HomeMy WebLinkAboutPermit Plumbing 1985-04-22INSPECTION LINE
7?6-37 69
CITY OF SPRINGFIELD
IIATI ON APPL I CATION/PERMTT 7?6-3
Job Address 7
Legal Description t nD3:Hea
Ranqe
EIIERGY SOURCES
l,later Heater
Owner
Va lue of l,lork:
Sq. Ftg. Access.--
Sq. Ftg. 0ther_
_llew_AddJliEilflep.
_Fence_Demo_C ha n ge/ Use
0ther
. l'lain
Addres s Phone /y Quilging Pernrit Info: DescribEWork(Farnily Residence l,lith Attached Garaee
.e. , Bui 1d Single
o
construct/onLender /A qZU77
Addres s Phone
il!
Y)n
h
DES I GN TEAI4 name address no exDr re5 ohone no.
Pri mary
Struc tura i
E I ectri ca i
Mechani cal
RACTORS name addres s lics. no.exoi res )(ohonp no
Genera I -a-I
3
0 q
hani I
El ectrica'l
PLUI.IB I NG ELECTR I CAL MECHAN I CAL
FEE CHARGE NN FFF CHARG F NO FFF .HAANF
Each single fixture Residence of
SQ. FT.
furnace/burner to
BTU' S
Relocated building
(new fix. additional )
New circuits alts.
or extensions
FIoor furnace
and vent
S . F. Res i dence(l bath)SERV I CES Recessed wal I
Soace heater and vpnt
Duplex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seDa ra te
l,later serv'i ce Change in existing
res i dencp
Stationary evap
cool er
Sewer multifami ly, conrn. or
I ndrrstri a I
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
i u :.(_/oe coMtt./IND. FEEDERS Mechani cal exhaust
hood and drrct
Instal i /al ter/rel ocate
di stri b- feeders l'Jood stove/heater
0f
ISSUANCE OF PFRIiIIT
TOTAL CHARGES /o r"TOTAL CHARGES IOTAL CHARGES
WHERE STATE Lll.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valiC until the label has been signed by an Electrical Suoervisor and returned to the Building Division
1.-1
et-tlAl.lE ( pl ease pri nt GNATUREEF-\E1
xempt
5 wil
LCAREFUL nt for t nda do cert icac0mrJ t on hereon ts rueDermtr)ap t aherebyfy
nd atc0 rrec nd fu errth cert L tha a a nd a wo perk dr fo rme sha be nedo accordanc hfynyt 0rdthe na ofnces citheewl tyfedfSprandLawsthetheofStaofngteDertan1thtowordekrlscbedn0regonnghere i and tha t NC wlOCCUPAI.ICY madebefostructuwlrehottuthess0nofanyperm r the Bu d D s on fu cert irther tha tng re s tra t V.lIon theth Bu de r sfymyg
funsrdBoa aforce end tffec sa th at f055red7ORS01 bas s forhetrequby 0 n hereonnoted a thand texempt
no bconsu tortrac ands who 'Ivempare n wlance 0l?sth 0 05 beoyeescomD u ed thon s p
FF
Flood P'lain Stories Occ.y Group Sq. FtS
'its Val ueZone
xFire Zone Bedrooms 0ccy Load S
I
Ftq . t4a iConst. Un
TOTAL VALUATION
Value
0ther
q. Ftg. Access
Plan Ck. Comm/Ind
65%/8ldo Per Fpp
Svstems Deve
Charqe (1.52 opmmtBUILDING PERI'IIT
Charges and
Su rcharges Plan Ck. Res
3l%/Bldq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges
/a_1/D Dgmo
Sidewal kELECTRICP,L PERI1IT
Charges and
Surcha rges A/C Pavi ng Tota'l Comb. Permi t
Curb CutNECHANICAL PERMIT
Charges and
Surc harges /is{010It\L /O
tr# 6q$r)
PERMIT VALIDATION
il/,i
Permi t Cl erk
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- he2. ExamFTIe- waE. Square footage
air gas
be delivered to the
by his electricalis not authorized
II
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
cIEEI-I-dd, etc.F. Bui lding permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be abie to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Piumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedules
are available at the Building Div'ision1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label mustelectrical contractor for signaturesupervisor. The general contractorto sign the electrical label.III. Applicant to sign and date
l,lhenever possible, the initial appl'ication will be used asa worksheet only. Where possible, Building Division Staffwi'll prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his
s i gnature.
IV. Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans will be processed until these
fees are paid. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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