HomeMy WebLinkAboutPermit Plumbing 1985-2-19
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I IrISPECTlON LINE
726-3769
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Job Address 'IlL.( _ I{ { (p
Legal De,cription (J. '^~ [4>
CITY OF SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
!~ater Heater
Ranqe
mlti VI ~ ~ s;prl',.~f:..\D
~-AM."~""'Y\.
J7'()3.~r.,U- ~7~t%::l
owner'J\t>.n', rQ L \J.. \ M.le ""'-
Address J R'1, ':'Krpw~r s +
Or-f'
Phone
, L.1o<..C\-e.f\P I
Constructiorrlender
"'1'0- f~1O
Address
Ut::'llirl H.Ar~
(namel
Phone
(address)
Primary
Structura 1
e.;"'l ~
'<<\Qol' .\ ~ -e .,
Electrical
Mechanical
CONTRACTORS
(namel
ZelA c:, C'''--.A~
(address)
'312' i ~...q"to
'7,~{.,~?2 ~(
Genera 1
Plumbina
Electrical
~1echanical
PLUIIBING
NO,
INFORlIATlON Ll,'<
726-3753
Sq. Ftg. 1,Iain ~<Ii"I"'"
~q. F'tg. Access.
Sq. Ftg. Other
..llew__Add~Alter__~ep.
__Fence__Demo__Change/Use
_Other
~
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.......
\J
'-1
nD .rXJ
~IUE of WDrk: ~
-If. ex 0--00. v...::::'
Buil'dina Permit Info: Describe Work(Le... Build Single
Famil '( f1es i dence-\~it~I1Attached ~araae)
- AJ1A?A~~ fA../
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v
--
'-
-""
(lies. no.)
{exoiresl
(ohone
11 ;('<;_ no.)
'".";~'O""". ~ ,
ELECTRICAL
MECHANICAL
Each single fixture
FEF rHI\Rr,f fill..- ~~~ rl-lARGFI NO.
Res i dence of furnace/burner to
SQ. FT. BTU's
I..EEL 1J:lJAB.G.l
I
Relocated building
(new fix, additional)
INew circuits alts.
or extensions
S.F. Residence
11 bath I
Duplex (1 bath) each
Additional bath
I ~Ia ter serv; ce
I Sewer
IStorm Sewer
ISERVICES
I
Floor furnace
and vent
Recessed wa 11
So~rp hp~tpr ~nrl vpnt
ITempOrary Construction
IChange in existing
rpc; j dJ'.nrp
Imultifamily, COlTlTl. or
Induc;;trial
Of
COMl'I. /IND, FEEOERS
IInstall/alter/relocate
dic;;trih_ fppdprc;; .
lor amp~1
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 oerformed shall be done in accordance with the, Ordinances of the City
of SDri ng fi e ld and the Laws' Df the Sta te of.Ore90n Derta i ni ng to the wo-rk deseri bed herei n. and thaCilO OCCUPAilCY wi 11 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builde~'s
Board is in full force and effect as required by ORS 701.055, that if exempt the basi f ex mpt n is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be u~d is ro ct. . '. ~
,\ c2- /'J-'1)
DATE rJ';:-;:';
SIGII^TURE\
FOP. OFF 1 CE USE OlIL Y
Sq. Ftg. Hain x Value
Sq. Ftg. Access x Value
Sq, Ftg. Ot~ ;;Y-E~"- Value.2.
a/;)/~ J'" ~6;j<J. s"G TOT^L VALUATION
J/,,,qtJ DO syste,ms Development A~ A
!lld_ rrrr. CharQe (1.5~) ,rY.N.
~R...a /N ~~_ c:::K.F't5S
"?V,....'OJ;." ~E' ffP /. -
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'I~ REQUIRES that the Electrical work be done by an
shall not be vali1 until the lab~l has been si~ned by an ~lectrical
1/Al.1E(please printl"Tlc.U;,S) 1,... \l..k('~o.....
...:
ZDne ~ C
Fi re Zone
F10Dd Plain
TVDe/Const,~1\t'
Bedrooms
Units
Occy Load
Occy Group A-'3
Stories
J
BUILDING PERfllT
Charges ant:
Surcharges
....., _ ~ Plan Ck. CDnm/lnd
____~_~:..____ 65%/Bldo PJ"r Fp@
~ Plan Ck, Res
'c;;;<ooo' 30%lBldo Per Fee
I Fence
I DeRlO
I Sidewalk
I' Al~ Paving
I Curb Cut
I
PLur~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlm'
Cha rges and
Surcharges
11ECHANICAL PERMIT
Cha rges and
Surcharges
amps.
Appliance vent
c;@oarAtp
Sta'tionaryevap.
cooler
Vent fan with
~inole duct
Vent system apart from I
heatino or A r
I Meehan i ca 1 exhaus t
hood and duct
I \'lood s tove/hea ter
ISSUANCE OF PFRIIIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Sup.ervisor and _~eturned to .~he Buildi~g Division
-
I
Irotal Comb. rermit
7a> .1!iJ:;:J
-::Z/8t>
I
I TOTAL
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COMBINATION APPlICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. JDb Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
II OJ 43
2. examp'le- lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceil;nqjor forced air QdS
2. exa~le- 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
attached garage
2. example - remodel existing garage into family room
3. examole. convert single family residence into
restaurant (change of use)
G. Value of wDrk as defined in Section 303 (a) of the
Structural Specialty Code
H, DESIGN TEAll 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
tD the apprDpriate item(s) tD 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) tD be installed are nDt covered on
the abbreviated schedules you ShDUld cDnsult the
full schedules
C. BUILDING DIVISION STAFF WIll Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
D. As nDted Dn 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~:T/Ii!'.NA~ ~~~'T'W1;.~E ,/re'"8:>e,..S,JlU!Z> ~--:...><
p,e.,>~/,H':;;'r' ~E"CH'~~~C ...-s1!! 5~"""
W#/C.p ~A C, "B~ /P~.-;'_~4?S!:> .
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Permit applicant exempt,from registration with the Builder's Board because:
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Ai:Jditional Project'Information:
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PLANS REVIEWED BY:
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". name-~ ~~~
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Signatur~~"~~~
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date "'2~g ~ ~
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