HomeMy WebLinkAboutPermit Plumbing 1989-6-13
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InSPECT lUll L1iH.
726-3709
Job Address
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I.eqal Oe~cription
?wn~r. ~C:-?? /5:),1;" rc
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.\Mress 4/4/8);>j '"?......
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Construction lender
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Primary
Structura I
Electrical
!1echanical
CONTRACTORS
LIlY III SI'f1llllif I llU
CO/IBIl/MION APPliCATION/PERMIT
E!/ERGY SOURCES:
Ileat
Hater IIcater
Ranl1e.
Va I~' of H.'''''-
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Bui It;inCl lermi t Info: Describe Hark( i.e.. Oui Id Single II ~
f.lr.lilv f!es enc(' \lith J\ttached r.araoel 'J
.4~~"'c ; fiR. :":. :~. <; ? /,:!:.....y__~
'OV1/M t/ &<:=-/" z> ;:c;c~C?_ .....-;.-A<::c.........?::5
LEAi 'e
1 ics. no.
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flfOR/IAT; .:1 ll..:.
716-3753
Sa. FlQ. I':ain
~CJ. rtf). Access.
SQ. Ftq. Other
lIel1 Add Aller ~eD.
--rence Demo Change/Use
-Other -- --
no. I
Phone
address
(cxoirE's \
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\.Ihlme ,
(Ilhone no. )
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1-1...--.
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TOTAL CHARGES ~ ~ -6".... TOTAL CHARGES
HIIWE STATE L.ill R[QUII~(S that tile Electrical work be done by an
shall not be v"lH until thl1labcl has been silJned by an Electricill
Genera 1
Plumbino .0~5 ?CL;//?7i!!Q~
Electrical ;r'~..".,.,..< T> ") C"LFe/ \
tlcchitnical
PlUlIfiI IlG
::0. -IlL CIIARGE
? E~~~e fi~.tu::: ?-.5P <'2.;
_J W~~_~
IRelo-ca~ted buildilH]
(new fix. additional)
l.s.F. r.esidence
r I bathl
-IOuPlex (I bath) oach
IAdditional bath
I ~!ater service
I Sewer
I Storm Sel'ler
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Zone
Fire lone
Flood Plain
BUllOII/G PERIIIT
Chitr']es an~
Surcharges
I Floor furnace
::s".::l..9 . and vent
I I Recessed wa 11
,_ ~e...l1ill.er and
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~ '<?&> I TOTAL CIIARGES
(address )
ELECTRICAL
.lID.......
Residence of
SQ. Fr.
~INew circu~ts alts.
or extenSions
? &1:F( ~~&
/SERVICES
-,
I Temporary Construct ion
IC'lanqe in existing
r('.<;; d~nr~
Imultifamily, con~. or
I nrille; tri.~ I
IOf
ICor~I.!INO. FEEDERS
II ns ta II /a I tel"/re locate
rlie;trih_ f('prl('r<;
IOf amps. I
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amps./
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{ 1 ics. no.)
1-
..ilL .CIIARGf. .JIl!....
flECllANICAl
I.HL .CJIARGL .
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II
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furnace/burner to
BTll's
I Apoliance vent
<;'PO<lI'a,tP
I Sta'tionary evap.
cooler
I Vent fan \~ith
sinnle duct.
I Vent system apart from I
heatin~ or A.C
I ~lechanical exhaust
hoorl .Ind rl',r t.
