HomeMy WebLinkAboutPermit Plumbing 1989-4-17
I INSPECTION L1I1E
726-3709
CITY Uf SPRINGFIElD
COImlllATlON APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
.
INFDRltATION liNt
726-3753
Sq. Ftg_ '.Iain
!:q. Ft9. Access.
Sq. Ftg. Other
liew Add Alter Pep,
--Fence Demo Change/Use
Other- -
~
~
~
Ranqe
Va 1 u, of I./'ftl ('0 I
Address ~-:l. '":J.c::::L ~\~,..,..'"'^ f'\~\ ~ Phone BuqdinQ P~nnit Info: Describe Work(i-.e.. Build Single
.:...JUI..-J.... 1 ~ X. )'\ \U \H ~ ~}\ J Faml1v nesldence Hlth.Attached GaraQe\
7=\ 'h.9 (\ Q 0eJ . 2A-S-B3~ \ ~~ C'r ,t\C11.o d \1\ Q l ~ \\'"\"\ CJ(\.)
Canstruction leAer j .\1Db ~~eM 1~6J-.. d~o l'),ffi~) C\--1. ~ ,'\\'\N -e- 0f'
Addrm Phone U\l.)~ QQ , ~k\ Q" Q.;n 0 t ,- I
DESIGfl TEAr~ (name) (address) (lies. no.) (exones) - IDhone no.\
--16
~1
Owner HDV U )
Primary
Structural
Electrical
Mechanical
. CONTRACIDRS (nall1':2.\ ,
Generai~Q,*, ~~R
Plumbino \1.. \ l
laddress)
C{~(D ~
\\
n.im &iT1 (oJ~U~{~
i\
\ (
v
E1 ectri ca 1
~techani ca 1
PlUIIBIrIG
ElECTRICAl
MECHANICAl
Each single fixture
fEF fIlARr,F Jill,..! ~FF fHJlJ!G.E. NO.
I Res idence of furnace/burner to
SQ. FT. BTU's
INew circu~ts alts. Floor furnace
or extenslOns and vent
~FF f"ARliL
NO,
Relocated building
(new fix. additional)
S.F. P.esidence
r I bath)
Duplex (1 bath) each
]Additional bath
1~later service
Sewer
SERVICES
Recessed wall
Soaee heater and vpnt
Storm Sewer
ITempOrary Construction
IChange in existing
res i d,p,nr:e .
Imultifamily, conrn. or
fnliustrial
10f amps.1
I COI1I.1. /lNO. FEEDERS
I~~~i~~~~a~;:~~~~locate
10f amp..1
I
Appliance vent
C;;PDaratp
Sta'tionary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
,Mechanical exhaust
hond and rlw::t
Wood stove/heater
ISSUANCF OF PFmllT
TOTAl CHARGFS TOTAL CHARGES
WHERE STATE L,\lj REQUIRES that the Electrical work be done by an
shall not be valii until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM11t1CO the completed aprlictltion for permit. and do hereby certify that all infonnation hereon is true
and correct, and I further certify that any and all work nerfonned shall be done in accordance with the Ordinances of the City
of Soringfield and the la\'/s of the State of OreC)on pertaining to the work described herein. and that HO OCCUPAUCY 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 re~uired by ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and emnloyees who are in comDliance wlth Or.S 7nl.055 will be used on this nroject.
IWIE(please pnnt~~f-H.t-I"r,nf::.a:- SICi/^Tl'RE A ~ ~~
FOr. orF I CE USE ellL Y
S'1. Hg. 'lain
Sq. Ft~. Access
Sq. Ftg. Other
DATE /~~,
/
/
Zone
Fi re Zone
Tyne/Cons t.
Bedrooms
Uni ts
x
Value
Value
Value
Flood Plain
Stories
Occy load
Occ'y Group
x
x
TOTAL V ALUA Tl ON
BUIlDING PWIIT Plan Ck, Conln/ I nd I
Charges ane '___________ 65X1Bldg Ppr Fee
Surcharges Plan Ck. Res I
3DXlBI do Per Fee
PlU'1BlNG PERMIT __J~Q2___ Fence I
Charges and
Surcha rges .'IS D~mo I
[L[CTR I CP,L PERI~IT Sidewalk I .9. 00
Cha rges and ------------ I
Surcharges A/C Paving
11ECHANICAL PERMIT Curb Cut I
( Charges and ------------
Surchar!)es I
Systems Development
CharQe (1.5~)
Total Comb, Permit
TOTAl
!Jf) . W
~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job'Address
B. 'legal Description
. . 1. example- Tax lot 100, Lane County Map Reference
17 03 43
2. exam~le- Lot I, Block 3, 2nd Additian to
~prlngtield Estates
C. . Name, etc. of owner and construction lender
D. EnergySources
1. example- heat/electrical ceil inqjor forced air qas
2./ examOle- waterheater/electrlca Ilor solar
E. Square footage or valuation, etc. -
,I. example- 1250 sq. foot hause, 500 sq, foot garage
~ 2. examele- if new project. check-new - if addition,
cheCK add, etc.
F. Building permit information:
L exam~le - construct single family house with an
attached garage
2. examele - 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) af the
Structural Specialty Code .
H. OESIGN TE~l ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonmation 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 Na. 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 fonm the schedules
have been abbreviated
2, If the item(s) to be installed are nat covered an
the abbreviated schedules you should consult the
fu 11 schedu 1 es
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
O. 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
paya~)e when the permit is issued.
V. FOR OFFICE USE ONLY
..--"
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.'
PERMIT VALIDATION
~(\~.\~. \~, ~
\~ .)
,\ 3 s0S1
Permit Clerk ~),~')
-vj - -
Permit applicant exempt from registration with the 8uilder's 80ard because:
Additional Project Information:
,
I,
PLANS REVIEWED BY:
..
name
signature
.
.
date