HomeMy WebLinkAboutPermit Plumbing 1989-04-02INSPECTION LINE
726-37 69
CITY OF SPRINGFIELD
COI1BI I1ATION APPL ICATION/PERMIT
TN-f0AI{A-'Il0ll-fIilr
726-37s3
Ranqe_-
l.later Heater
EIIERGY SOURCES:
Hea t
Owner
l-ega 1 Desc ri pt i on
Job Address
vatue fr'rA
Sq. Ftg. I'lain_
Sq. Ftg. Access.--
Sq. Ftg. 0ther_
_l{ ew_Ad dJ 1 t e r_Ae p l-
_Fe nce_-Demo_C ha nge/ U se
-other--
Add res s Phon n t i
)
,e., Build Single
Constructi\n Lenaer -l \
Addres s Phone
Dos
E
-ac
DESIGN TEAII name address lics. no.exDl res phone no.
Pri mary
Structura I
Electrical
l4echanica'l
CONTRACTORS n anre address (lir< nn exol res ohone no- l
'al
P
PLUIlB I I,JG ELECTR I CAL MECHANICAL
FFF C I]ARGF NN FFF CHARGF I'10 FFF CIIARGF
Each si ng1 e fi xture Residence of
SQ. FT
furnace/burner to
BTLI' s
Relocated bui lding
(new fix. additional )
New circuits alts
or extens'ions
Floor furnace
and vent
S. F. Residence(l bath)SERVICES Recessed wal l
Snace hpatpr and vcnt
Duplex (l bath) each
Temporary Constructi onAddi tiona'i bath Apol iance vent
seDa rate
l.la ter serv i ce Change i n exi sti ng
res'i dence
Stationary evap
cool er
Sewer multifamily, comm. or
Industrial
Vent fan with
sinole duct
Storm Sewer
tt ,l
Ven
hea
system apart from
nq or A.C.
t \if\ttNvft$xIL scc c0r,il.!./IND. FEEDERS Mechanical exhaust
hood and duct
Instal I /a I ter/rel ocate
diqtrih- fcPdFrs ljood stove/heater
0f
I SSI'ANCF OF PFRI/iIT
TOTAL CHARGTS <DL<- ).TOTAI. CIIARGES TOTAL CHARGES
i^lli[Rt STATE L1N RTQUIRIS that tlre Electrical work be done
shal l not be val'i I unti l the label has been signed by an ilec
bytri an ilectrical Contractor, the electrical portion of this permit
cal Supervisor and returned to the Building Division
I IIAVE CARTFULLY trXAlllNtD the completed apnlicatjon for oermit, and do hereb.y certif.y that all information hereon is true
and correct, and I further certif_v that any and all urork rrerformed shall be done in accordance with the Ordinances of the Cityof Sprinqfield and the Laws of the State of 0reqon nertaininq to the work described herein, and that N0 0CCUPAIICY will be madeof any structure withouL the permission of the Buildinq Djv.ision. I further certify that m.y reqistration vrith the Builder's
Board is jn full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
onl-y subcontractors and enrnloyees who are in comcliance with C)nS 701.055 will be used on this Dro.ject.
l,lAl.lE (pl ease pri S I GIIATURE D/1.TE /*z-xr
Val ue
Tyoe/ Con s t
ToTAL VALUATI0N--
Zone
x
'I ilp
x Val
i ts
Load_Sq. Ftg
Gro Ftg
Bed rooms
Stories
Fi re Zone
Fl ood Pl ai n 0ther
Access
Fto. l,lain
Plan Ck. Conrn/lnd
65%/fr1do Pcr Fep
s tems opmentBUILDING PERI.lIT
Charges anC
Su rcha rges Plan Ck. Res
30%/B1dq Per Fee
Fence
Sidewal k
Domo
Total Comb. Permit
PLUI4BING PERMIT
Charges and
Surc ha rges
ELECTRICAL PERI,:IT
Charges and
Surcha rges A/C Pavi ng
Curb Cut \b.t'iTOTAL
I,IECHANICAL PERMIT
Charges and
Surc ha rge s
0f _ _ amps
COMBINATION APPLICAT]ON/PERMIT (CAP)
I Applicant to furnish
A. Job AddressB. Legal DescriPtion
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot ]. Block 3, 2nd Addition to
SFFTn-ETield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
I. example-2, example-
E. Square footag
hea t/ ei ical ceiIi or forced air gas
solarwa
e or valuat o[t
examp l e-
exampl e-
check add
1250 sqif new
foot house, 500 sq. foot garage
proj ec t ,check new - if addition,
, etc
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exarnplE - convert single family residence into
iiltaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specia'lty 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 iob 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 adiacent
to the appropriate item(s) to be installed
B. Full PIumbing, Mechanical, and Electrical Schedules
are available at the Building Division
l. 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
ful I schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractoris not authorized
to sign the electrical label.III. Applicant to sign and date
l,lhenever possib)e, the initial application will be used as
a worksheet only. Where possible, Building Division Staffwill prepare a type written copy
applicant at the time the actual
s i gna ture .IV. Fees and Charges
and return it to the
permit is issued for his
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.
FOR OFFICE USE ONLYV
PERMIT VALIDATION
A0p
Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY
name s'r gnature date
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