HomeMy WebLinkAboutPermit Plumbing 1983-5-9
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Construction LendJ}
CITY UF SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork:
INFORlIATlON LINt
726-3753
Sq, Ftg. I'lain
~q. Ftg. Access.
Sq, Ftg, Other
flew Add Alter Rep,
--Fence Demo Change/Use
Other -- --
I INSPECTION LINE,
726-3769
Job Address 5'70 (t:lo.."..t.wJ
Lega 1 Descri pt i on \ '1 () '5 d." ) (D rj ~:.;o l
Address
Ot~lGN ItAI1
Phone7u7- 17' _ Builciinq Pennit Info: Oescrlbe Hork( he" Build Single
7 1G4' FamilY nes;dence With Attached Garaae)
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(name)
Phone
(address)
(lies. no.'
(exoires)
(phone no.- J
Primary
Structural
Electrical
(name)
(address)
(lies. no.)
(exn;res)
(ohone no.)
Plumbina
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General
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Electrical
~lechan;cal
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PLUIIB I NG
ELECTRICAL
MECHANICAL
Each single fixture
I FEE I CHARGE Nn..o..-I I ~FF I rH~ -1:l..O...-1
Residence of furnace/burner to
SQ, FT, BTU's
, IIL '.cHARGE.
NO.1
Relocated building
(new fix, additional)
S,F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp hp~tpr ~nd vpnt
Storm Sewer
Of
amps,
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
, rp~ j qPJll".P
Imultifamily, comm. or
Tnnuc;tri"l
\<Jater service
COffi1,/IND. FEEDERS
Install/alter/relocate
r1i~trih_ fpPr1pr~
Of
amps.
ISSUANCE OF PFRlllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
. WHERE STATE L'\~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical 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 UO 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 OPOS 7Ql.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Slf~M~~/ ~.-/ DATE'>-=.9-8'.:3
FO~ orFI~lLY .
Sq. Ftg, liain
Sq. Ft9. Access
Sq, Ftg, Other
x
Value
Value
Value
IW-IE(please print)...(~"'V,q. ro/
..
SfAjc,/fJ
x
x
TOTAL VALUATION
BUILDING PER/lIT
Charges and
Surcharges
Plan Ck, Comm/lnd
65%/Bld~ Ppr Fpp
Plan Ck, Res
30t/BldQ Per Fee
Fence
Systems Development
Charqe (J.5~) ,
PLUI1BING PERMIT
Charges and
Surcharges
D~mo
_ ___ _ _ ___ __J .Sidewalk
I A/C Paving
___________J Curb Cut
I
1'6.00
ELECTRICAL PERI~IT
Cha rges and
Surcharges
IIECHANICAL PERMIT
Cha rges and
Surcharges
Total Comb. Permit
TOTAL
\'&.~O --.J
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COMBINATION APPLICATION/PERMIT (CAP)
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
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air oas
2. example- waterheaterjelectrical/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 gari~ge
2. examyle - remodel existing garage into family room
3. exa~le - 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 TEM1 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 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
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PERMIT VALIDATION
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Permi t Cl
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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perm?t app 1 i c~ I. exempt ~ from '/egistrati ~n with the B'uil der I S Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name
signature
:j, .,~-~.
1
date
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