Sewer
IStorm Sewer
I I fufD r qmJ-J
I
I
I
I
I
amps,
15. ()O
I
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I
I
I I I
15. too I TOTAL CHARGES
WHEflE STATE L'\\~ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
. COf1f'" II NO. FEEDERS
I
1
I
-I
I
IInstall/alter/relocate
distrih. feeders
IOf amp~1
!
4~/D
TOTAL CHARGES
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.......... INFORllATION LINt.
726-3753
Sq. F tq. r'la i n
~q. ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
_Fence _Demo_Change/Use
Other
(exniresl
(ohone no, )
,.;
.
'QQ
()'-
o
\fl
~
1(:)- \ 5-'?J.a
b '& '7~3S. ~
x
x
Value
Value
Value
I
I
I
I
I TOTAL CHARGES
(~x~ir~5)
(I)hl)ne no.. I
rHARr:" I
I
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MECHANICAL
"""
. furnace/burner to
BTlI's
Floor furnace
and vent
I Recessed wa 11
50Mre hPMter Mnrl
I -.. .. -
vent
I
Electrical Contractor, the electrical portion of this permlt
Supervisor and returned to the Building Division
I Apo I i ance vent
seoa ra te
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heating or A.C. .
Mechanical exhaust
hood and duct
Wood stove/heater
I
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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 oerformed shall be done in accordance with the Ordinances of the City
of Soringfield 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 Division. I further certify that my registration with 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 comoliance with OP.S 701.055 will be used on this project.
ilW1E(please print;[Sf,'fIA t. I"\.
SWIATURE Y $J ;
FOR OFFICE USE ONLY
Ftg. f1ain
Ft~. Access
I SSUANCr OF PFR11IT
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o lcQ '"R. & (. :.-....111'......: Dft.TE - ;/7/ (;,ro
Zone Tyoe/Cons t. Units So.
Fire Zone Bedrooms Occy load Sq.
Flood Plain Stori es ''Occy Group Sq.
.
Ftg. Other
BUIlDIrlG PER~1IT
Charges anc
Surcharges
PluP1BING PERMIT
Charges and
Surcha rges -
__-'!b~ 00
I roO
-
Plan Ck. Comm/Ind
65%/Bldq Per Fee
Plan Ck. Res
30%/Bldq Per Fee
I Fence
I D~m~
Sidewalk
x
TOTAL VALUATION
------------
Systems Development
Cha rqe (1. 5:r..)
1
I
.1
IT'" 1 Comb.
I TOTAL
ElECTRIUL PERr~IT
Charges and
Surcha rges
------------
AlC Pavi n9
I Curb Cut
I
MECHANICAL PERMIT
Charges and
Surcharges
------------
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I
Permit
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III.
IV.
II.
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COMBINATION APPLICATION/PERMIT (CAP)
1.
,
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, "PERMIT VALTDATION
Applicant to furnish
A., Job Address
B. Legal Description
1. examp 1 e- Tax Lot '100, Lane County Map Reference
17 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. ' Name, etc. of'owner and construction lender
~. Energy Sources '
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 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. examole - 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 avoi.d design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
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 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 delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. -
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.
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.
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FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Bui!lder1s Board because:
Additional Project Information:
.
,
,
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PLANS REVIEWED BY:
name
signature
date
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