HomeMy WebLinkAboutPermit Plumbing 1985-3-5
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INFOR/1ATION ll,\t
726-3753
Sq. Ftq. 1.la i n
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add A Iter Rep.
--Fence Oemo Change/Use
Other- -
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Owner l((.G:;~NM/n:r _Uv~LCP~ehr
Address ?.I!:)."B::>x f/V.L ./ Phone
Z:4!f..4N'& CA.. 1''9/~)~.~;Z/;)' ~V/~ ~1'"A'/AI.s.
C;nstruction Lender . ~D!'it::.A.P/.N4 .
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of tl~: oO~
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Bu;ldinQ Perm;~ Info: Describe Work(i~e" Build Single
Familv n.esidence Hith A.ttached r.araae)
Lc:T' -/
Address
Ut>luN ftAI.'
(name)
Phone
(address)
(l;es. no ) (e~..;res) (phone no. \
'J""1II't: ;.c.cRSd- ~? .,'C- ~ "'~ - /;,?O
Primary 'S4t...,,e,,AI p~~,?~-.e, /NC, ~ ~~LJ.&;:::. Gcz.. ~~. 6>r'.-
~"r~"No, ."v;~ /NIt::.. . ~r:9. ~x 'S";2<f8 ;rl-.,.,/N~ <:A. ("9/,.;.:):::?2/-l/gSS"
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Electrical
Mechanical
CONTRACTORS
(namel
(address)
flics.nn_'
(fI'xoirps'
(I)hnnp nn \
Genera 1
Plumbina
Electrical
~1echanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FFF
l":HARr,E
~LI I ~~r:
I Res i dence of
SQ. FT.
I'New circuits alts.
or extensions
I SERVICES
I
r"@.Gf. .llO.....i
furnace/burner to
BTU's
I..fFF
I
r"@.Gf.
Each single fixture
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F. Residence
(1 bath\
Duplex (1 bath) each
IAdditional bath
1~later service
I Sewer
l Storm Sewer
Recessed wall
~n~rp hp~tpr ~nrl vpnt
II"
!remporary Construction.
IChange in existing
re-Oj j rly.ncp
Imultifamily, COntrl. or
Inrluc;triil.l
IOf amps.1
ICOffi1./IND. FEEDERS
l'Install/alter/relocate
rli<:trih fppnpr<:
~.79th'.n:~
I~-
I
I
I
/ t:?,tH>
Of
amps.
Appliance vent
seoaril.tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
I' Mechan i ca 1 exhaus t
hoorl il.nd durt
I Hood stove/heater
I
I
I
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANcr OF PFRlllT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State .of Ore~lOn pertaining to the work described herein, and that flO OCCUPAUCY 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 comoliance with ORS 7nI.055 w~ ~
NAt.IE(please print) c-'R;e/-4~'" ('~I?r-* SIr.IIATU~~ (_ ......".~ DATE '3-/7-,$6
FO~ OFFICE USE-orrrY
Sq. Ftg. 11ain
Sq. Ftg. Access
Sq. Ftg. Other
Tvoe/Const./lI"'~~
Bedrooms
Units
,
Value
ValuE'
Value
Zone
Fire ZonE'
Flood Plain
Stories
Occy Load
Occy Group
x
x
TOTAL V ALUA TI Ofl
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Blda Ppr Fpp
------------PTan Ck. Ifes
3D%/Bldo Per Fee
1t?..e> Fence
____4-I,i_~____
. 'It:!? Demo
5'''. 80
Systems Development
CharQe t1.5~)
PLU'1BING PERMIT
Charges and
Surcharges
/1ECHAN I CAL PERMIT
Charges and
Surcharges
A/e Paving
, , I Curb Cut
------------1
'1'7. ..0
I
I
Irotal Comb. Permit
I
I TOTAL
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It):? ejd
16.4.~ -~
ELECTRICAL PERr~1T
Cha rges and
Surcharges
Sidewalk.
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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
II 03 43
.2.. exam~le- Lot 1. Block 3, 2nd Addition to
:sprlngt:ield Estates
C: Name. etc. of owner and construction lender
D. Energy Sources. r .'~ "': ~ ,
1. example- heat/electrical ceilinq/or forced air qas
2. example. waterheaterjelectrlcal/or solar
E. Square footage or valuation, etc. -
1. exam~le- 1250. sq. foot house, 500.sq. .foot garage.
2. '"exa-mple- jf newproje~t.\ check"new - if addition'."-
check add. etc.
, F. ,Bui.1ding:pennit .information:.. ~ '.~' '( '"
1. example - construct single family house with an
attached garoge
2. examyle - 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 Code
H. DESIGN 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
fu 11 schedu 1 es
C. BUILOING 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. ---
Ill, 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permi t C1 erk
t
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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