HomeMy WebLinkAboutPermit Plumbing 1985-1-28
I INSPECTION LINE . CIIY Uf SPRINGffELO
726-3769 COMBINATION APPLICATIONfPERMIT
Job Address S 11.5'~ r!P47J/4.}j IIJJ~;~GY SOURCES:
Legal oescriPtion\1(')d-.:='>\ 'd.\ oo-:,()() lIaterHeater
Range
J -.J _ /l ~ ValuE of Hork:
Owner~ X:;1~- . I
.~.~ ~_ BU11GlnQ Permit Info: Describe Work(i.e., Build
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Construct'(on Lender .4. ~ ~~ Q
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INFORlIATION LINt "
726-37<;:1
Sq, Ftg, ~ain .
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add A Iter Hep,
--Fence Oemo ChangelUse
Other- --
.
Single
~
~
.......
...
~
Address
DES I GN TEAr'1
(name)
Phone
(address)
(lies. no.)
(~xoires)
(ohone no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(1ic~_ no.)
(pxoi rpc:.)
(ohnnp M_ )
Genera 1
Plumbina
Electrical
Hechanical
PLUI1BING
ELECTRICAL
" MECHANICAL
~~~ r~~ NO.
. HI=' . ruARGt
NO, '
Each single fixture
, FFF 'r.HARr,E Nn.-."
Residence of
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fix, additional)
"New circuits alts.
or extensions
I SERVICES
I
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
IAdditional bath
I Water serv; ce
I Sewer I
'Storm Sewer tJA I
-1- (j(11 " ~) r1.PJ..d
I
I
I
, I
I
Recessed wall
~n~rp hp~tpr ~nrl vpnt
)DIJ1
ITempOrary Construction
IChange in existing
rps- j rlJ>nrp
Imultifamily, COI1ll1. or
Indu"triitl
I Of amps.
ICO~1,/INO, FEEOERS
I Install/alter/relocate
r1i<:.trih. fpprlF>r<:.
Appliance vent
c;eoaratp
Stationary evap.
coolar
Vent fan wi th
sinala duct
Vent system apart from I
heat;na or A.C.
Mechanical exhaust
hood nnd durt
Wood stove/heater
Of
amps.
ISSUANCF OF PFRIIlT
TOTAL CHARGES JfJ fTD TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
1 HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that a'1 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 IlO OCCUPAIlCY 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 701.055 will be used on this project.
NAf.lE(please print) SIGNATURE
FOP.OFFICE USE DIlLY
Zone Type/Const, Units Sq. Ftg,
Fire Zone Bedrooms Occy Load Sq, Ft9.
Flood Plain Stories Occ'y Group Sq. Ftg,
OATE
t1ain
Access
Other
x
x
Value
Value
Value
~
x
TOTAL VALUATION
PLU'1BING PERMIT
Charges and
Surcharges
-----:.j12~
Plan Ck, CommlInd
65%/Bldo P~r Fpe
Plan Ck. Res
30t/BldQ Per Fee
Fence
Systems Development
CharQe (1,5~) ,
BUILDING PERflIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECNANICAL PERMIT
Charges and
Surcharges
D/j1llo
I'Sidewalk
I AIC Paving
I Curb Cut
------------1
I
I
I
ITota' Comb, Permit
I
I
I TOTAL
"'-C/u
)0 --
.
.
R- -':0 I a.. ~
COMBINATION APPLICATION/PERMIT (CAP)
[, Applicant to furnish
A, Job Address
B, Legal Description
I, example- Tax Lot 100, Lane County Map Reference
1/ oj 43
2, exa~le- Lot I, Block 3, 2nd Addition to
Sprlngtield Estates. ,','. _,
C. Name. etc. of owner and construction lender
D. Energy. Sources u . \
1. . examl?le- 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, 500 sq, foot garage
2. example. if new project.> check---riew - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exam~le - 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, 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 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, ---
Ill, 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
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PERMIT VALIDATION
"I( ~L/I &:t
~'~J '- I !f),t/J-J"
Permit Cl erk
ff);j
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
n~ c ..&':.}'4b~~ dgnature ~
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date /-~ 7-77