HomeMy WebLinkAboutPermit Plumbing 1988-8-18
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I INSPECTION LINE ~-' ....
726-3769 .
Job Address "<&:>/1 t..4V/7# e:;;;;;r;.
legal Description/7""~2?-/6' ~~__~,_~ #"'2'_
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CITY UF SPRINGFIELD
COHBIIIATION APPLICATION/PERMIT
E!/ERGY SOURCES:
Heat
Hater Heater
.
INFORltATION LINt
726-3753
Sq, Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg, Other
flew Add Alter Pep.
-Fence Demo Change/Use
Other- -
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";Pr,...c..c;, ~p,.<C' /Y-~'''''''~
Owner LL>V.-Ik" _~_ ~ ~_..-
Address 7J.L?< ~....v /t:>tt:?
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Construction len~r
Range
ValuE of Hark,
Phone
Buildino Permit Info: Descr.be Work(i~e" Build Single
Familv nesidence With Attached Garaael
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~AY/~/6rf' /--r---~ 8~~.
F 11 i CS. no.) (exoi res) ~ (ohane no.)
~.e 71<;<(. 'Yi;f&S~
Address
DESIGN TEAI'1
(name)
Phone
(address)
Structura 1
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Primary
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(1 ic.... no.)
(~xnil"'Pc;.'
lohnnp nn_ 1
Genera 1
~r"~
Plumb, a
~&;&;G 59.",.,.~ -r~-:::..,v~ .9~_5""::>"~""""""'K.2>. .E,u:;.~<<p::>"".:57
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q~.../17r-~
Electrical
Mechanical
PlUI1B I NG
ELECTRICAL
MECHANICAL
NO,
FEf f.HARr:F Nn
~~~ r~AQr,r NO
SQ. FT.
furnace/burner to
BTU's
~~~ r~AQr..E,
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
I ~Jater servi ce
I Sewer
lo.n-1Storm Sewer /:1P.-
SERVICES
Recessed wall
~nArp hp~tpr Anrl vpnt
ITemporary Construction
IChange in existing
rp$ j qp.ncp
Imultifamily, conm. or
Inrlllc:.t.ri<l.l
10f amps.
ICO~1./IND. FEEDERS
I Install/alter/relocate
rli~tr;h fpPdprc:.
jOf amp~
Appliance vent
~POA ra tp
Stationary evap.
cooler
Vent fan wi th
~inole duct
Vent sys tern apa rt from I
heatino f'r A.C.
Mechanical exhaust
hnnr! ;!Ind rlllct
Wood stove/heater
TOTAL CHARGES ~;I~_"" TOTAL CHARGES
WHERE STATE L\\~ REQUIRES that the Electrical work be done by an,
shall not be vali1 until the label has been signed by an Electrical
ISSUANCE OF PFRlllT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
NAr,IE(please print)E;,fc; HI)I-Err
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 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 110 OCCUPAlICY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
5 Ir,IIATURE ~~JljJ-jj-
FOr. O"FFICE USE OIll Y
So, Ftg,
Sq. Ft~.
Sq. Ftg,
DATE~'--)9- y{
Zone LH /_-5VZ>
Type/Canst.
Bedrooms
Units
Occy load
Occy Group
r1ain x Value
Access x Value
Othe;.C............." jP"r.:....:;;-i,i ~<:x.<hlue
TOTAL VALUATION
Fire Zone
Flood Plain
Star; es
BUILDING PERfIIT
Charges an~
Surcharges
4 Plan Ck, COlllll/lnd
________ ___~/Bldo PJ"r Fpp
Plan Ck. Res
...' , 30%/Bldo Per Fee
Fence
Systems Development
Charoe (l.S~) "
PlUI~BING PERMIT
Charges and...-"
Surcha rges .
.' /-::?a -
___1________
6.~
Oemo
ElECTRICAL PERIHT
Cha rges and
Surcharges
MECNANICAl PERHIT
Charges and
Surcharges
'Sidewalk
IA/c Paving
I ' I Curb Cut
-----------1,
...'..
~TPtal Co~b. Permit
I
1 TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. ~xample- Tax lot 100, lane County Map Reference
I! 03 43
2. example- lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name, etc: of owner and construction ,lender
D. Energy Sources.
1. exam~le. heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add. etc.
F. Building pennit information:
1. examele - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family room
3. exam..ple - 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 del,ays. Bui.1ding
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
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
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. ---
Ill, 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.
I d IJ es
g- /t-r%
V. FOR OFFICE USE ONLY
Permit Clerk
c(/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
"
',r"
PLANS REVIEWED BY:
name /.L>'b'~ H~~
signature
d~_,,~_,?
date R-/;>-I:i:'~
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