HomeMy WebLinkAboutPermit Plumbing 1986-5-19
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INSPECTION LINE,
,726-3769
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CITY UF SPRINGFIELD
COMBINATION APPLICATIONIPERMIT
ElIERGY SOURCES:
Heat
l~ater Heater
Ran~e
ValuE of Hark:
INFOR/lATION LINl I
726-3753 ,
S~. Ftg. flain
!~. Ftg. Access.
S~. Ftg. Other
lIew Add Alter Rep.
-Fence Oemo Change/Use
Other- -
'-
Job Address
~(tj
'/// ~
Legal DescriptlDn
Address
UlSiGN TEAI1
(namel
Phone
faddr~ss\
E:)':
D
lrv
-c.
I~
I
I
Owner'
Address
AJe.M-O
4{(c(
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/J G"'L-;;" r Pho e //1/1 Builciino Permit InfD: Descr1be Hork(Le.. Build Single
/1C- ;1./1~~ n Ii' Familv nesidence With Attached Garaoel
n (;J/s-f, "J:'lAfJ/~/X:~ M
;Jflf m 0/l/u/ U' ./ /' t:I
Constru~t.ion lender
(1i~s.no.l
(~xoir~sl (ohon@
I\~"
~..
no. )
Primary
Structural
El ectri c'al
MeChanical
CONTRACTORS
(name)
(addrpss)
(1i,.~ !'In 1
(pYnir"p~'
(nknnp nn \
Genera 1
Plumbino (14/ L
Electrical 4
~A~'/
6
~'echanical
PLUI1BING
ELECTRICAL
MECHANICAL
....!!Q.,.
Each Single fixture
FEF rHAP,r.F tj(l 1CEL1..cJJABliE'-Jj~1
Res i dence of furnace/burner to
5Q. FT. BTU's
F<LI
Relocated building'
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
_ 11 bathl
Duplex (1 bath) each
IAddltiDnal bath Temporary CDnstructiDn
-Iwater service '/f{+ Change in ex;sting----
, "p~jc!fJ1"P
I Sewer I multifamily , COITm. or
Inrlll<.t,.;;jl
I 10f amps I
StDrm Sewer 1
I ICOMJ.1./IND. FEEDERS I
I I -CO I Install/alter/relocate I
,~. rI;<.tr";h. fpprlpr"c
I 10f amps.1 I
I ~.fo ,hO I . I
I I I
I I I ISSUANCE OF PFR1UT
TOTAL CHARGES /6.(!L TOTAL CHARGES I TOTAL CHARGES
WHERE STATE l'W REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portiDn Df this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
SERVICES
Recessed wall
_ _ ....,Sg,a,cp hp;jtp,. Plnrl v,,"nt
Appliance vent
~eo~riltp
Stationary evap.
cooler-
I Vent fan wi th
~; no 1 educt,
I' Vent system apart
heatino or A.c.
I Mechanical exhaust
hond ;jnd dlJl"t
I Wood stove/heater
I
I
I
from
JUU1E(please print)
I HAVE CAREFUllY EXAMiNED the cDmpleted application for permit, and do hereby certify that all InformatiDn hereon is true
and correct. and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State Df OregDn pertaining to the work described herein. and that UO OCCUPAllCY 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 comol;ance with ORS 7nl.055 will be used on this project.
, . ,
Ru F '( SIGUATURE a ' II~ ~P,V'
.. . .FOP."iifFICE USE mil Y \ w/
Sq. Ftg. l10in
S~. Ftg. Access
S~. Ftg. Other
Itf<~H/E
DATE -9'9/~-6
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy lDad
Occy Group
,x
Value
Value
Value
TOTAL VAlUATIOtl
x
x
BUILDING PERf.llT
Charges and
Surcharges
Plan Ck. Cornrn/lnd
____________ 65%/BldC1 J:p!, ~....
Plan Ck. Res '
30%/Blda Per F..e
jS. e:;o I Fence
---- ---:-(po-I D"""
j'S1dewalk
------------
I AIC Paving
I Curb Cut
------------
I
Systecs Development
Charoe tl.5~1 '
PLlJlotBING' PERMIT
Charges and
Surcharges
ELECTRICAL PER/m
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
ITotal Comb. Permit
I
I TOTAL
15. iP'O
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COMBINATION APPLICATION/PERMIT (CAP) co: ' ',,,,"r,,,..
'".'
1. Applicant to furnish" ",,-; "...._,-
A. Job Address ' '," . ' \-
","
B. legal Description
1. examDle- Tax lot 100, lane CDunty Map Reference
11 oj 43 ' ';
2.examele' lot 1. B1DCk 3, 2nd Addition to <' ,
. ~pr.lngtield Estates '., . . :~"':~'f.;..
C. Name. etc. of owner and construction lender '. .,.;.' ,".
D. Energy SDurces ' ,
1. example- heat/electrical ceilinq/or forced air aas
2. examDle- waterheater/electrlcal/or solar _
E. Square footage or valuation, etc. - .
1. examDle- 1250 sq. fDot house, 500 sq. foot garage
2. example- if new project, .check-new.- if addition,
check add, etc.
F. Building pennit information: .
1. example - construct single family house with an
a ttached garage '"
2. examole ~ remodel existing garage into family room
3. examole - convert single family residence' into.
restaurant (change Df 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 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 apprDpriate 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 cDnsult 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. _.
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
cv'
Permit, applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
','
date
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