HomeMy WebLinkAboutPermit Plumbing 1987-7-16
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IItISPECTlON LItlE
.' 726,3769
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CITY U, SPRINGFIELD
CDMBI;IATION APPLICATION/PERMIT
E!lERGY SOURCES,
Heat
l~ater Heater
Range
ValuE of l'lark:
/ :/, O'l.b. ....
Builri;na Pennit Info: Describe Work(Le..
Familv nesidence With Attached Garaae)
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INFORlIATION LINt
726-3753
Sq. Ftq. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
Owner 7J""'/Y~D ~'#-.4./?D
Address ~ L5'/t::> ~ft..-At '157-
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Construction lender'
Phone
Build Single
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Legal De5cr;ption
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Address
UlSIGN TEAI~
(name)
Phone
[address)
(1 ics. no.)
(exnires)
(ahOM no.
Primary '-::::>WN.-e-Z>
Structural
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Electrical
!1echan; ca 1
CONTRACTORS I name I I address I
General ';::::;...:;r-~ ~~ ~':::;;.?A?Y~ ,
('ic~. no.) (pxniresl
(ohonp nn )
Plumbina
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Electrical
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PLUI,IBIIIG
ELECTRICAL
MECHANICAL
Each single fixture
FH rHARt;F Nn I ~H. rI.lA~r.~ NO_
Residence of furnace/burner to
SQ. FT. BTU's
i="~~ rI-lIlIU~~ ~
NO.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
I'S.F. Residence
(j bath)
IDuplex (I bath) each
IAdditional bath
! ~Ia ter servi ce
!Sewer
/dIP' I Storm Sewer 13'S7"'""
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SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
re$ i df!nce
I multifamily , conrn. or
Inrlustrial
10f
ICOMM./IND, FEEDERS
I Install/alter/relocate
rlic;.trih. fppdprc;
amps.!
Appliance vent
seDaratp
Stationary evao.
cooler ~ .
Vent fan with
sinole duct
I Vent system apart
heatina or A.C.
Mechanical exhaust
hnnrl nnd duct
from
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
I
C/-:::? 9> TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an-'Electrical Contractor. the electrical portion of this perTilit
label has been signed by an Electrical Supervisor and returned to the Building Division
ISSUANCf OF PFR!llT
I HAVE CAREFULLY EXM1INED 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 Ore(]on pertaining to the work described herein, and that fiC 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 for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
....
SIGIIATUREl~ 13, Lt-tf!p
FO~ OFFICE USE DrILv' 1
.
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Sq. ftg. Other Lb~A'A'---=-- Value
TOTAL V ALUA TI ON
IlAI.IE(please print) DA U I D
L'I TI F
DATE..lI6-![
Zone
Fi re Zone
Type/Const.
Bedrooms
Units
Occy Load
Occy Group
BUILOING PER/lIT
Charges ant::
Surcharges
Plan Ck,
65%/Bldn
'-------------p;an Ck.
30%/Bldo
Conm/Ind
P",r Ff'P
Res
Per Fee
.....
1"':-
VtH-?,N""-"Y.
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12. o'riC. ,
Flaad Plain
Stories
Systems Development
7t? -'" Charqe (J.5~)
PLUt~BING PERMIT
Char.,ges and /
Surcharges ~
,___7:.~:.~~_
7-/3
Fence
Demo
ELECTRICAL PERI:IT
Charges and
Surcharges
Sidewalk
I A/C Paving
. IC~rb C~~
------------,
o
./.tJf. :)6-
Tot..l Comb, rermit 1_ / r.-r, /3
11ECHAN I CAL PERMIT
Charges and
Surcharges
,
TOTAL /67/?
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COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
-'
Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
II oj 4j
2, example' lat 1, Block 3, 2nd Additian ta
_ SPr:ingtield Esta.tes. "
C. . Name. etc. of owner ana construction lender
,D. Ef)ergy Sources. .'.
."'1. examl?le- heat/electrical ceiling/or forced air QdS
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house, 500 sq, faot garage
2. example- if new project. check-nfw - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached gan~ge
2. examEle - 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.
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) ta 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
electrical contractor for signature
supervisor. The general contractor
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
signature.
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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be delivered to the
by his electrical
is.not authorized
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IV.
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V.
FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED 8EFORE OCCUPANCY:
Permit appl'icant. exempt from registration with the Builder's Board because:
Add,itional Project, Information:
.
PLANS REVIEWED BY:
name'L.oh'#~ ?~pt'f
signature /2 ~~ ~..::
~~ ,
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date 7 'l6-g?