HomeMy WebLinkAboutPermit Plumbing 1986-12-4
'\INSPECTION LINE
726-3769 '
, Job Address ;;i t7 () </ ~., _,.'
Legal Oe5cription L tj rr:s;2,:) fi5'f)
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Owner r:f3--j; m~o-J7.
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Address 1/8'S- /.-.;-y- 91'.-"V.
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CITY UF SPRlilGFIELO
COI1BliIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
o L ;:3 (YO rlater Heater
RanQe
Valu, of I'/ork:
ltlFORl'A Ii O~1 U :it.
726-3753
Sq. Ftq. I'iain
~q. ::tg. Access.
SQ, Ftg. Other
Uew Add Alter fl,eo,
--Fence Demo Change/Use
Other - -
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Phone~;;";;>
BuilciinQ Pennit Info: Describe l'Jork(Le.. Build Single
Family P-esidence IHth l'l.ttached llaraoe) J
1~bt1.dC~/j)A../..// ~
{J/.e(..J U-6 (f
Construction Lender
Address
DES I GII TEArl
(name)
Phone
(address)
(1 ics. no,)
(exn; res)
(ohane no, J
Primary
t-lechan;cal
CONTRACTORS
{name}
C11,0I) ~C{OO
, ..~ /
... I'}es
Structura 1
Electrical
(addres.c::)
(l1CS. no.'
((.>xoirpc::\
(ohn'1f'l M ,
General - A /1
Plumbino {J,-L d ;./h~ j)f5t). r;,,' ~t.uf)j,M..t-V-
V iJ
Electr;aa-
,.;}CJ-/b9 f'B
r,lechanical
PLU/1BIIIG
ELECTRICAL
MECHANICAL
ilO.
Each single fixture
FFF cHARr,F ~I ___ _ <:EL1J:'HARGl -1'0
I R-esidence of
SQ, FT.
INew c.ircuits alts.
or extensions
I SERVICES
furnace/burner to
BTlI's
I <:EL J:llARGl.
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F, Residence
(1 bath)
Duplex (1 bath) each
Additional bath I
~!ater service I
Sewer I
Storm Sewer I I
/6~!~ 3.""d%w I
. . - ,;
( ih..t.~ /i;? I
I
Recessed wall
Sn~,p hp~t~~ ~nrl vpnt
Temporary Construction
Change in existing
rpc; i rte>n,p
multifamily. comm. or
TnrllJc;tri~l
IOf amps,
I COI~'1.IlND, FEEOERS
I Install/alter/relocate
riic:trih fpI'>ril'>rc:
Appliance vent
.seo~r.i'"t!" _
Stationary evao.
cooler Y ,
Vent fan \'ii th
sinole durt.
Vent system apart from I. -
hp.atinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Of
amps..
,
/)!I'\.
f '1
I SSUANCf OF PFR'\IT
TOTAL CHARGfS
WHEnE STATE L~W REQUlnES
shall not be vali1 until the
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed, by an Electrical $urervisor and returned to the Building Divi~ion
I HAVE CAREFULLY EXMllNED the completed application for !Jermit. 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 Orel]on:'oertaining to the work described herein. and that tJO OCCUPAr~CY 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 basis for exemotion is noted hereon, and that
only subcontractors and employees \'iho are in comoliance with OP.S 701.055 \'Iill be used on this flroject.
IIAllE(please print) ~/l11J ,4 .f)tf(/S....;v
S IGIIATUrJ'd0'1-'_/,I. u:>rko,A) D/3/f k d}(N~/}Jkm /2/i/ffb
FO~ OFFICE USE DilLY
Zone Tvpe/Const. Units Sq. Ftg. t1ain
Fire Zone Bedrooms Oeey load SQ. Ftg. Access
Flood Plain Stories Occy Group Sq. Ftg, Other
v
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERI.UT
Charges an~
Surcharges
Plan Ck. Comm/lnd
____________ 65%/BldC1 Ppr Fp~
Plan Ck. Res
30%/B1de Per Fee
------l5;k~~1 Fence
t! ,(Ji) Demo
ISyste.ms Development
Charoe (1.5~)
I
PLU'1BING PERMIT
Charges and
Surcha rges
..E,ECTR/CP,L PERI:IT
Charges and
Surcha rges
_/ --
11ECHAN I CAL PERMIT
Charges and
Surcharges
Sidewalk
I A/C Pavi ng
,J Curb Cut
____________1
Total (omb. rermit
TOTAL
/5 to
-
.,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,
1. 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
D, Energy Sources '
1. examole- heat/electrical ceilinqlor forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 12SD sq. foot house, SOD sq, foot garage
2. example- if new project. check-new - 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 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 wi,ll 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
signa ture.
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.
Ero71rt
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V, FOR OFFICE USE ONLY
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit,.applicant'exempt from registration with the Builder's Board because:
Additional Project Information:
~
PLANS REVIEWED BY:
1
name
signature
date
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