HomeMy WebLinkAboutPermit Plumbing 1985-6-20
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IrISPECTIOtl LINE
726-3769
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CITY UF SPRINGFIELD
COMBHIATIDN APPlICATION/PERMrT
EIIERGY SOURCES:
Meat
l~ater Heater
Ranqe
,
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Job Address -<jolt It/a_ /A)
Legal Description \{ln~~s.~\ rfl,\r:fJ
INFDR/IATION liNt
726-3753
Sq, Ftg. 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
tlew Add A Iter ~ep.
Fence_Demo _Change/Use
_Other
~i, "J..t: .J'! _ Y.
L/ f'3 J/M)"A,///t1/AJ
~jJJ_td
Construction lender /
PLUlIB I NG
NO. FFE CHARr,F I:l(l
Each single fixture
Relocated building
(new fix. additional)
Is.F. Residence
11 bathl
Duplex (1 bath) each
Additional bath
I ~Iater service I
Sewer I
Storm Sewer I
? I !2t?r"kflt, P..Jvr...;Jr.t 5.00
/
I
I
Owner
Address
Address
Dl> t GI' IlAIi
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~'echani ca 1
(name)
(namel
G4," r...<. -I
. .J
No IL r. L,
V
ac:r hr.).(
Phone /It! 7
@>.23
ValuE of I-Iork:
Builriina Permit Info: Describe Work(i.e., Build Single.
Familv ~esidence With Attached ~araoe)
IYYnJJ Ur_ I ~V kJlthfcl
~~ /- ~fJax./
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Phone
(address)
no. (
(1 ics. no.)
(exniresl
.*
(ohone
f'addrpss 1
(l ir.s. no.)
(pxnirps)
(nhnnp nn. )
PILl/fA In /1 j
bY? /lfC/'<>j;"l.y ~5"/!~JttM c'tjoi'J
'(I-z1 pa~/q;/~< ?f./(./2'1/
ELECTRICAL
MECHANICAL
~~~ r1:fAR.GL Nn_
I...EEL .c.HAIlli.E.
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
Recessed wall
~o~~p hp~tp~ ~nrl ~pnt
ITemporary Construction
IChange in existing
rps- j qp.,nrp
/multifamlly, comm. or
Industri~l
I Appl iance vent
seoaratp
I Stationary evap.
. cooler
I Vent fan wi th
sinole duct
I Vent system apart
heatino or A.C.
IMechanlcal exhaust
hood ~nd duC"t
I I-Iood stove/heater
I
I
I
from
Of
amps.]
COMt.l.flND. FEEDERS
l'lnstall/alter/relocate
.distrih_ fpprlprs
IOf amps.
ISSUANC, OF PFRI1lT
TOTAL CHARGES It) ,00 TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\l/ REQUIRES that tile Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN11NED 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 110 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 DRS 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
SIGtlATURE l/,&/.-r! ~i
FO~ OFFICE USE DilLY -
So. Ftg. tlain
Sq. Ftg. Access
Sq. Ftg. Other
IlAl'IE(please print)
Zone
Fi re Zone
Flood Plain
BUILDING PER/lIT
Charges and
Surcharges
PLUl1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
___________._~/Bldo Pj>r Fpj:i
Plan Ck. Res
30%lB1 da Per Fee
_____L/2~Qf?_ Fence
, 10 Demo
___________J Sidewalk
I AIC Paving
___________J Curb Cut
I
/V11"';/",
RJrL
TYoe/Const.
Bedrooms
Stories
DATE h -Jo -Y..(
Units
Occy Load
Occy Group
,x
Value
Value
Value
,
x
TOTAL VALUATION
Systems Development
Charae (1.5~)
I
Total Comb. rermit
I TOTAL
16~.Z/b
1
,
,
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. I
#- ~?c;e63!
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II U3 43
2, example- Lot 1. Block 3, 2nd Addition to
~prlngt;eld Estates '
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole~ waterheater/electrical/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 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. 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
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.
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V, FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.'
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
signature
date