HomeMy WebLinkAboutPermit Plumbing 1989-10-18
I INSPECTION LINE
726-3769
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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
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~
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
-
-
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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
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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.
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Lane County Map Reference
I I I.
V, FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY:
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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
...
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