HomeMy WebLinkAboutPermit Plumbing 1988-10-7
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Job Address
c240
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ciTY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
\~ater Heater
Range
ValUE of Hark:
<W
BuildlOQ Pennit info: Describe Work{Le.,
Familv ~es;dence With Attached Garaoe)
.
INFORllATION UNl
726-3753
Sq, Ftg. 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
Other- -
\ INSPECTION LINE
726-3769
legal Description
Owner'-17itJ~/q :tA~--'
Address c::> h4'J 4?rL~
Phone 1 f{-;
5"3 IC/I
Build Single
~,
~ I
-r
Construction lender
~
~(?
/
Address
Ul:.~ tliN I tAf~
(name)
Phone
(address)
flies. no.)
(exoires)
(ohorte rtO,(
Primary
'*
~~
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
{name}
'/ A J./ YI'AA--
(address)
~JZ. /
(1 ies. no.)
(pxniresl
(ohnnp nn.)
Electrical
"1!l -.,
-IV(')
~~ ../1
-jojJc
cA7"l
I~ v-
Plumbina
~'echani ca 1
PLUII8ING
ELECTRICAL
MECHANICAL
NO,
FFF CHARGF ~
EO> rlJARGf..J:!Q....1
I ~H. I rl-ll1RG.E.
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex <1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~~p hp~tpr ~no ~pnt
Storm Sewer
Of
amps.
Appliance vent
<:p.oarate
Stationary evap.
~nnler
Vent fan with
sinrJle durt
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud
Sewer
Temporary Construction
Change in existing
rpsj4~n("p'
multifamily. comm. or
Tnrh,c,tri~l
Water service
COMM,/IND, FEEDERS
Install/alter/relocate
rH dri h fppr!prc,
Wood stove/heater
Of
amps.
f)\
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ISSUANCE OF PFRrilT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\l~ REQUIRES that the Electrical work be done by an, 'Electrical Contractor, the electrical portiort of this pernit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 Springfield and the laws of the State of Oregon pertaining to the work described herein. and that rm 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 and employees who are in compliance with ORS 701.055 will be used on this project.
iR I\JDEesotU SIGtlATUR~f?j)af~
FO~ OFFICE USE Q;lL Y
So, Ftg, liain
Sq. Ft9. Access
Sq. Ftg, Other
13~D
DATlo -7-fJJ>
NN1E(please print)
Zone
Fire Zone
Flood Plain
TYDe/Cortst,
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Stories
x
TOTAL VALUATION
,
BUILOING PERMIT Plan Ck, Conrn/l nd
Charges and ------------ 65%1Bldo p.f'r~~
Surcharges Plan Ck, Res
30%/B1do Per Fee
PLUI~B ING PERMI T -' Fence \0\
Charges arid_,....-. ------------
Surcharges' Demo,
ELECTRICAL PERI~IT 'Sidewalk
Cha rges and ------------
Surcharges A/C Paviog
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
syste,ms Development
Charoe (1.5~) ,
5,fJO
Total Comb. Permit
TOTAL
s: 0&
.
.
.
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
II oj 43
2, example- Lot I, Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air QdS
2. exa~le- waterheater/electrical/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. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examjple - 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
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 ~ivision 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.
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V. FOR OFFICE USE ONLY
Permit Cl erk
cC-
.
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
signature
date