I Hood stove/heater
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I SSIIANCF OF PFmll T
Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division
I
Plan Ck. Comm/lnd
____________ 6S!/BldQ Per ~pp
Plan Ck. fles
JO%/Bldo Per Fee
~ ~ -So. I Fence
-----/--;-3--1 Demo
~?-S-C>.. I Sidowalk
._n_/~/_;_-:-1 A/C Pavinq
I Curb Cut
I IIAVE CAI!EFULlY [xN1JrI[i) t~lc completed apf11ication for flermit, clnd do hereby certify that all information hereon is true
and correct. and I further certify that any and all \~ork nerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the St.lte of Drenon nert(1ininC) to the work'descrihed her.ein, and th<1t UO OCCl!PAIKY \~i 11 be made
of any'structure without the permission of ' the Bllilclin~ Oivision. I further certify that illY re!listration ...lith the Builder's
Ooard is in full force ,lnd effect as required by OI~S 701.055, ttl.lt if cxelllot the basis for exemntion is'noted hereon. and that
only subcnntr,lCtors and orn~lop~~JO iKRO~iL with O/'S 7"1.0S5 ,ill I be usod on this nrojocl.
lIA:IE(please ~rlnt) U -:J 11//_ . SIr.r/^TURE -~J' t1-<
V FO~ nrFI[~ IISE O:lLY .
Tyoe/Const. \Jnits Sf'!. HfI. '\ain
Bedrooms Occy load SQ. Ftrr. Access
Stories Occ.v Group 51'}. rtg. Other
Plu'm ING PERMIT
C~arges ilnd
Surcharges
. ([[CTRICf.l rERf:IT
CharQCS and
Surcharges
I1EClIAtlICAl PEP.lllT
Charges -and
Surcharl")es
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i//J/ a)
x
Value
Value
x
Value
TOTAL VAlOATIOll
x
Systems Oevelopment I
Char"e (1.5')
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ITotal (omb. rermit
I TOTAL
'17.26
'-l
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p
COMBINATION APPLlCATlON/PfRMIT (CAP) PERMIT VALIDATION
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I. Applicant to furnish
.A. Job Address
B. Legal Oescription
1. example. Tax lot 100. larie County Map Reference
II OJ oJ
2. eXclmnle- lot t. Block 3, 2nd Addition to--
~prln9fjeld Estales
Name. ctc.,of owner 'and construction lender
Energy Sources _ ,
1. exam,!le-'heat/electri~~.! ceilin.:!/or forced air Qas
Z. examele- waterheater{t!II!ctr-1Cil1/or solar
t." Square rootage or valuation: elc-. -
1. examale- J250 sq. foot house, 500 sQ. foot garage
.~.: exarup'le. if new project. checknew _ if addition,
Check add, etc.
F. Building permit information:
J. examole - construct sinyle family house with an
attached 9olr~ge
2. examale - remodel existing garage into family room
3. exanlllle - COuvert single filllJily residence into
restaurilnt (change of use)
G. Villue of ""ark as defined in Section 303 (a) of the
Structura 1 Spec iillty Code
H. Of SIGN TfNI ANO COIITRACTORS
To avoid design or consl,.uclion 'delays, Builditlg
Division Staff must be able to conlilct appropriute
persons regarding design infonmation or job site
corrections, etc.
Abbreviated Plumbing, Nechanical, & Electrical Schedules
A. Except ,.,here 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 1tem(s) to be installed
B. Full Plumbing. Nechanical, 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. BUILDIIIG OIVISION STAFF I/lLL FILL OUT ALL FEES AIID
CHARGfS 011 Tllf SCllfUULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and dale
Whenever possible, the initial application will be used as
a worksheet only. Where Possible, Bui Iding Division Staff
wi 11 prepare a type wri tten copy and return it to the
applicant al the time the actual permit is issued for his
s igndture.
Fees and Charges
Plan check rees are due and payable at the time of the
application, and no plans Nil} be processed until these
fees are paid. All other fees and charges are due i1nd
payable when the permi t is issued.
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II.
be de 1 i vered to the
by his electrical
is not authorized
Ill.
IV.
V. FOR OFFICf USE OIlLY
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Pernri t.
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PROJECT CONDITIONS TO BE SI)TISFIED BEFORE OCCUPAtICY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name /.-,-:;7~ h=-....,~ signature //..,_.
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da te ?; -/7-89