HomeMy WebLinkAboutPermit Plumbing 1984-7-31
I INSPECTION LINE
726-3769
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
.
Owner, t?~" ~
Address 2; 3-z..l
Range
ValUE of Hork:
I NFORl1ATION U NI:
726-3753
Sq. Ftg. r'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Job Address 33 2 7- ~..f ,
Legal Description \1 D~ v\ d.., (1) ~C()
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Construction LLnder '
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, Buildino Pernlit Info:
Phone7'47_~~~ 9 Fami 1 y Res i dence Hi th
, 'g~ ~ ':4'~,1J-<AJ
Descrlbe Work(i.e., Build Single
Attached Garaoe)
61~~
Address
DES I GN TEAr~
(name)
Phone
(address)
. (lics. no.)
(exoires)
(ohone no. J
Primary ,
Structura 1
"
El ectri ca 1,
Mechanical
CONTRACTORS
(name)
(address) .
(lies. no.)
(exoires)
(ohone no. )
, Genera 1
Electrical
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Fo,'~ 554q
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: Pl umbi no
, ~lechanical
;
PLUr,1BI NG
ELECTRICAL
MECHANICAL
NO.
,FEE CHARGE NO.
FFF rHARhF NO.
FFFrHARGL
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
'New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~~~ h~~tpr ~n~ vpnt
~Iater servi ce
Temporary Construction
Change in existing 'I
residence
multifamily, comm. or 1
Industrial
Of amps. I'
COMr~.1I NO. FEEDERS I
Install/alter/relocate I
distrib, feeders
Of amps.1 1
,I I
I 1
I I
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinille duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Storm Sewer
I HAVE CAREFULLY EXAllINED 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAr~CY 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, an,d employees who are in compliance with ORS 7()L05~e used on t' '~o/
"""("",, ,dot) eel,! If 11?r;~n-t SIO"ATUR(~ ( DATE '7 J3!/o/
- ,- FOr. OFFICE USE' orlL Y <.. - /./
Type/Const. Units Sq. Ftg. f1ai;;---'.
Bedrooms Occy Load Sq. Ft!J. Access
Stories Occy Group Sq. Ftg. Other
Zone
Fire Zone
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcharges
I Plan Ck. CommlInd
____________ 65%/Blda Per Fee
Plan Ck. Res
30%/Bldo Per Fee
__10:...00_____ Fence
. Lf 0 Demo
, '
'Systems, Development '
Charge t1.5%), ' , ,
PLur~B ING PERMIT
Charges and
Surcha rges
ELECTRICAL PERrm
Cha rges and
Su.rc;ha rges
ISidewal k
I A/C Paving
, 'I Curb Cut
------------,
I
I
ITotal Comb. Permit
I TOTAl
)o.tjO
I
MECHANICAL PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant tO,furnish
A. Job Addre~s
B. Legal Description
1. examp 1 e- 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 qas
2. example- waterheater/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 (a) ~f the
" Structura 1 Specia lty Code
H. DESIGN, TEAM ,AND CONTRACTORS'
To avoid design,or construction delays, Buildjng
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, Methanfcal, 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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 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. ---
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 type written 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:
.
.'
PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
name
signature
date