HomeMy WebLinkAboutPermit Plumbing 1986-8-15
II InSPECTION LWE
1726-3769 .
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Job Address
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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
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Legal Oe~cription
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Address /.,..." ~
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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)
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Address
Ul:.~rliU HAfl
(name)
Phone
(address)
(lies. no. \
(exn; res l
{ahone no.
Primary
1- .'
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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 .
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V. FOR OFFICE USE OilLY
Permit Clerk
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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