HomeMy WebLinkAboutPermit Plumbing 1982-12-6
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INFORlIATION LINt
726-3753
Sq, Ftg. 1,Iain
:q. Ftg. Access.
Sq. Ftg, Other
Ilew Add Alter P.ep,
-Fence Demo Change/Use
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Legal De,cription 1,-0<'-::>'5-31- ID'100
CITY UF SPRINGFIELO
COI1BIiIATION APPLlCATION/PERMIT
E!IERGY SOURCES:
Heat
\-la ter Hea ter
I INSPECTION LlIIE,
726-3769
Job Address
Ranqe
ValuE of Hork:
Owner. .?~ sr ;.::Ltch IMd LA
Address S3S rnt1.~.....
?~"..."O! O?
BuilciinQ Pennit Info: Describe 14ork{Le., Build Single
Family nesidence With Attached Garaoe)
,l(~P.l;R W,fI.,r=,... _J~v'C~ ,,'
~~c r= S:Z:J~t:tA9c..~
Construction Lender
Address
DESIGN TEAll
(name)
Phone
(address)
(1ics.no.\
(exoires)
(OhOM no.
Primary
*
Structural
Electrical
!1echan i ca 1
CONTRACTORS
Plumbino
~ name)
Se.l0
, <:: '!-Ii?
(addrpsd
(lies. no. \
(exoi ree;.)
(ohone no.)
Electrical
I
_ r c."...~ I.lJ,J/J4_e
l
, t.J? -o30?
Genera 1
~'echan; ca 1
PlUlIBlIlG
ELECTRICAL
MECHANICAL'
NO,I
Each single fixture
I FEF I rW\Rr,F NO I
Residence of
I ~~~ 1...ctlARG..E. NO I
furnace/burner to
SQ, FT. BTU's
I ~~~ I 21ARGE.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (I bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p ~p~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
~eD~r~tp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnrl ~nd rlu~t
~Iater servi ce
>
Temporary Construction
Change in existing
re}id~n;p
multifamily, comm. or
Inrlustri~l
Sewer
CO~1,/IND, FEEOERS
Install/alter/relocate
rli~tr;h fpprlpr~
Wood stove/heater
Of
amps.
ISSUANCE nF PFR!lIT
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 pemit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED 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 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 rw OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 compliance with ORS 7Ql.055 will be used on this project.
IIAf.IE(please print).Ga"", lLJ,II,c;.Iow' SI('IIATURF~~ IA)/t?~
FOr. OFF I CE USE OIlL Y
Sq. Ftg. riain
Sq. Ftn. Access
Sq, Ftg. Other
DATV.! ~ -PL
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Stories
x
TOTAL VALUATION
BUILDING PER~IIT
Charges and
Surcharges
Plan Ck,
65%/Bldo
------------ Plan Ck,
3D%lBldo
_____s-'. ~ Fence
. ~c:o D~mo
I.Sidew.al k
I A/C ~avin9
CorranlInd
Per Fee
Res
Per Fee
Isyste.ms Development
CharQe (1.5~)
PlU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
/lECHAN I CAL PERMIT
Charges and
Surcharges
-;;.--
Total Comb. Permit
Curb Cut
TOTAL
1"< . ~e>
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COMBINATION APPlICATION/PERMIT (CAP)
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I. Applicant to furnish
A, Job Address
B. Legal Description
1, example- Tax lot 100, lane County Map Reference
1/ uj 43
2, example- lot 1. Block 3, 2nd Addition to
Springtield Estates , ."' \
C. Name, etc. of owner-and construction lender'
D. Energy Sources ,
1. . example- heat/electrical ceiling/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-nfw - if addition,
check. add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examale - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (al of the
Structural Specialty Code
H, DESIGN TEN1 ANO 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(sl 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. I f the item( s) to be ins ta 11 ed 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. ---
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
ifc Pf. #- ~(X> 5''1
Permit Clerk
4~
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Permit applicant ,exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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'Si;nature~ -
name
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date 12.€-e ~
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