HomeMy WebLinkAboutPermit Plumbing 1987-2-18
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legal De<cription jf7tJ 3.305 tfOl OsSon
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Owner, \~,-II iJ A f rv- Y ( ~l' AM I1Y\ )
Address XI II'.) , .' f1/Ili;~ PhoneJc(1
C//4/
I INSPECTION liNE
726-3769
Job Address
Construction lender.
Address
Ut::illiN IE.Af4
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
General
,
~
INFOR/1ATIDN L1Nl
726-3753
Sq. Ftg. I"ain
~q. Ftg. Access.
Sq. Ftg, Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
CITY Uf SPRINGfiELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Meat
l~ater Hea ter
Range
ValuE of Work:
O'Y
~
~
Phone
(address)
BuilriinQ Permit Info: Describe Work(i.e., Build Single
~;U;j;A;t:hed Jejt1f:7/mJ
;$Ah)ll~ dd;,.n.J
jI
(lies. no.l
(exoiresl
Cohone no.l
r address)
\
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....1')
11' ,
(lic~_ nn. \ (pxoirp~) (ohonp nn.)
Plumbinq
~:Jt.{'U2/Tn /L41
/
fl(b'/rL~LQ/
Ij
Electrical
~1echani ca 1
PlUIIB I NG
-1!Q..,.
F" rHARr.F ~
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath\
Duplex (1 bath) each
IAdditional bath
I Water servi ce
I Sewer
IStorm Sewer
1&1': IUt/}. dptl,1
I' I
I I
I I
I if/c I
I 1
I
/ l/s.{f(J
1
I
I
I ~O
I
/5,&0
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be vali1 until the
ELECTRICAL
MECHANICAL
~~~ r~~ Nn
n'l' r...HARGE
Residence of
furnace/burner to
BTU's
SQ, FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~nArp hp~tpr ~nrl vpnt
ITempOrary Construction
IChange in existing
rp~ j qpprp
Imultifamily, corrm. or
Tnnll~tri,:11
10f amps,1
ICO~~,/IND. FEEDERS
IInstall/alter/relocate I
rlic:tritL fl1pnpro::;
IOf amps.1
cJP
Appliance vent
~~oitratfl
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hnnd and durt.
Wood stove/heater
ISSUANCf OF pmmT
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 oerformed shall be done in accordance with the Ordinances of the City
of Spri ngfi e I d and the Laws of the Sta te of Oregon pertai n i ng to the work descri bed herei n. and that 110 OCCUPAI~CY will be made
of any structure without the permission of the Building Division. 1 further certify that registration with the Builder's
Board is in full force and effect as required by ORS 701.055. that if exempt th asis r xemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 will use on is ~~
IlAI-1E(please print) t.." RoBerT (?1IlPMr'\!0 SIr.IIAT, (AAd. "'.... DATE~'
. 'F'dfi'li"F'F I CE-1JSE OIIL Y /
I
Sq. Ftg. 11a;n x
Sq. Ftg. Access x
Sq. Ftg. Other x
IS . frO
------n,-io-ID6mo
I'S1de.:.lk
I A/C Paving
I Curb Cut
------------
I
Zone
Fire Zone
Tvpe/Const.
Bedrqoms
Flood Plain
Stories
BUILDING PER~1lT
Charges and
Surcharges
PLur~BING PERMIT
Charges and r'
Surcharges '?
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
SurCharges
Units
Occy Load
Occy Group
Value
Value
Value
TOTAL VALUATION
Plan Ck. Comm/Ind
65~/Bldo Ppr Fpp
Plan Ck. Res
30%lBl do Per Fee
syste.ms Development
Charoe (1.5~) "
Fence
I
1
1
1 ITota' Comb. Permit
,I 1
I I TOTAL
) 5, 0{)
>
,
.
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax lot 100, lane County Map Reference
II oj 43 . ,
2. examele- Lot I. Block 3. 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
"I. example- heat/electrical ceilinq/or forced air Qas
2. exa~le. waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check-n€w - if addition,
cneck add, etc.
. F. -Building permit information:
1. exam~le - 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. OESIGN 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
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 ON 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, ---
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.
gG t'f<;;?-G
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V, FOR OFFICE USE ONLY
Permit Clerk
CC-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'.
,
,
,
:Permit appl ica,~t"e~emPt from registration with the Builder's Board because:
'.
Additional Project Information:
PLANS REVIEWED BY:
I,
name
Signature
date