HomeMy WebLinkAboutPermit Plumbing 1985-6-10
I ItlSPECTION LItlE
726-3769
Job Address ,:?/,C: 'I
legal Description
. CITY Uf SPRINGfiELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Meat
\~ater Heater
Ranqe
ValuE of \oIork:
"
INfORllATlON liNe
726-3753
Sq. ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A lter ~ep.
Fence_Demo _Change/Use
_Other
(OoItlf/)tXtA /'
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Address. 3"/34;;2.., ~
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. con~~t i on le~der /
Owner
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IJuf ~Phone~;"; ""
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'97 <.(7If
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BuildlnQ Permit Info: Describe Work(i.e.~ Build Single
Familv nesidence With Attached Garaael
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Address Phone
U,~IGN TEAI~ (name) (address) (lies. no.) (exoiresl (ohane no. l
Primary
Structural
Electrical
11echan; ca 1
CONTRACTORS (namel (address) (1 ics. no. \ (j:>xoiresl (ohonp nn. \
Genera 1 , J-f,l~
Plumbina
Electrical
~1echanical
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TOTAL CHARGES 1040 TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
PlUllBING
-1!Q,.1
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath \
Duplex (1 bath) each
Additional bath
~/ater. servi ce
Sewer
Storm Sewer
Jb8-.J (~
'-110
ELECTRICAL
MECHANICAL
FFF
I..QjARCF
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Residence of
I CELl J:IlARGl: . ...lllL I
1!:'!:'L1..cJ:lAB.G.E,
furnace/burner to
BTU's
SQ. FT.
New'circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp hp~tpr ~~rl vpnt
ITempOrary Construction
IChange in existing
rp'i5 rtenc~
Imultifamily. comm. or
Tnrlllc:;.tr;al
IOf
ICOffi~./IND. FEEOERS
I Install/alter/relocate
n;c:;.trilL fpprh'rc:;.
Of amps.!
Appl iance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
s;nole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood and rluct
\.....
from
amps.
Wood stove/heater
ISSUANC, OF PFR!11T
TOTAL CHARGES
'Electrical Contractor. the electrical portion of this penmit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 NO 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
Plan Ck. Comm/lnd
65'.t/Rldo Per ~".p
------------ Plan Ck. Res
30%lBldQ Per Fee
I Fence
I DfIlI10
I Sidewalk
I A/C Paving
I Curb Cut
------------1
NM1E(please print91
f/ f~
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
BUILDING PER~IIT
Charges and
Surcharges
PlU'~BING PERMIT
Charges and
Surcharges
G r-Cqte
;2L~
DATE b -/ o-!- r-
SIGIlATURE
FO~ OFFICE USE OfIL Y
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
x
Units
Occy load
Occy Group
riain
Access
Other
x
Value
Value
Value
x
TOTAL VALUATION
Systems Development
Charqe O.5~)
(0,00
------:1;0----
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$/D:-Z;V
ELECTRICAL PERlm
Cha rges and
Surcharges
11ECHANICAl PERMIT
Charges and
Surcharges
ITotal Comb. rermit
I TOTAL
J S- rJ' r..j {; I
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Appl ieant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
>pr,ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examEle- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 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. 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 TEM4 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonmation 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
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the penmit fonm 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 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
payable when the permit is issued.
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V. FOR OFFICE USE ONLY
Permit Clerk
,t/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
PLANS REVIEWED BY:
name
signature
date