HomeMy WebLinkAboutPermit Plumbing 1991-12-10I NSP
726-
r'lEL CITY OF SPRINGFIELD
COMBI NATI ON APPL ICATION/PERMIT 726-3753
b c.J V
EIIERGY SOURCES:
Hea t
l,later []eater
Ran
Sq. Ftg. Access._
Sq. Fto. 0ther__
_ll ew_Ad d__-rA 1 te r_P.e p .
Fence Demo Change,/Use
$
\
tl'r
Crr
Lesal Description t/03 ZS 33 )AOOS
Val ue of l,lorkownerJtgll,ff^a . f)Sr+
Address Eoo 9N Phonc Builrii
Farni I y
nq Perntit Info: Describe' Residence l,li th Attached
Work (
Ga rage
.e., Build Single
dD 2oe
Constructi on Lender
Addre s s Phone
DES IGN TEAI.I name addres s lics. no.exDt res ohone no.
P ri nra ry
Structura l
Ei ectri ca l
l.lec ha n i ca I
name address 'lics- no-exD l res ohone no. )
Genera I kq)
Pl umbi #zG-4 -z
F
I'lechani cal
PLUI.lB I NG ELECTR I CAL I.4EC HAN I CAL
FEE CHARGE NN FFF l^HAAGF NN FFF CtlARNF
Each single fixture Residence of
SQ FT
furnace/burner to
BTLI' s
Relocated building
(new fix. additional)
New ci rcui ts ai ts.
or extensions
Floor furnace
and vent
S.F. Residence(t bath)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
sepa ra te
l.Jater servi ce Chan
res i
ge in existing
dence
Stati onar-v evap
cool er
Sewer multifamily, comm. or
Industria l
Vent fan with
sinqle duct
Storm Sewer 0f s.
Vent systern apart from
heatinq or A.C.
c0r4t1./IND. FEEDERS
Mechanical exhaust
hood and duct
I &u^z/ws rlr,l /si:tu Instal l,/al ter/rel ocate
di stri b. feeders llood stove/heater
F cwe- SctuY 0f amp s.
t N stewcL Ul
ISSUANCT OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I^IHERE STATE L,1li REQUIRES that the Electrical rvork be done by an
shall not be valiC until the label has been signed by an Electrical
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Buiiding Division
rmatjon hereon
and correct, and I further certify that any and all rvork rrerformed shall be done in accordance wjth the Ordinances of
of Springfield and the Laws of th; State oi 0regon oertaininq to the t^rork described herein, and that tlO 0CCUPAI{CY will
of any siructure without the permission of the Building Diviiion. i further certify that m.y registration vtith the Bui
Board is in full force and effect as required b.y ORS 701.055, that if exempt the basis for exemfrtion is noted hereon,
only subcontractors and ernployees who are in comcliance with 0l1S 701.055 r,rill be used on this Dro.ject'
'i s true
the City
be made
lder's
and that
I'lAl''lE (pl ease pri nt I GNATURE DAIE /2-tQ11
F
Zone /Const. Uni ts S q Ftg
Ftg
Ftg
l'1a i n x Val ue
. Access Val ue
Val ue
TOTAL VALUATlON
0ther
BUiLDING PERI'lIT
Charges and
Surc ha rges
Plan Ck. Comm/Ind
65%/B1do Per Fee 5L
opmen
Plan Ck. Res
30%/81dq Per Fee
PLUI4BING PERMIT
Charges and
Su rc ha rges
a'2
,7{
Fence
Demo
ELECTRICAL PERI,IIT
Charges and
Surcha rges
Si dewa l k
A/C Paving Total Cornb. Permit
14ECHANICAL PERMIT
Charges and
Surc ha rges
Curb Cut
TOTAL /;,;"'
Job Address
Fire Zone Bedrooms Occy Load Sq.
Flood Plain Stories Occ.y Group Sq.
COMBINATION APPLICATION/PERMIT (CAP)
I Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
?. example- Lot 1. Block 3, ?nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. slqIp_l e- heat/,e_lslticjl c!-l-Ilg/o
2. Ex-amp lE- wa terhea terl glSgqfLqgI /or
Scluare footage or valuation, etc'
1. gxarnp_Le_ 1250 sq. f oot house, 500
2. example- if new proiect, check new
check add, etc.
r folce{g !131!
E
_s{ it
sq. foot garage
- if addition,
II.
III.
IV.
F. Bui lding permi t information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examilE - convert single family residence into
Festaurant (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 des ign or construction delays, Bui lding
Division Staff must be ab'le to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occulin the description
portion of the Mechanical and Electrical Schedules,
the app)icant need fill-in only the No. Boxes adiacent
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. BUILD]NG 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 e'lectrical
supervisor. The general contractor is not authorized
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial appl ication 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.
Fees and Charges
Plan check fees are due and payable at the t'ime 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
#33 //
/ f,2{
/2 -/3*?/
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
perm'it appl jcant exempt from reg'istratjon w'ith the Bujlder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name Si g nature da te