HomeMy WebLinkAboutPermit Plumbing 1989-3-20
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Job Address
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8/ (o IYl fL<.4L, /
/I! 03 35" 4:2 OSCin{)
CITY UI SPRINGFIE~D
COHBIIIATlON APPLlCATION/PERMIT
EIIERGY SOURCES:
Heat .
l'Jater Heater
Ranqe
Valu, of Hork:
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IRIURlIATIDR LINt'
726-3753
Sq. Ftg. "'ain
~CJ. rt.g. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other - --
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726-3769
Legal Description
Owner
J
( ;!;,().;)./1Jh( )
Auuress Fo 13&x ;:;2;)f)
S-f;~_. tuff
f Cf~111
Construction lender
Phonec9DG
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5,1~0
Bull<iinQ Permit Info: Describe Work(Le. f Build Single
Familv Residence With Attached Garacel
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I - ,- -
(l~~
(exnires) (ohone no.)
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Address
OESIGIl TEAl'
(name)
Phone
(itddressl
Pri ma ry
Structural
Electrical
l1echanical
CONTRACTORS (nallle )
I/~J/Dl-R.LV fV\--
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Genera 1
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(j0;~csiAJer;1
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'exnires)
(nhone no.)
'2, X'K - l./'j '50
Plumbino
Electrical
~lechan;cal
PLUlmlflG
ELECTRICAL
MECHANICAL
/10.
FFF rHARGF jJn
FFF r'JARG( .JJll
J:'rr ru~
sq. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Re 1 oca ted bu i1 ding
(new fix. additional)
New circuits alts.
or extensions
Fl oor fu rnace
and vent
S. F. Res i dence
(1 bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
COflfTI. or
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with.
sinole'dvct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ~nd dul' t
Sewer
ITempOrary
I Change in
re$idp.nrr.
ImUl t i fami ly,
InrllJc;.trial
Construction
existing
Additional bath
~Iater service
Storm Sewer
IOf amrs,
I C0I111. II NO. FEEDERS
I Install/alter/relocate
rlic;.trih. feederc;.
IOf amps.
I
Wood stove/heater
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\lj REQUIRES' that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I SSUANCF OF PFRllIT
, TOTAL CIlARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY f.XN1INED the comrleted arrlication for ~ermit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State 'of Oregon pertaining to the work described herein. and that UO OCCUPAllCY will be made
of any structure without the permission of the Building Division. 'I further certify that my registration \'l1th the Builder's
Board is in full force and effect as required by or.s 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7~1.055 will be used on this project.
SI"IIATl!}3~.~,$//'k~Tf!J?-;/g7~~l- I
ro~ OrF~ I!Sl' OIlL ''/''/ . I
:::' ~ Sn. Ft9. 11ain 'x Value ,
Sq. FtlJ. Access x Value
Sq. Ftg, Other x Value
L"E:\.U
W~S.T
IIAf.lE(please print)
Zonc____.___)yoc/cons t .____.____~ni ts__,
Fire Zone Bedrooms Occy Load
Flood Plain Stories .~ccy Group
TOTAL VALUATlOtI
PLU'~BING PERMIT
Charges and
Surcha rges .
Plan Ck, Conm/lnd
65X/Rldo Ppr Fee
Plan Ck. Res
30%/BldQ Per Fee
'5 (1'0,: Fence
______l.::_~___~
. 75; O~mo
-Systems Development
CharQe (1.5~)
BUILDING PERflIT
Charges anc
Surcharges
. ,
IV,DU
ELECTRICP.L PERI~IT
Charges and
Surcharges
,Sidew' I k
A/e Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
sjC!.-
, 9'D I TOTAL
3~,b5
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. example- Tax lot 100, Lane County Map Reference
1/ OJ 43
2. examele- Lot 1. Block 3, 2nd Addition to
sprIngfield Estates
C. Name, etc. of owner and construction lender
D.. Energy Sources
.,1. examele- heat/electrical ceiling/or forced air qas
: 2. examE'le- waterheater/electncal/or solar .
E. Square footage or valuation, etc.
I. examole- 1250 SQ. foot house, 500 SQ. foot garage
2. example- if new project, check-new - if addition,
check add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examele - 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 TEAll 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 ~ivision
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
0, 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
wi 11 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 I
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
payab 1 e when the permi tis issued. I
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V. fOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY:
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Permit Cl erk
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PERMIT VALIOATION
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Permit applicant exempt from' registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name
signature
date