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HomeMy WebLinkAboutPermit Plumbing 1986-8-15 II InSPECTION LWE 1726-3769 . __-, ~ Job Address h9J~ CITY OF SPRIf,GflELU COf1BIIIATION APPLICATION/PERMIT I E!lERr,y SOURCES: Heat l~ater Heater Ranqe NFORtlA T J ON LJ lit 726-3753 So. ftq. '.Iain ~q. H!}. Access. Sq. ftq, Other flew Add Alter fl.ep. Fence_Demo _Change/Use _Other ~ (} ~ I~ I Legal Oe~cription n , ,~ f!.!~/ _~h' ~ - A Address /.,..." ~ . (~r') V ~. ~ q.7l.{V Cons'tr~ Le~der ,. Phone 'XYI1 v~l;'Jork: Bui1(;ina Permit Info: Describe I~ork(i-.e., Build Single Far.lilv nesidence Hith t\.ttached harace) _~;~~~P-)U} I / Address Ul:.~rliU HAfl (name) Phone (address) (lies. no. \ (exn; res l {ahone no. Primary 1- .' .~ Structural Electrical r1echan; ca 1 CONTRACTORS (name) ~.PA~ {addressl (1 ire;. no_' (pxo;rpc;.\ (ohnnp nn ) Genera 1 Plumbino Electrical t.lechan; ca 1 PLUIIBIfIG ELECTRICAL MECHANICAL ::0. / lEaSh s;n91e fixture Relocated building (new fix. additional) I FF~ 'r.HARr.F . r-Jn '" r\.lADr.C nn '" r\.lAQ(:c Residence of SQ. FT. furnace/burner to BTU's S.F. Residence (] bath] Duplex (1 bath) each I I I SERVICES I New circuits alts. or extensions Storm Sewer -j.{ ~. ".) Temporary Construction Change in existing resjQ~n('P I Imultifamily. COIlln. or Induc;.tri",' ~ I~IIND. fEEDERS I Install/alter/relocate nic;,trih fpprlprc;, I r A-;. ~ I tf?O I~ I --/;' (;;.clJ TOTAL CHARGES .1 TOTAL CHARGES / s: Go that the Electrical work be done by an Electrical Contractor. the electrical rortion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division amps.l I Floor furnace, and vent -++1 Recessed wall . I ' Sn",rp hpilltp\'" "nri \H'nt App 1 i ance vent- seO[lratE' Stationary evap'. cooler Vent fan with sinole duct Vent syste~ apart from heatina or A.C. I ~lechanical exhaust hood Clnd dun , _I Additional bath ~!a ter servi ce Sewer Of amps- .~,.oM~ / () .1 t/fb I I I I /.f.' en ~-~ Wood stove/heater I SSUANCF Of PFRtIlT TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali1 until the I HAVE CAREFULLY EXAt1WED the comp 1 eted appl i ca ti on for ~ermit. and do hereby certify tha tall i nforma t i on 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 Soringfield and the Laws of the State of Drel)on pertaining to the work described herein. and that tlQ OCCUPAIlCY 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 exemotion is noted hereon. and that only subcontractors and employees who are in comp~nce with OP.S 701.055 will be used on t - project. IlAIIE(ple.se printl(/llZi f' ,~ i&~"r:fc~^~~:E~it. !- . Dm!~tr:-?~ Zone Type/Const. Units Sf!. Ftg. f1ain x Value Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value Flood Plain Stories Occ.y Group Sq. Ftg. Other ;II: Value TOTAL VALUATION BUILOIIIG PERI.nT Charges an~ SurCharges Plan Ck, 65%1B1 do ------------ Pian Ck, 30%lB1do _-:7~:~-,_-' Fence ~60 I Demo I Sidewalk I Ale Pavi ng ~_L~,_~__: Curb Cut Corrm/lnd PJ"r Fpp Res Per Fee Syste~s Development Charoe (J.5~) PLU'1BIIIG PERMIT Charges and Surcharges ELECTRIC;.L PERI:IT Charges and Surcharges Total Comb. Permit 11ECHANICAL PERMIT Charges and Surcharges iiOTAL r~ {j)-O . . COMBINATION APPLICATION/PERMIT (CAPl PERMIT VALIDATION j ,I , r t. Applicant to furnish A. Job Address B. Legal Description 1. examDle~ Tax Lot -lOa. Lane County Map Reference II 03 43 2. examole- Lot I, Block 3. 2nd Addition to ~prlngfield Estates C. Name. etc. of owner and construction lender ~ Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Qas 2. examole- waterheater/electrlcal/or SOlar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage ~ 2. example- if new project, check-new - if addition. check add, etc. F. Bu"i1ding. pennit information: 1. examole - construct single family house with an attached garage 2. examale - remodel existing garage into family room 3. example - convert single famlly residence into restaurant (change of use) G, Value of work as defined in Section 303 (al 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 I. 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 Oil 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 penmit is issued. 13 (of!? ? {j 10 . f{/(5' r " V. FOR OFFICE USE OilLY Permit Clerk ~ ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: ----- -~ .= - ....--.-_. PLANS REVIEWED BY: name signature date