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HomeMy WebLinkAboutPermit Plumbing 1989-10-18 I INSPECTION LINE 726-3769 . Job Address, Kl 2-. - f\\() ~ 1\ ~~ . , ~SOURCES: LegalOescription \ll'Yoo,:,)L\-'LO"l \C'L I~ater Heater--. Range CITY Uf SPHINuflELD COMBINATION APPLICATION/PERMIT .. ~ INFUR/jATlON LINE 726-3753 Sq. Ftg. Hain ~q. Ftg. Access. Sq. Ftg. Other New...Add A 1ter Pep. ~ence Demo Change/Use Other- - ~ Owner \-\\A-t0 'f\\Q~ ~D\C\,(~ Address -~\.p. o",'\i'\ \. f\.. ; Phone : g""",-~~! Ji'lu',.Sf H!lLIl: DC) ~ \ ':l ' I 0'1, ' Buildino..Jermit Info: Deser be Work.(Le., Familv nesidence With Attached Garaqe) Build Single - - ,~ J {name} Phone (address) ,..., -.k.Q n'Nl \ Address DESlufl TEAll (l its. no.l fexoires) {ohone no. Primary * Structural Electrical Mechanical f:DNTRACTDf~ I name I (address I General~~~ \ ~\ 'f\\ \..fficr-Q~ Plumbino ~lM4no>-Jl(Et\.'\\b~o~on~ , , Q-,4f\? ~ 'lo ~<K - \~ Flprt,riri\l - --. -- ~1echanical PLUliB I NG ELECTRICAL I ~.Jlll MECHANICAL NO, HF l':HhRr,F Nn HF ru SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits a1t5. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~rp hp~tpr ~nrl vP~t Storm Sewer Of amps. Appliance vent s~oaratp Stationary evap. cooler Vent fan wi th sin9le duct Vent system apart from hea t i no or A. C. Mechanical exhaust hood and rlur: t Wood stove/heater Water service Temporary Construction Change in existing re:;iqp'.nC".~ multifamily, conm. or Tnrlu<:.triill Sewer CO~1./IND. FEEDERS Install/alter/relocate . rlhtrih_ fpprlpr<:. Of amps. \ I TOTAL CHARGES WHERE STATE l'H REQUIRES shall not be vali~ until the I SSUANCF OF PFR'1lT TOTAL CHARGES TOTAL CHARGES 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 I HAVE CAREFUllY EXJ\tHNED the completed application for flermit. 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 ld and the laws of the Sta te of Orel)on pertai ni ng to the work descri bed herei n, and tha t ue OCCUPAllCY wi 11 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 ens 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. rlAf.IE(please pri~ ~/ E. f(.<!!Je; d SIGIIATURF. ~~C ~ DATE Itigftr /\,' FOr. OFF I CE USE OIIL Y Zone , Tvpe/Cons t. Units Sq. Ftg, nain Value , Fi re Zone Bedrooms Occy Load Sq. Ft9. Access , Value Flood Plain Stories Occy Group Sq. Ftg, Other , Value TOTAL VALUATION BUILDING PERIIlT Charges and Surcharges Plan Ck. Comm/lnd 65l/Bldo P~r Fpp Plan Ck. Res 30l/Bldo Per Fee Fence D~mo Systems Development Charoe (J.5~1 PLUI1BING PERMIT Charges and Surcharges ~.oo ELECTRICAL PERIHT Cha rges and Surcharges 'Sidewalk A/C Pav; ng I I MECHANICAL PERMIT Charges and Surcharges Curb Cut Irotal Comb. Permit I I TOTAL ~.\D . . ;. COMBINATION APPLICATION/PERMIT (CAP), '; , I. Applicant to furnish A. Job Address B. legal Description I. example- Tax Lot 100, II U3 43 2. example- Lot I. Block 3, 2nd Addition to springtield Estates C. Name, etc. of owner and construction lender O. Energy Sources .. \, J #" . , ~. 1. example- heat/electrical ceilinQ/or forced air Qas 2. example- waterheater/electrlcal/or sola~ 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, . cneck add, etc. F. Bui.ld,ing permit information: 1. exa'mple - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exam~le - convert single family residence into restaurant (change of use) G. Value of work, as defined in Section 303 (a) of the Structural Specia,lty Code . . I H. DES I GN HAIol AN'D 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 WrLL 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, --- 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 signa ture. 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. .' .1 Lane County Map Reference I I I. V, FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY: ., " j " I , ,PERMIT VALIDATION 10 (8.PO'.. '/ ~l, I , , \ ~\ lo'l Pennit Clerk !-Arm) . \, Pennit appli cant l~xemPt fr~m, reg1strati on with the- Bull d~r - s' Briard' becau1e: " Additional Project Infonnation: PLANS REVIEWED BY: name signature date ... . "