HomeMy WebLinkAboutPermit Plumbing 1984-10-11
.. L~s<rV~311 .
CITY UF SPRINGFIElD
COMBINATION APPliCATION/PERMIT
E!IERGY SOURCES:
Meat
legal De,cription Township 17, Range 03, l'later Heater
Range
Section 27, Tax Lot 301 Lane County
Valu€ of Hark:
Owner Peter & Betty and Paul & Brenda Hor rath ~25. 000.0'0
Bui1dino Permit Info: Describe Work(Le..
Address 1066 Fairview Drive Phone 726- Familv nesidence I~ith Attached Garaael
6803
Temporary Construction
Change in existing
rps i nJ>f1l"'P
multifamily, camm. or
Tnnllo;.trial
IOf
ICOMM_/IND. FEEDERS
I Install/alter/relocate
rlic:trih_ fpprlF'rc;,
IOf
\C\ \-\\~ S-F9\)\c.E
I HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon ;s true
and correct. and I further certify that any and all work oerformed shall be done ;n 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 rw OCCUPAIKY 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 exemp.tion ;s note eon, d tha
only subcontractors and ~1~ees who are in comoliance with ORS 701.055 ~. 1 sed n th s p ojec
7n-~..~
IWIE(please print)?~t~1t ~T H SIG!IATUR
FOr. OFFICE USE
Sq,
Sq.
Sq, Ftg. Other
I INSPECTION liNE
726-3769
Job Address
1120 Fairview Drive
Construction lender
N/A
Address
-Vt~ !tjN TEAf1
(name)
Phone
(address)
Primary Branch Enqineerinq
?l? () ~t-_
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
(name)
Owners
(address)
Plumbino
Electrical
~lechanical
PlUI,IBI NG
NO,
FFF rI--IIl.R(;F NO
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
SERVICES
\ \'V, \oJater service
Em I Sewer
~IStorm Sewer
I
\ ~",t
,~_.
'3s-
TOTAl CHARGES 'l U/)~ TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electr;cal work be done by an
shall not be valij until the label has been signed by an Electrical
Zone
Type/Const.
Bedrooms
Units
Occy load
Occy Group
Fire Zone
Flood Plain
Stories
BUilDING PERflIT
Charges ancl
Surcharges
.~ . Plan Ck. ConrnlInd
. 65%/Rldo Ppr Fpp
----------- Plan Ck, lies
30%/B1do Per Fee
r Fence
I D/IRlo
I Sldewa 1 k
I A/C Pav; ng
I Curb Cut
I
PlU>1BING PERMIT
Charges and
Surcha rges
_ _ _~_l.\O .-
"'. (iO
___~9.0.-
'1.CoC>
ELECTRICAl PERf~1T
Cha rges and
Surcharges
MECHANICAl PERMIT
Charges and
Surcharges
INFORJIATION UNl
. 726-3753
Sq, Ftq_ f,lain
:q. !="tg, Access.
Sq, Ftg, Other
flew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
I~
t
\J
~
00
Build Single
~~~,,\C"\\. "\
~Fs..
('"\r;;. \ (:). ~\1 F W"\~ ~
(ahane no. \
(llcs. no.)
(exo;res)
746-0389
J
(lics.no.)
(exoirflS)
rohnnp no. \
ElECTRICAl
MECHANICAl
l ~~~ r~ Nn
\ ~~~
("~l
furnace/burner to
SQ, FT. BTU's
amps.
I
I
I
I
I
I
I
I
I
I
I \()-:" ro-
I
I
ISSUANCE OF PFRflIT
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
amps.
Appliance vent
C:PI).:}rate
Stationarv evan.
cooler" ,
Vent fan wi th
sinale duct
Vent system apart from I
heating or A,C.
Mechanical exhaust
hood rind duct
Wood stove/heater
I
\~--- TOTAl CHARGES
Electricai -C~tractor. the electrical portion of this permit
Supervisor and returned to the Building Division
~
riain
c
x
Value
Value
/
Access
x
x,
Value
TOTAl VAlUATION
7::('. __ 7P,-II Systems Development
q~~~. Charae r1.5~) .
~15. -
'1 (,., -
Total Comb. rermit
I TOTAl
~Of~. '20
~
-
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 oj 43
2, exam~Je- Lot I. Block 3, 2nd Addition to
Spflngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqfor forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examDle- 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. exam~le - 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
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 SCHEOULES
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.
R~ tL/a99
fI 02/:liJ ~
V, FOR OFFICE USE ONLY
Permit Clerk ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name.) }~\\\~~F\.\'
Signatu~.A1:?..... 'r-
date \\-\S-<i\L\
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