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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 "',," ~W&oJif '1L<l7 ~ ""; ~~7 ~:;;:;;;::4'";: Construct'(on Lender .4. ~ ~~ Q . 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. \ ' .~, ~ " V, FOR OFFICE USE ONLY . 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 ~ . date /-~ 7-77