HomeMy WebLinkAboutPermit Plumbing 1988-6-29
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CITY UF SPRINGFIELD
COMBINATION APPLICATIDN/PERMIr
EilERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of 1,lork:
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INFORlIATION lINo
( '~b~j/;)J )
Sq, Ftg, flatn
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep,
--Fence Demo Change/Use
Other- -
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'1 INSPECTION LINE
726-3769
Job Address :J 5"-:<5' ~WA' r
Legal Description /7...o"3-::l< -"2.0.
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Owner
U/~A.c.. (VN/,&s",6 % 57>>7/6.#)
Address
Phone
Builo;no Permit Info: Describe Work{i~e," Build Single
Familv nes;dence With Attached Garaae)
Vi97J.d/..S# 25;S7/A"Zrl ~Y/ CE
~"'7"..,.-..y -~ ~-J-.~ ~
h'::;;~):&P O~Y:~'-;?,/:> Uv.,S,
flies. no.) (exoires) (ohane no.,
Construction lender
Address
DES I GN TEAr1
(namel
Phone
(address)
Primary
Structural
Electrical
f/j"tt ~ ~DU
Mechanical
-CONTRACTORS (name 1 raddress1 Jl;,<- no,l
//e>;;;e;> ~.c ~ /I:L>
General ~/.H ~/S7D-44VA"Z''''''''': ~=--1.....,,;t!?- <7::>?<U::
Plumbino
(pxnire~) (ohonp nn. \
t:::b/-9c~
Electrical
_ A
l/ IV/
~'echanical
PlmBIllli
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE Nn
~H r1-l;&G[ NO ^
H"!=, r~~
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fixR a~itional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S, F, Res idence
(1 bathl
Duple. (I bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
'f<-J
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ITempOrary Construction
IChange in existing
rp"jdp':nr:~
Imultifamily, COIl1Tl. or
Innu<;.trial
IOf amps.
ICOffi1,/IND, FEEDERS
I Install/alter/relocate
rli,trin_ fpprlpr,
IOf amps. I
I
I
I
Appliance vent
Sf'!oarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust 1
hood and dUI".t
~lood stove/heater I
I
I
I
~Iaterserwice
Sewer
Storm Sewer
I 'SE;.,,-~?<'if7"
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V'-t'
ISSUANCF OF PFRr1lT
TOTAL CHARGES
, WHERE STATE L!\lJ REQUIRES
shall not be valii until the
/.5":- ,TOTAL CHARGES rOrAL CHARGES
that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supf'!rvisor 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 rw OCCUPAHCY will be made
of any structure -"thout the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full f3fce and effect as required by ORS 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 7Ql.055 will be used on this project.
Zone C. ,/
Fi re Zone
Flood Plain
lyoe/Const,
Bedrooms
Stories
Units
Occy Load
Occy Group
SIr.IIATURE
FOr. OFFICE USE OIIL Y
Sq. Ftg.
Sq, Ft9,
Sq, Ftg,
j2~
OATE ;:; -"'2- 'j~<i
IWIE(please print)
11th
;(M'll?
-
t1ain
Access
Other
x
x
x
ValuE'
Value
Value
rOTAL VALUATION
BUILDING PER/<1lT
Charges and
Surcharges
Plan Ck, Comm/lnd
65%/Blda Por Fee
Plan Ck, lies
30%/Blda Per Fee
Systems Development
Charqe t!.5~)
PLUI1BING PERMIT ----_!~~- Fence 1
Charges and ('
Surcharges -7.5 D~o \\1 /Ef. 9"
ELECTRICAL PERI~IT I'Sldewal k I
Cha rges and ------------ I A/C Paving ITotal Comb.
Surcharges Permit
MECHANICAL PERMIr I Cu"rb Cut I .
Charges and ------------ I I TOTAL ~ <f,~5"
Surcharges
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COMBINATION APPLICArION/PERMIT (CAP)
..-:........
"
I. Applicant to furnish
A, Job Address
B, Legal Oescription
1, example- Tax Lot 100, Lane County Map Reference
II 03 43
2, exam~le- Lot 1, Block 3, 2nd Addition to
Ie Springfield Estates" '.' ~ -, (" I'
C.""' Name-, eec. of owner and' constr~ucti'on'-lender' .
D. Energy, Sources' . . .' ,'_ T'
'1. ,examEl'e. 'heat/electrical 'ceil inqJor forced air Qas
. '. .,}. example- .wa,terh,~at.er/electr1ca I/...qr. solar:~,
~ r::T. """:Square' footage' or-valuation, etc. -, .
1, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project, check-n€w - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam2le - 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 Cod~'~'..F; ~.". - '.; '~'-' .';:.
',' ".H,'\'OESIGN 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
tp 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, BUILOING DIVISION STAFF WILL FILL our ALL FEES AND
CHARGES ON rHE 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,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.
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V: FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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,', .PERMI,T, ~ALIDAJION
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12.E"~EIf"-r II '1; ~I
Permit Clerk a, ~~l",,_,
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" \: :Permit appl icant exempt 'f.rolll}egistration with the Bui1de~'.s B~ard b~c;lU~e:
Additional Project Information:
PLANS REVIEWED BY:
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name
signature
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date
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