HomeMy WebLinkAboutPermit Plumbing 1986-11-18
Job Address
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CITY UF SPRIIIGFIELD
COIlBlIlATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
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'jlllSPECTIOl1 LIIIE
726-3769 ,
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I. Ranqe
I Valu, of Hark:
INfORlIATION LUlt
726-3753
Sq. Ftq. I.iain
~q. ~tg. Access.
So, Ftg, Other
Ilew Add ~.1ter ~ep,
--Fence Demo Change/Use
Other - -
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legal Description
Owner
Address
B~~~vpa Pen111t Info: Oeser be I'Jork!JJ11.e.. B 11d Single
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cY f-/jii;ie;:jJ ~ 1.1//:-' # ./
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Construction L~der
Address
lJt:.::ilGrl Il:.Nl
lnamel
Phone
(address 1
f 1 les. no. \
(exo; res.)
(nhnn~ no. l
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Primary
Structura 1
Electrical
:-lechanical
CONTRACTORS
(name)
(addrf>ss)
(1 ;r<; no.)
(pl(l)irps'
(ohnnp nn.l
Genera 1
Plumb;na
t:J.wru /L/
Electrical
t.lechani ca 1
PLUIIBUIG
ELECTRICAL
MECHANICAL
ilO.
Each single fixture
FFF r:HARGF tm ~~~ nlAQr,r 1m.
Residence of furnace/burner to
sq, FT. BTU's
I ~rr rl-l.llpr,r
I
Relocated building
(new fix. additional)
S.F. Residence
(I bath\
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
SO;lrp hp~tpr ~nrl vpnt
\.-!ater service
Sewer I
Storm Sewer I
, I
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(S~
IOf
COMM,/INO, FEEOERS
Install/alter/relocate
rl;c;trih_ fpprlprc;
amps.
I Apol iance vent
c;.eO;lrrlte
I Stationary evap.
cooler
I Vent fan wi th
c;innle duct
Vent system apart from 'I
heatina or A.C.
1"lechanical exhaust
hnod n nd dud
Wood stove/heater
Add it i ana 1 ba th
Temporary Construction
Change in existing
rpc; i (tE'nc~
Imultifamily. comm. or
Inrluc;tri;!l
Of
amps.
J/6
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I ISSUANcr OF PFR'IIT
(_c:::-_ 6 0 I TOTAL CHARGES rOTAL CHARGES
thai tile Electrical work be done by an Electrical Contractor. the electrical rortion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
HHERE STATE L1W REqUIRES
shall not be vali~ until the
I HAVE CAREFULLY EXA~1INED the completed ap'p1ication for germit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the. Ordinances of the City
of Soringfield and the laws of the State of Oreqon pertaining to the work described herein, and that IW OCCUPAIlCY 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 ORS 701.055. that if exempt the basis for exemDtion is noted hereon, arid that
only subcontractors and employees who are in compliance with OP.S 7~1.055 will be used on this project.
C~
print) ~O \0
SIGilATURE .O~ t!i:/~
D~TE
1(-(3-Y'f-,
ilMIE(please
FO~ OFFICE USE DillY
Zone Type/Canst. Units Sq. Ftg, t1ain
Fire Zone Bedrooms Occy load So, Ft!!. Access
Flood Plain Stories Occy Group Sq, Ftg, Other
x
x
Valul;'
Val ue
Value
x
TOTAL VALUATION
BUILOING PERI.IIT
Charges ane
Surcha rges
Plan Ck, Comm/lnd
65%/R1da Ppr Fpe
------------P'ian Ck. Res
30X/Bldo Per Fee
-' ~~ tyl) I Fence
----- .-:'W-I Demo
Systems Development
Charqe (1.51.)
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICft.L PER':IT
Charges and
Surcharges
Sidewalk
11ECHAN I CAL PERMIT
Charges and
Surcharges
A/e Paving
I Curb Cut
------------
I
Total Comb. rermit
TOTAL
JS.IoO
,
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
]1 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. exam~le- heat/electrical ceilinqjor forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, ete. -
1. examole- 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. 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, OESIGN TEAM AND 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 OIVISION SrAFF WILL FILL our ALL FEES AND
CHARGES ON THE SCHEDULES
0, As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.~ 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.
3~ l~;20
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V, FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant 'exemp,tJrcim registration with the Builder's Board because:
Additional Project Information:
j
PLANS REVIEWED BY:
signature
date
name
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