HomeMy WebLinkAboutPermit Plumbing 1987-4-24
IiISPECTIOil UilE
726-3769 '
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Legal Oescription J t-j 0335 t./;;(
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tlFORllAT: .:1 L.l..:.
726-3753
So. Ftq. /-iain I
~Q. f"tg. Access.
So. Ftq. Other '~
-1le\v~Add~.lter_P.eD. ,~I~'
Fence Demo Change/Use
ValuE' of I-lark: -Other- -
(~~U I - iJ)
111 Buihiina Permit Info: Descrlbe \.Iork(l.e.. Build Single I
Phone.., Familv nesidence I/ith ^,ttachpd r.araael , 6"
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Job Address
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Owner 1./ tnL ~
Addre. '7 J.j I rn f1/1~
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RanQe
Construction lender
Address
Ul:~ Hirl H.All
lname)
Phone
( address)
( 1 ics. no.)
(exnires)
(ahone no. I
Primary
Structural
"(1 in no.'
nn \
!~echanical
CONTRACTORS ;1 namel
II. I, I /
Plumbina I/) t?Vtr:t'~ W tAd
/) 11
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(address)
() ~,
, \9,~\J'
Electrical
(~)(.,i~I>" ,
Genera 1
; El~ctriral
~"echanica'
PLUI1BIrlG ELECTRICAL MECHANICAL
UO.I 'FF '" no
lEaCh single fixture Residence of furnace/burner 'to
SO. FT. BTU's
-----'Relocated building New circuits alts. Floor fu rnace'
(new fix. additional) or extens ions and vent
I.IT.L J:HAB.G..E..
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I
I
rl- Of
COl11-1. II NO. FEEDERS
I
I
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TOTAL CHARGES ,I TOTAL CHARGES
WHERE STATE L\I'I REOUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
IS.F. Residence
(1 bath]
I Duplex (1 bath)
each
ISERVICES
I
Recessed wall
S~nrp hp~tpr ~nrl vpnt
Additional bath
Storm Sel'ler
amps.1
i
Apol iance vent
<;poarntl'!
I Stationary evap.
cooler
I Vent fan \oJi th
sinale duct
Vent system apart from "
heatino or A.C.
Nechanical exhaust
hood and dur:t.
Wood stove/heater
J
j
Temporary Construction
Change in existing
rp~ i rl.pnrp
multifamily, comm. or
Inrlllc:.triill
~!ater service
Sewer
Install/alter/relocate
rlic:.t.rih fpprlprc:.
Of
amps.
Zone
Fire Zone
Flood Plain
I HAVE CAREFUllY EXAtlINED the completed application for permit, and do hereby certify that all inronnation 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 Ore/)on pertaining to the work described herein, and that 110 OCCUPAIKY \'1111 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 Or.S 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this project.
IlAIIE(please print) -;::S-Ot\1'0 f\R.~~ SICIIATURE ~~
FOr. OfFICE USE ~LY
'Sq. Ftg. t1ain
SQ. Ft!J. Access
Sq. Ftg. Other
J SSUANCF OF PFR'II T
TOTAL CHARGES
Electrical Contractor, the electrical rortion of this permit
Supervisor and returned to the Building Division
D^TH- 2 L{-8''j
Tvee/Const.
Bedrooms
Units
x
Value
Value
Stories
Occy load
Occ.v Group
x
x
Value
TOTAL VALUATION
BUILDIIiG PERI'lIT
Clla rges an~
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
------------PTan Ck. R-es
30%/Bldo Ppr F~e
!' ~. If!J I Fence I
--------.7;0-' Demo I
___________-' Sidewalk I
A/e Paving I
Curb Cut ./
------------
I
Syste~s Development
Charae (1.5')
PLU'1BIIIG PERMIT
Charges and
Surcha rges
. ELECTRIU,L PERI~IT
Charaes and
Surcharges
IIECHAN I CAL PERI11T
Cha rges and
SurcharlJes
Total Comb. rermit
! TOTAL
(5. rou
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100, lane County Map Referen~e
17 OJ 43
2. examDle- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examDle- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check-new - if addition,
check. add. etc.
F. Building permit" information:
1.' example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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. DES I GN TEAt,I 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, ~lechanical, 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 011 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 \"orksheet 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:
.
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
(lame
,
signa ture
.
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PERMIT VALIDATION
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Permit Clerk
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