HomeMy WebLinkAboutPermit Plumbing 1987-4-24
IiISPECTIQ;1 LHiE ~,
726-3769 '
Job Address tJ/ /J /JltZL#.'"
CITY Uf SPRlilGflELD
CDlIBIiIATIDN APPLICATIDN/PERMIT
E!IERGY SDURCES:
Heat
Ha tel" Hea tel"
Ranoe
IIfDRlIAT:.:l l:..,.:
726-3753 :
So. Ftq. '.iain
~q. ~t9. Access.
Sa. ftg. Other
rle\<J Add p.,1 tel" ~eD.
--Fence Demo Change/Use
Other - -
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legal Description
Dwner /~7ui/J ~
Address i-1J ~.~ R'k
ValuE of Hork:
Construction Lender
Phon Buill:inQ Permit Info: Describe I'Jork(;-.~., bUl;o ;iJgle
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Address
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name
Phone
address
1 ics. no.
exnlres
(ohane no. J
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1.cHAJlGL1
Primary
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Structural
Electrical
(name'
(address )
flies. no.)
leXOlresl
(ohnnp nn
General
!'~echanical
PLUIIBIfIG
ELECTRICAL
MECHANICAL
1';0.
fEE
CHARGE
-----I Relocateo bUl1ding
(new fix. additional)
!S.F. Residence
11 bathl
Duplex (1 bath) each
!Additional bath
!Hater service
I Sewe r
SQ. fT.
'=f'1
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
~n~rp hp~t~r ~nrl V~nt
Each single fixture
Residence of
New circuits alts.
or extensions
Storm Sewor
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SERVICES
amps.
Apol iance vent
'H'oariltp
I Stationary evap.
cooler
Vent fan vdth
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and t1urt
Hood stove/heater
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Temporary Construction
Change in existing
r~c;_i d_enrp
multifamily, comm. or
Tnrluc;.trirll
COIII'1. II ND. fEEDERS
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[Install/alter/relocate
t1ic;.trih fppdprc;.
IOf
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amps.
TOTAL CHARGES
HHERE STATE L-\II REQUIRES
shall not be valij until the
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,j TOTAL CHARGES
ISSUANCE OF PfRrtIT
TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor, the electrical rortion of this perr.Jit
label has been signed by an Electrical Surervisor and returned to the Building Division
[ HAVE CAREFUllY EXAtlINED the completed aprlication for .I)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 Soringfield and the laws Qf the State of Ore()on pertaining to the work described herein, and that riD OCCUPAUCY \oJi11 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 Or.S 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and e:;:s~:hO a~e~n,,:OomOLli:ce with ORS m1.DS5 l'/i11 be u~on this n~oj~
f1MIE(please print) '-...iV\\ \'-> 1If-\'0 U SIr.II^TURE f:,?/ D~,T/(~2L( -~'7
fO~ OFfiCE USE
Zone
Fire Zone
flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
'S~.
Sa.
Sq,
IL Y
Ftg. flain
Ftg. Access
ftg. Other
x
x
Value
Value
Value
,
TOTAL VALUATlOII
BUILDIIIG PERI.IlT
Charges an~
Surcharges
Syster.Js Development
Charqe (I.S')
PLU'IBIIIG PERMIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65X/Rldo Ppr Fee
------------""""PT'an Ck. R-es
30%/Bldo Per Fee
--____U:i:..~~_' Fence
. (PO Demo
,ELECTRIC~.L PERI:IT
Cha roes and
Surcha rges
IIECHAN I CAL PERI1IT
Charges and
Surcharges
Sidewalk
------------
I A/C Paving
Curb Cut
Total (omb. rermit
! TOTAL
fs". ~ '0
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COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. examDle- Tax Lot 100, lane County Map Reference
17 OJ 43
2. ,examnle- Lot I. Block '3. 2nd Addition to
5prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electr;cal/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. DES I GN TEAl,! 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. 1'1echanical. 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
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 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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" Permit Clerk ce-
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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date
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