HomeMy WebLinkAboutPermit Plumbing 1989-2-13
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IrISPECTIOII L1i1E
726-3769 .
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CITY UF SPRIrIGFIELD .
CmlBIllATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
I' !'/ater Heater
I RamIe
/J ~ ." I Valu, of I./ork:
fU/.1A~~-=. _I
/1-, I I13Uilt:inQ Permit Info:
Phone /~ Far.lilv P.psidence Hith
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name address
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im.l - FEE CHARGF Nn FFF cHARGE.
=1 Each single fixture Residence of
.. u ~- sq. FT.
/Relocated building 1~INew circuit; alts.
(new fix. additional) or extenslons
-t- - Temporary Construction
Change in existing
rpS i denrp
I Imultifami ly, Comm. or
Inl1u<;tritll
IOf
I cm11.1. II NO. FEEDERS
IInstall/alter/relocate
rli<;trih. fPPdpr<;
IOf amps.1
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TOTAL CHARGES .1 TOTAL CHARGES
\.JHEr!.E STATE L"\~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Job Address
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I.egal Description
Owner
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Address
Construction lender
,\ddress
OESIGfl ItAl1
(name)
Phone
(address )
Primary
Structural
Electrical
~1echanica 1
CONTRACTORS
Genera 1
Plumbinq
Electrical
Meehan i Cd 1
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PLUlIBIrIG
Is.F. Residence
(l b.lth)
IOuple, (1 bath)
Additional bath
each
ISERVICES
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~!ater service
Sewer
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Storm
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Sel'ler
ELECTRICAL
NfORtlA T: _':1 L I ;,t
726-3753
Sa. Ftq. nain I I
~q. !="tg. Access. ;
So. Ftq. Other C><:J I
flew Add 11.1 ter ~eo. ...... r'\ I
Fence_Oemo_Change/Use ':v i
Other C:sl I
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Bui Id Single 'p i
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Describe Work(l~e..
Il.ttached r.araae)
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ft;.-a [f, A.-<:1-/
v.J a:; ,c
( I iGS'. no. I
(exnires)
(ohone no. I
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x lres
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MECHANICAL
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.l1!L1
furnace/burner "to
BTLi's
Floor furnace
and vent
I Recessed wa 11
I\n"rp hP,'/tpr ilnrl
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\fpnt
amps.1
I Apol iance vent
""'Oil '.i1 t.P
I Stationary evap.
roolpr
Vent fan loJlth
o;.inole riuet
Vent system apart
heatina or A.C.
rlechanical exhaust
hood and durt
I Hood stove/heater
from
ISSUANCE nF PFRIJIT
TOTAL CHARGES
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I HAVE CAREFULLY EXMlINED the comflleted apfll ication for ~ermit~ 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 Soringfield and the laws of the State of Ore~on pertaining to the work described herein, and that rlO OCCUPAHCY \'I'i11 be made
of any structure without the permission of the OUilding Division. I further certify that my re9istration with the Builder's
Goard is in full force and effect as required by ons 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees \'iho are in comoliance with OP.S 7/11.055 \'Jill be used on this "roject.
IIA:IE(please print)Qf-\ \ U ~c,
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SIClIATURE ('.---<--J '--- -
FOP. 1J;;; ~~ uSE DilLY
om2-13-~9
Zone
Fire Zone
Flood Plain
Type/Cons t.
Bedrooms
Stories
Units
_ Occy load
Occ,Y Group
BUILOII1G PERI.IIT
Charges an;::
Surcharges
Plan Ck. Comm/Ind
-------_____ 65'.t1BldCl Ppr Fpp
Plan Ck. Res
30t/Bldn Ppr Fpp
PLUI1BING PERMIT5~ ~ fc-. ~ I F~
Charges and ____ 2..:...___
Surcharges r 751 Demo
.ELECTRICf..L PERI~IT I Sidewalk
CharQes and ____________
Surcharges
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~--~-~- CU~:J.?ftbr
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IIECHAN I CAL PERI1IT
Charges and
Surcharges
A/e Paving
Sq. Ftg. f1ain
So. Fta. Access
Sq. Ftg. Other
,
Value
Value
Value
,
,
TOTAL VALUATION
Systems Development
Charae (1. 5')
~C7
IS I lJt)
ITotal Comb. Permit
I TOTAL
30 ,7 2:,
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examDle- Tax Lot 100, Lane County Map Reference
II OJ 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-nfw _ if addition,
check. add, etc.
f. Building pennit information":
1. examole - construct single family house with an
attached garage
2. examole ~ remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of '...ork 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 infonnation or jab 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
8. full Plumbing, t-lechanical. 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
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. -
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 Cha rges
Plan check rees 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
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Permit Clerk
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PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
]
name
signa ture
date
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