HomeMy WebLinkAboutPermit Plumbing 1984-5-16
I H1SPECTIOII LlIIE
726-3769
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CITY Of SPRINGfIELD
CDMBlilATION APPLICATION/PERMIT
E!lERr,y SOURCES:
Heat
Hater Heater
Job Address ~ ~ k, 3 r-x. ~J
Legal Description ~.d,,~ Lnm.i; J}
-rn...;;'G,-, /).J
Range
ValuE of l'lork:
Owner f.l..J1M ~ JU.. r4'/f'jJ~
Address, ~..1. ;,l!2to..i-I~
f:j '"i'-- , ,
Construction Lender 0
INfDRllATION LINt
726-3753
Sq. Ftq. 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter Rep.
--Fence Demo Change/Use
-Other- --
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Phone7o/?, 337'1
BuilriinQ Pernlit Info: Describe Work(i~e" Build Single
Family nesidence With Attached GaraQe)
(Y~"'\~
- ( .
Cj7'/(J)
Address
DES I GIl TEAI1
Phone
(address)
(name)
(lics. no.)
Primary
Structural
Electrical
11echanical
CONTRACTORS
(name)
(address)
(1i~<;.. no.)
Genera 1
Plumbino 1n~/~ ~
Electrical 0 ,
~~,
-11
(J-U ~/fY'-- Q11, '2..n
o
~1echan1cal
PLUIIBIIIG
ELECTRICAL
110,
FFf rH~ ~n
j:r~ tl-l4B.G.E.. NO_
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
rpsjd.pJlrp
multifamily, comm. or
Tnrlllc;.triill
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IlrJ tJO
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Water service
Sewer
Storm Sewer
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
rlic;.trih_ fppnprc;.
Of
amps.
, "ria
(exoiresl
(ahona no.
(pxoirpc;.)
(ohnnp nn
AA:rd"'''''''''
, "/li.IY..'-ftL J0
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MECHANICAL
"IT- .QlARliE.
furnace/burner to
BTU's
,
Floor furnace
and vent
Recessed wall
~n~rp hPAtpr Ann vpnt
Wood stove/heater
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froJ ~l
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Appliance vent
o;;~oaratp
Stationary evap.
rnnlpr
Vent - fan wi th
sinole duct
Vent system apart
haatino or A.C.
Mechanical exhaust
hond and dud
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\W REQUIRES that tile Electrical work be done by an,
shall not be vali1 until the label has been signed by an Electrical
/0, <fO ISSUANCf OF PFRIIIT
/O,c{O TOTAL CHARGES
Electrical Contractor, -the electrical portion of this permit
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 oerformedshall 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 NO OCCUPANCY will 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. . .
M&'/a'f---:fsTr.;IATURE k~ P k~TF,..~--/,d, ~
FOP. OfFICE USE OrlLY
Sq. Ftg, Ilain
Sq. Ftl]. Access
Sq, Ftg. Other
NA/-IE(please print)
/t4(JI-'I-is
I.
Zone
Tvpe/Const.
Bedrooms
Stari es
Units
Occy Load
Occy Group
Fi re Zone
Flood Plain
BUILDING PER/tIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65~/Bldo Ppr Fpp
Plan Ck, R.es
30%lBl do Per Fee
Fence
PLU11BING PERMIT
Charges and
Surcharges
_LP_.~-Q____
-VO
Demo
I'Side.;al k
I A/C Pavi ng
Curb Cut
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
,
Value
Value
Value
x
,
TOT^L VALUATION
Systems Development
CharQe (I. 5~)
I
I
I
ITotal Comb. Permit
I
I TOTAL
,/Y
10.'/0
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
1I U3 43
2. example- Lot I, Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project. check new - if addition,
check add. etc.
F. Building permit information:
1. example - construct Single family house with an
attached garllge
2. examole - remodel existing garage into family room
3. example - convert single family residence into
restaurant (chan'ge of use) ..
G. Value of work as defined in Section 303 (a) 'of the
Structural Specialty Code '
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Sta"ff 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. ---
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.
:
I II.
V. FOR OFF!CE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit C1 erk
,
Permit appl icant exempt from registration with the Builder's Board because':
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date