HomeMy WebLinkAboutPermit Plumbing 1983-4-25
I IrISPECTION LINE. .~ CITY Uf SPRINGfiELD
726-376g COMBIIIATlON APPLICATION/PERMIT
Job Address /"J /L/ ,,~~ ~ -, L/.,/ ~ E!IERGY SOURCES:
/~/ 7" .;A/f - - d. ~. Heat
Legal Description \fl D?,2.2.00 O'Z~ I/ater Heater
Range
.
INfORllATION LINt
726-3753
Sq. Ftg. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
Q()
(jJ
16"
,(jJ
U
J
Owner '7n;'-..e./' e~~- ~d
ValUE of I/ork:
Address
Phone
Builriino Permit Info: Describe Work(i-.e.. Build Single
Familv Residence With Attached Garaqel
Q0 ri - alLuntl:u ft5
JJ~j/LJ/l,'/\ +ri
() ~rria.O hfda
(lies. no.) (exOires) d (phone no.'~
Construction lender
Address
DESIGN HAI1
(name)
Phone
(address )
Primary
Structural
Electrical
Hechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(exoires)
(ohone no. l
Genera 1
Plumbina
JJ ~,. PL 8 t: /lYC- ep. 8D ~.2/ 8"
/~9
8//.1/::..1
~8S-DSSl
Electrical
~'echanical
PLII!IBING
ELECTRICAL
MECHANICAL
NO.
FEF r.HARhF .n
~~~ r~AQr.~ Nn
I='~I=' rl-IAlu:r
SQ. FT.
furnace/burner to
BTll1 S
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~~P hp~tpr ~nrl vpnt
Storm Sewer
"2! .4. .~
/ J.J. u.
Of
amps.
Appliance vent
5~o!lri'!;t.p
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and dUr't
Wood stove/heater
~Ia ter serv; ce
Temporary Construction
Change in existing
fP'i jrlJ>nr'P
multifamily, conm. or
Tnnu"trial
Sewer
:>
ID.~
.s.06
COMM./INO. FEEDERS
Install/alter/relocate
dhtr;b. fppdprc;
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQIIIRES
shall not be valij until the
ISSUANCE OF PFRllIT
/'7. C:C. 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 Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMllNED the completed ap[llication for permit, and do hereby certify that all infonnation 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 Springfield and the laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAI~CY will be made
of any structure without~the1Permission of the Building Division. I further certify that my registrat;on with the Builder's
Board is in full forceJand e "ct as requir$4 by ons 701.055, that if exempt the basis for exemption is noted hereon. and that
:~::(::::::tractors and : ~~comDliance with :::N:::~:55 will be used on this project. OATd ~~~~
... FOr. OFFICE USE DIlLY
Type/Const. Units Sn. Ftg.
Bedrooms Occy Load Sq. Ft9.
Stories Occy Group Sq. Ftg.
Zone
riain
Access
Other
x
Value
Value
Value
TOTAL V ALUA TI ON
Fi re Zone
x
Flood Plain
x
BUILDING PERIIIT
Charges anc
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr ~pp
------------ Plan Ck. Res
30%/Bldo Per Fee
_____1.~,J::()_ Fence
. ffl 0 06mo
IsystemsDevelopment
Charoe (1.5~) ,
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
'Sidewalk
A/C Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
45. (o()
.
Curb Cut
.
.
,
~
..
'.
COMBINATION APPLICATION/PERMIT (CAP) \
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le~ heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example. if new project. check:ruew - 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. 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 AND CONTRACTORS
. To avoid design or construction delays, Building
Divisibn 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.
WJ I.G\~
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.
V. FOR OFFICE USE ONLY
Permit Clerk (lL
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board b~cause:
Additional Project Information:
PLANS REVIEWED BY:
I
name
signature
date
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