HomeMy WebLinkAboutPermit Plumbing 1987-12-14INS
726
ON LINE CITY OF SPRINGFIELD
COMBI',{ATI ON APPL I CAIION/PERMIT 726-3753
Job Address /ne4zrl
Legal Description liater Heater
Ranqe
EIIERGY SOURCES
Hea t
/,a),I Value of l,Jork
Sq. Ftg. I'lai n_
!q. Ftg. Access.--
0wne r
.e., Build SingleBui lrlinq Pernlit Info: Describe l^lork('
Farnily llesidence l,lith Attached GaraqePhoneAddress
1/"?
\
\
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7Construction Lender I
Addres s Phone
addres s l i cs. no.exni resDESIGN TEAI{name
Pni mary
Structura I
E I ectri ca I
Mechani ca l
(exni res )(lics- no- )(ohone no-RS name addres s
IGenera I
E l ectri ca l
v
l,techani ca l
ELECTR I CAL MECHAN ICALPLUI{B I NG
FFF rHA AGFFFFCHARGFNOFFFCHARGFNO
Res idence of furnace/burner to
BTLI' sEach single fixture
Floor furnace
and vent
Relocated building
(new fix. additional)
New circuits alts
or extensions
Recessed wal I
Snacp hpatpr and vPnt
S. F. Residence
( I bath)SERVICES
Duplex (1 bath) each
Temporary Constructi on Apol iance vent
seDarateAdd i tional bath
Change in existing
rps i dence
Stationary evap
cooi erl,later servi ce
multifamily, conrn
Tndrrstrial
or Vent fan with
sinole ductSewer
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
hnnd and dttct
Mechanical exhaustCOMI'I./IND. FEEDERS
InstaI I /a1 ter/rel ocate
di stri h- fecders l'Jood stove/heater
0f amps.
ISSUANCE OF PFRtlIT
TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES
WHERE ST,I not be
ATE LA!,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
valii unti'l the label has been signed by an Electrical Supervisor and returned to the Building DivisionshaI
EXAI1INED the completed apnlication for Dermit, and do hereb.y certify that all information hereon is true
and all work performed shall be done in accordance with the Ordinances of the City
on oertaining to the work described herein, and that NC 0CCUPANCY will be made
uilding Division. I further certify that my registration vlith the Builder's
only subcontractors and ernployees who are in comcliance with 0l?S 701
\z-14-fI'lAl'lE(please print LE-I GNATURE
I HAVE CAREFULLY
0reg
the Bperm
ffect
ny
of
and correct, and I further certify that aof Springof any st
field and the Laws of the State
ructure without the i ssion of
Board is in fuil force and e as required by ORS 701.055, that if the basis for ex emption is noted hereon, and thatexempt
055 wilI on this Droject
FI Y c-
Ftg
Ftg
Ftg
l'la i n al ue
Val ueBedrooms
Flood Plain Stori es Value
TOTAL VALUATION-
(_/
x
x
x
Load
Uni tsConst.
Group
Fire Zone
Zone
Access
0the r
rqe (1.52Svs
Cha
tems DevePlan Ck. Comm/lnd
65%/B1do Per Fee
opmeiltBUILDING PERNiT
Charges and
Su rcharges Plan Ck. Res
30%/81dq Per Fee
FencePLUI,4BING PERMIT ,-ILnarges anq /Surcharges -")
/75
oo
Demo
Sidewal kELECTRICAL PERI1IT
Charges and
Surcha rges Total Comb. PermitA/C Paving
Curb Cut 1s.75I,IECHAN I CAL PERMIT
Charges and
Surc harges TOTAL
!w..*-
rnnC nn
SQ.FT.
b
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
17 03 432. ela4ple- Lot 1. Biock 3, Znd Addition toffiigFielo EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. examol e-2. exampl e-E. Square footag
heat/electricai I or forced air gas
wate e ec relsr.-e or va.l uat ion, e
II
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - .if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage2. example - remodel existing garage into family room3. efimFTE - convert single iailily-resiaence iniorestaurant (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, BuildingDivision Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & E)ectrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the applicant need fi'll-in oniy the No. Boxes adjacentto the appropriate item(s) to be instailedB. Full PIumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
Hhenever possibie, the initial application will be used asa.worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theappiicant at the time the actual perm.it is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
loact
t"-/(4C
III.
IV
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Perm'it applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name S'I gnatu re date