HomeMy WebLinkAboutPermit Plumbing 1985-3-1 (2)
I INSPECTION LINE CITY OF SPRINGFIElO
726-3769 COMBIIIATION APPLlCATION/PERMIT
JDb Address "/I'f- 1(1(, tJ1 AA..... 0 f- Sa~ ~~~~GY SOURCES:
legal Oescription (A"c i of' ~Q..N\ \ . I ~c:.... ' - Ilater Heater
Range
.
Owner ~~ 'f W 0'\ +0 "'-
Address L ( ') I - rs.r...pw~,. 1-1-.3
O-.Jl.
'E ~ C2A-Q
Construe on lender
Address
DESIGN TEAI1
(name)
Primary
Structura 1
Electrical
f1echanical
CONTRACTORS
tnamel
Genera 1
Plumbina
~v.::..."'t ~ .'l\.w,'cY
I"Jp~J j -:ilt44J:.J
I '
Electrical
~1echani ca 1
PlurlBING
NO,
FEE rHARGE Nn
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath I
Ouplex (1 bath) each
Additional bath
~Iater service
Sewer
I
I
I~-
I
I
I
I
I
I~.~
Storm Sewer
~;> o,q: 6/1>. - .
'I
I
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
.
INFORllATION L.N"
726-3753
Sq. Ftq. 1,1ain
~q. ftg. Access.
Sq, Ftg. Other
Ilew Add Alter Pep,
--Fence Demo Change/Use
Other - -
~
l'
.........
\C)
~
VgjE of WDrkj
-!j . DW '+
BUiltiina Permit Info: Describe Work(i~e., Build Single
Phone n I
j~-1S((j ~~v~es~w~:;::~r:;;~r L. ~~
~\u.r J/ J. (' A..: "'- C
~
Phone
(address)
ilics.no.)
(exniresl
(ohone no.
faddrpssl
(1iC".~_ nn_l
(pxoirp~\ (ohnnp nn
~
,~
to:.
lU('l~C1""
~~"'
ELECTRICAL
MECHANICAL
Residence of
<r> r",!J1GE.C,llil.....1
I FFF I CHARGF l
SQ. FT.
furnace/burner to
BTU's
~ New circuits alts.
or extensions ~
'2 P7!:l ""'e>R~
SERVICES
IS:-
Floor furnace
and vent
Recessed wall
~n~iP hp~tpr ~nrl ~pnt
lTemporary Construction
IChange in existing
rp~ j dJ>.niP
Imultifamily, COlTlTl. or
Tnr1lJdrin.l
IOf
ICO~1,/INO, FEEDERS
I Install/alter/relocate
r1i~trih. fpprlpr~
10f amps.1
Appl iance vent
seoarat~
Stationary evap.
cnoler
Vent fan with
sinale dur:t.
Vent system apart
heatino or A.C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
amps.1
from
TOTAL CHARGES
I
I
I
15:-
I SSUANCf OF PFR'1lT
TOTAL CHARGES
that the Electrical work be done by an "Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXJ\t1INED 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 Springfield and the laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAUCY 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 OP.S 7Ql.055 will be used on this project.
SIGIIATURE ~p{J~~
FO~ OFFICE USE Q;TlY
So, Ftg, Ilain
Sq, Ftg. Access
Sq, Ftg, Other
, .,! Plan Ck, Conm!lnd
____..:._.....:..:.___._ 65%/~1r1o P.fr J:"pf't
Plan Ck, Res
30%/Bl do Per Fee
.Lt:?.-c Fence
---- --~-9o-1 Oemo
15'. Qp I Sidewalk
-------~6(;-1 AIC Paving
I Curb Cut
I
IIAHE(please print)J)4u,'J ~. lJ~o"'-
Zone
Fire Zone
FlDDd Plain
Tvpe/Const.
Bedrooms
Stories
BUIlOING PERNIT
Charges and
Surcharges
PlUI1BING PERMIT
Charges and
Surcharges
ElECTRICAL PERr:IT
Charges and
Surcharges
I1ECHANICAl PERMIT
Charges and
Surcharges
OATE3- j- '1 ')'
Uni ts
Occy load
Occy Group
Value
Value
Value
TOTAL VALUATION
x
,x
x
Isystems Development
CharQe (1.5~)
i
I
I
I
ITotal Comb. rermit
I
I TOTAL
-;z 6. ~o
;:?G~'.e:>f>
.
, "
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
II oj 43
,2, examele- Lot 1. Block' 3, 2nd AdditiDn to,
. Spnngtield Estates., ..'! . I' '.
C. 'Name, etc. of owner'and construction lender
D. Energy Sources j .. I' '..... ;
1. example- neat/electrical ceilinq!or forced air Qas
2. example- waterheater/electrlcalfor ~
E. Square footage or valuation,etc.
I, examDle- 1250 sq. fDDt hDuse, 500 sq, fDDt garage
2. example- if new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G. Value Df work as defined in Section 303 (a) of the
Structural Specialty CDde
H. DESIGN TE~I 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 ND. BDxes adjacent
tD the appropriate 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 b'-installed are nDt.,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
0, As nDted Dn the CAP, the label must be delivered tD the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant tD 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'SATISFlED BEFORE OCCUPANCY:
.
.'
,
PERMIT'VALIDATION
J?ql, /o'7?~, fl
, ,
II 3'/ j)JSX
. ~,
"
.1..... "
,"
Permi t Cl erk M
. \
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
. J.-
name
signature
" -
, ~. I
--.......
. ."
,.
, '
:>,'.
,
"
date