HomeMy WebLinkAboutPermit Plumbing 1984-4-30
I INSPECTION LINE CITY OF SPRIhurl~LD
726-3769 COMBINATION APPLICATION/PERMIT
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Job Address la....on ~~,-", Heat
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- 1 ,\IN n. ~ Buildino Permit Info:
Address'?, 9/& ( ~ .;.,J1Phone7Y't..-;tc; 1lFamilv nesidence Hith
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Construction Letder
.
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INFORl1ATION LINt:. ,
726-3753
Sq. Ftg. I'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Describe Work(i.e., Build Single
Attached Garaoe)
Address
DESIGN TEAf1
(name)
Phone
(address)
'~6-cJjL~) ~.u- _
0- ~1.t.~J t~
(lies, no.) (exoi res) fJ (ohone
no,)\'
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(exoires)
(ohone no. )
General
,Plumbino 3~ tl~ ~
Electrical .. \j
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~1echani ca 1
PLUI1BI NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF r.HARr.F NO,
FFF r.H.ARr.F
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
.
.'
Relocated building
(new fix. additional~
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Fl oor furnace
and vent
SERVICES
Recessed wa 11
Snace heatpr and vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from "
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
~Jater servi ce
~vk~~n) \O;~I'
l.fv(o
10.DO
vVO
COMM./IND. F~EDERS
Install/alter/relocate
distrib. feeders
Of
amps.
TOTAL CHARGES
. WHERE STATE LAW REQUIRES
shall not be vali1 until the
ISSUANCE OF PFRr1IT
~ 10.1./0 TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an.Electrical Contractor, the electrical por1:ion"ofthis permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY.EXAMINED 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 performed'shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAI1CY 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
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'-.-./ ~ ....... '\. FOr. OFFICE USE orj~ I
, .
Sq. Ftg, 11ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION
Zone
Fire Zone
Fl.ood Plain
Type/Const.
Bedrooms
Units
Occy Load
Occy Group
Stori es
BUILDING PER~1IT . Pl an Ck. CommlInd
Charges and ------------ 65%/Bldo Per Fee
Surcha rges Plan Ck. Res
. 30%/Bl do Per Fee
PLut4B ING PERMIT /O.lYO Fence
Charges and ------------
Surcha rges . YO D6ffiO.
ELECTRICAL PERfm Sidewalk
Charges and ------------
Surcharges A/C Paving
MECHANICAL PERMIT I Curb Cut
Charges and ------------
Surcharges I
.
. Systems. Deve 1 opment
Charge (1.51) '.,.
ITotal Comb. Permit
I TOT~L .
I
10. (/0
I
.,1 II" II
.
, ,
COMBINATION APPLICATION/PERMIT (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 ,0-
1. example- heat/electrical ceilingjor forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examp 1 e- 1250 sq. foot house, 500 sq. foot ga rage
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 (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 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 n
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
~HARGES ON THE SCHEDULES
D. 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
signa ture'.
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.
~
III.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board becaus~~
Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
name
signature
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date