HomeMy WebLinkAboutPermit Plumbing 1989-11-30
Build Single
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I INSPECTION LINE
726-3769
Job Address ,-~'6' ~.
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ITY OF SPR NGFIELD
COMBINATION APPLICATION/PERMIT
I EIIERGY SOURCES:
Heat
I Hater lIeater______
Ra~
ValuE of ,rf rl ~
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Bui1(iinQ )ehltit- Info: Describe Work(Le..
Family nesidance With Attached GaraQe'
/
NFORllATlON
726-3753
Sq. Ftq. I,'ain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other- -
legal Description
Construction Lender.
\W\~)(\~ \e(l.\..~-,
Address
UESIGN rEM
(name)
Phone
{address \
(lies. no.'
(exniresl
(Dhone no. '
Primary
Structural
Electrical
t1echanical
CONTRACTOPf) , \ II ~a~"I1 .
General \- 1. (l\ \U.U OD
(address'
(l ;r.o;.. no. \
(p~nirps' (nhnnp nn \
q( b ",1,LJ I...'\:'YP /
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PlumbinQ
Electrical
~lechan; ca 1
PLUI.1BING
ELECTRICAL
MECIIANICAL
NO.
FFF CII'iBliL .1Jl1
Fe< r".'.&liE. .JIll
J:'~r .c.uARG.E..
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
~o~rp hp~tpr ~nrl vpnt
Sewer
Temporary Construction
Change in existing
rps5 qrncp
multifamily, comm. or
Industrial
\5(:(
Appliance vent
s~oarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hoor! and duct
Wood stove/heater
Water service
Storm Sewer
Of
amps.
'f )}tu ~fl~
ffif\ boqd',U
COffi1./IND. FEEDERS
Install/alter/relocate
rli..trih. fppdprs
Of
amps.
TOTAL CIIARGES
WIIERE STATE L,'l~ REQUIRES
shall not be vali~ until the
ISSlIANCF OF PFRrlIT
~c::L TOTAL CIIARGES ,~OO TOTAL CI1ARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Surervisor and returned 'to the Oui1ding Division
I HAVE CAREFULLY EXAMINED the comrleted application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work nerformed 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 1m OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my re~istration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the b 's for exem' . noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will bused 0 t 's roject.
I1AI-IE(please prinWEL- q ~EiES ~
.... FOP. OfFICE USE QllLY
DATE
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Zone Type/Const. ,
Units St"!. Ft.g. f1ain
Fire Zone Bedrooms Occy Load Sq. FtlJ. Access
Flood Plain Stories Occy Group 5q. Ftg. Other
x
Value
Value
Value
TOTAL VALUATIOtl
PLU!1BING PERMIT
Charges and
Surcha rges
Plan Ck. Comm/Ind
____________ ~/B'da Ppr Fee
Plan Ck. R'es
30%lBldo Per Fee
,'-<'D ex.:.> Fence
__'-d. \ ~~l)- Demo
--15_.~__- Sidewalk
. '\C::; AIC Paving
Curb Cut
. Sys te, ms Deve I opment I
Charoe (1.5~) .
BUILDING PERflIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
flECIIANICAL PERMIT
Charges and
Surcharges
Total Comb. Permit
TOTAL
L\!1.~S
,
,
.
.
..;
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
\ \-30-~
?- \ tf'L.oO
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinQ/or forced air Q3S.
2. exa~le- waterheater/electrlcal/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. example - remodel existing garage into family room
3. exam.,ple - 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 ANO 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
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.
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 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.
,
V. FOR OFFICE USE ONLY
. )
C1erkd)(llL)
Permi t
.
I
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