HomeMy WebLinkAboutPermit Plumbing 1988-7-29
III""" ,-,
I INSPECTION lINE
726-3769
.
CITY UF SPRINGFIELD
COMBINATION APPlICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range_. _... '_
ValuE of Hork:
.
04
oC.
o
0-
~
INFORllATlON UN<
726-3753
Sq. Ftg. I.la i n
~q. Ftg. Access.
Sq. Ftg, Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
Other- -
Job Address
"
s~S""
M",,:,
LegallOe5cription
,
. ~)I'I/lCPX:" ~Lqtd (\j.- h
o~ner./'-M.tgy-I trl-\I U
Add{ess I 'b 5 r .N'r-'A UY' I ~ \~
Euqel-UL {)/L. 9'1<165
Construction Lend/r
Address
Ut:;)lliN TEAr~
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name I
Genera 1
X Plumbino U+PIl5~X\ f1',ll1Lb;')l,'1
Electrical
~1echan;cal
PLUI1BING
NO,
FfF rHARr.F NO
Each single fixture
Relocated building
(new fix. additional)
Is.F. Residence
t1 bath)
IDuplex (1 bath) each
Additional bath
~Iater service (eQ1Lr'
U'
~
/5.CJJ
I Sewer
Istorm Sewer
I
:ill
[
Phone:>":> ",/_Builciino Permit Info: Describe Work(Le.,
<L'lJ-tLlJFamilv nesidence With Attached Garaoel
WA..~ ~.e..Vv:c.-'L
Build Single
,
V-."" .Aat'\., V-
CJ
Phone
(address)
fl ics. no.)
{exoiresl
(ahoM no.)
t:)~~, s ,vO '-l.J\
v
(addressl
(l in. no. l
(pxnirpc:.\
(ohoop nO,l
'15.Q':, UJ (" &
S'1C2.11>?<c
\
';261fo,;)oo
:545 955"1
ELECTRICAL
MECHANICAL
J:'~J:' rliARGE. Nn
H~ rl-l~
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~~p np~tpr ~nn ~pnt
Temporary Construction
Change in existing
rp'liopnrp
"multifamily. comm. or
Inollc;tri.11
IOf amps.[
ICO~1./IND. FEEDERS
[Install/alter/relocate
ni~trih fpprlpr~
IOf amp~
I
I
'1
Appliance vent
~po~rat.p
Stationary evap.
cooler
Vent fan with
sinole duct
1 Vent system apart
heatin(1 or A.C.
I'Mechanical exhaust
hood .1nd dud
[ l'/ood stove/heater
I
I
I
't>..A
A'~'
'If
from
ISSUANCf OF PFRlllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\\j REQUIRES that the 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 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 OCCUPAI~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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in complian~e with ORS 7nl.055 will be used on this proj t.
~ (P~ A. ~k~ SIGIIATUR
I FOP. OFFICE USE OIIL
Tvpe/Const. Units Sq. Ftg.
Bedrooms Occy load Sq. Ft~.
Stories Occy Group Sq. Ftg.
NN1E(please print)
Zone
Fire Zone
Flood Plain
BUILOING PERNlT
Charges and
Surcharges
PLUHBING PERMlI,(." JC .CD
Charges and....... ---- ~
Surcharges I '1~
ELECTRICAL PERIHT
Charges and ------------
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
1/z.C/ )]3;
. . I
~TE
~
fiain
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
Plan Ck. Comm/lnd
65~/Bldn Ppr ~pp
Plan Ck. Res .
30%/Blda Per Fpe
Fence
syste.ms Development
CharQe (1.5~) .
I
I
I
DOffio.
.Sldewalk
A/C Pavi ng
I Curb Cut
I
ITotal
I
I TOTAL
Comb. Permit
)1:) 12
.
.
.
COMBINATION APPllCATION/PERMIT (CAP)
,- -
I
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. ~xample' Tax lot 100, Lane County Map Reference
17 03 43
2. examEle' lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. exa~le- waterheater{electrical/or ~
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. exam~le - construct single family house with an
attached garage
2. examole - 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 TEAfl 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. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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 Permit Cl erk
'l2eDL'rY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
d. G? ~o---
/200'2.- 1/z.ql15 ;-
Permit applicant exem~t from. registration with the Builder's Board because:
Additional Project Information:
'.
PLANS REVIEWED BY:
. name
signature
../"
-'
date