HomeMy WebLinkAboutPermit Plumbing 1987-4-24
l1lSPECTIOH L11iE
726-3769 ,
CITY UF SPRIIMIELD. /lFORlIAT: ,;. L.,i,
COIIBl1lATlON APPLICATION/PERMIT 726-3753
I E!lERGY SOURCES: So. Ftg. 1,Iain I
-. Heat ~q. F'tl). Access. ~
U7f (fO I !'Iater Heater So. Ftq, Other I
rle\~ . Add fo.l ter P.eD. ~
I Ranne Fence_Demo_Change/U'e "\J
~ ~ Valu, of l'lark: _Other N
I ~ /b///d,
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.
'6t,3 m~
1''1 U j 5, e;; (j;;).
Job Address
le9al Description
Owner
Address
(onstructlon lender
name-
Phone
address
1 ics. no.
eXlllres
/\
-1~~~\\
(onone no. I
Primary
Structura 1
Electrical
!1echanical
CONTRACTORS
I nrlmel
Il_!~ If
ILU;'IU' - w Or
(address )
f1 ics. no.)
fPxo~rp~1 (ohnnp
~
I"
'11').)
Genera 1
Plumbino
Electrical
~"echanical
~"n
I Res i dence of
-,
I
I
I I
It+
" H-Of
C0I11.1. II NO. FEEDERS
I I I
I
I
I
I
TOTAL CHARGES J TOTAL CHARGES
WHEf1E STATEl:'l.\~ REQUIRES that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
sq. FT.
L
"'=r
MECHANICAL
PLUlIBIriG
ELECTRICAL
riO.
furnace/burner "to
BTU',
I..EELJ .cHAB.li.l
Each single fixture
-----'Relocated building
(new fix. additional)
S. F. Res i dence
il bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
Recessed wall
C;Orlrp hp;ltpr' ;Inri \/J'nt
Additional bath
Temporary Construction
ChanQe in eXlstinQ
rp~i~p~rp .
multifamily, camm. or
InrllJ<;.trii'll
Apo 1 i ance vent
c;eOilratE'
Stationary evap.
cooler
Vent fan I'll th
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood tind durt
I
~!ater service
Sewer
Storm Sewer
amps.l
j
Install/alter/relocate I
rli,trih_ fpprlpr,
Of amps.
I
Uood stove/heater
ISSUANCf OF PFR!IIT
IIAilE(plea,e print)
I HAVE CAREFULLY EXAtlINED the completed apfllication for rJermit. and do hereby certify that all information hereon ;s 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 Orel)on pertaining to the work described herein, and that rlC OCCUPAUCY \....i11 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 DRS 701.055, that if exemot the basis for exemotion is noted hereon. and that
only subcontractors and employees who are in comoliance with DRS 701.055 will be used on this nroject.
SDHAJ (112N1JLD _ SIG:IATURE ~~
FOr. IYF"FI C'E' U::ltZJjjt.'v"
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
DATE
t(-)c;-f1
Zone
Fire Zone
Flood Plain
Tyae/Can't,
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftg. rlain
SQ. Ftg. Access
Sq, Ftg, Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERi,l1T
Charges an~
Surcharges
Plan Ck.
65%/Rldo
------------Pian Ck,
1D%/Blda
Comm/l nd
Ppr Fpp
Re,
Ppr Fpe
Systems Development
CharQe (1. 5,)
PLUI1BIIIG PERI1IT
Charges and
Surcharges
----!~~~--
. bO
Fence
Demo
,ELECTRICft.L PERI~IT
Charoes and
Surcharges
'IECHAN I CAL PERI1lT
Charges and
Surcharges
____________, Sidewalk
lAIC Pavi n9
Curb Cut
Total Comb. rermit
--------I
TOTAL
I
(5Joo
------------
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference
11 oj 43
2, examole- Lot ), Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc.'of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air QdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1, examole- 1250 sq. foot house. 500 sq. foot garage
2. example- Tflnew. project. check-new - if addition,
check add. etc.
F. Building permit information';
1. examole - 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 TEAI.I ANO 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 \'/here 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, Nechanical, 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
fu 11 schedu 1 es
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
O. 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 orepare 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 OCCUPAfJCY:
.
PERMIT VALIDATION
60~qob
0-q-1?
8 0 g( b0
L{-;;L Lf-((1
Permit Clerk
(C"
j
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
"
PLANS REVIEWED BY:
nam~
signature
date
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