HomeMy WebLinkAboutPermit Plumbing 1991-12-10.
CITY OF SPRINGFIELD
TOMBI NATiON APPL ICATION/PERMIT 7?6-3753
Job Address o t^l (
l-ega1 Description /3 t o6ge
EIIERGY SOURCES
Hea t
llater Heater
Ranqe
Sg. Ftg.n
Sq. Ftq. Access._
Sq. Ftg. Other-_
_l{ew_.Add_A1 ter_PeP .
Fence Demo Change/Use
:0 ther-
s
)N
CI+"Vai ue of l,lork
0wner U x)o cAL-
Address /oo N l/*,*tsoA.gr#zz-t Ph"^e443-1trz Builtiinq Permit Info: Desc
Farni I y Res i dence lli th Attac
ri be
hed i
llor(
Ga raqe
i.e- Auild Single
)
9urrue, u/4 ?gil 1 ,fl;-zztnz'E Dlztst -z .frx7i
Construction Lender
Addrcss l)honc
DES I GN TEAI{name addres s exr,t res ohone no
Pri ma ry
Structura I
Electrical
Hechani ca l
CONTRACT RS n ame (address exDt res (phone no. )
Genera.l ( g,z)
PE 283-2IS
Electrical
l'lechani cal
PLUI1B I NG EL ECTR I CAL 14ECHAN I CAL
NO FEE CHARGE NO FFF CHARGF NO FFF CIlAPGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional )
New ci rcui ts al ts
or extens i ons
Fl oor furnace
and vent
S. F. Residence
( l hath)SERV ICES Recessed wal I
Soace heat-er and vent
Duplex (l bath) each
AdditionaI bath Temporary Construct ion Apol iance vent
seDa ra t-e
l,later service Change in existing
res i dence
Stati onar-v evap
cool er
Sewer multifami1y, conrm. or
Industrial
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent system apart from
heatino or A.C.
COMI'1./IND. FEEDERS
Mechanical exhaust
hood and duct
I ?*9H'T2,,K)^?in/D /5.6',I nstal I /al ter/rel ocate
distrih. feeders l,lood stove/heater
t* <tRt/tct- E4l 0f
ISSUANCF OF PFRI1IT
TOTAL CHARGES /5r'TOTAL CHARGES TOTAL CHARGES
I^IHERE STATE Llt'l REQUIRES that the Electrical work be done by an Electrica'l Contractor, the electrical portion of this permit
shall not be vaiid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE
and correct
FULLY EXAMINED the compl ted apnlication for nermit, a nd do he re b.y CE rt I fy t ha t a I I I n f rma t 'I on he reon I s true
and I further certif-v that any and ll work nerformed shall be done in accordance with the 0rdinances of th Ci tyof Snr.ingfield and the Laws of the State of 0regon Dertaininq to the work described herein, and that NC 0CCUPANCY wili be madeof any structure without the permission of the Buildinq Division. I further certify that m.y re-oistration vrith the Builder,s
Board is in full force and effect as required by ORS 701.055, that if exempt the baiis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in compliance with OllS 701.055 r,rill be used on this pro.ject.
I'lAl.lE(please pri nt)S IGIIATURE DATE -/0 -
Tone Typelconst. Un 'i ts So
Sq
. Ftg
' Ftg
. Ftg
l'la i n xr Val
Fire Zone Rp d ro oms Load :Access.
0the r
xr Val ue
Val ueFlood Plain es Occ.y Group x
ToTAL VALUATI0N_
Stori
BUILDING PERNIT
Clra rges and
Su rc ha rges
Plan Ck. Conrn/Ind
65%/8ldq Per Fee
Sys
Cha
ter,ls opmen
e 7 .5,E
Plan Ck. Res
30%/81dq Per Fee
PLUI'4BING PERMIT
Charges and
Surcha rge s
/5,
,7{
Fence
Dgmo
ELECTRiCAL PERI1IT
Charges and
Surcha rges
Si dewa I k
A/C Paving
Curb Cut
Total Comb. Permit
IiIECHAI'IICAL PERMIT
Charges and
Surc ha rges TOTAL /f ,7s-
PERMIT VALIDATION
")-LPermi t Clerk
?
# s3ra
/z-*/ S -*t/// s.? s-
COMBINATION APPLICATION/PERMIT (CAP)
II
Applicant to furnish
A. Job Address
B. Legal DescrjPtion
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
?. example- Lot 1. Block 3, Znd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
I . exampl e- hea r,/ e I ectr i ca l ce i 1_pg/o r _fo-rcS!_g:f_S!_!-2. exarnoTa- waterheater/electrical/or solar
E. Square footage or valuation' etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exatele- JTnew project, check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. Example - convert single family residence into
resTi-urant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural SpecialtY Code
H. DESIGN TEAI'I AND CONTRACTORS
To avoid design or construct.ion delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A, Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules'
tfre applicant 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 shou)d consult the
fulI schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the labe'l must be de'livered to the
electrical contractor for signature by his electrical
supervisor. The general contractolis not authorized
to sign the electrical label.
Applicant to sign and date
Whenever possibie, the initial application will be used as
a worksheet on)y. Where possible, Building Division Staff
wil'l 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 time of the
application, and no plans will be processed untjl these
fees are paid. All other fees and charges are due and
payable vihen the permit is .issued.
FOR OFFICE USE ONLY
III
IV.
PROJECTCoNDiTIONST0BESATISFIEDBEF0RE0CCUPAI.ICY:
eb ac Su eerdrdSBoahtBtheu'tt n0 w'leritSraftr0mCjnae+gatempePrm'l pp
Add jti onal Proiect Informat'ion:
PLANS REVIEWED BY
da tes i gnaturename
II
- r\IltrRESS-
1657 HTJHAhJH
N[:5[R: REHOTIEL
-OIJNER-
UN ION O IL I]O
P0 trtlx 7b
SEATTLE' tlA 98111
- INFO-
REPA IR
CO},iT,IERC IAL
530CI
OO l-OO?-BU ILI' INE PERi-t IT
OO.:-OO4..ELECTR I[AL
OO3-OO6-i.IECHAN ICAL
OO4-OO1-PLAN f,HECK EEE
OOl-016-PROGRESS IUE
OO3-O 1 6.PROGRESS IUE
PTIILBINft NIUI$ION JOB* 8?OE^{
.LEIJAL*
LOT EILOIT{
r INAL
-VALUE_
?50 0
900? 12 TERI4 38
T00313 TERH 3S
1 703:53 I 05800 8907I't I t]00x 1?
-EI.IERGY- .STATS*
I{EAT 1- 3. BLBIJ U ONE CCH3O. STOR IES TLOONPLA INRANfiE- BETIRH OCE ERP B1
UN ITS
$A EEET
CONSI TYPE 5N
-CONTRACTORS-
6ENL.AC SCHLE I$TER
CONTRAf,TOR PHONE-74?-4944
PLI'IB-
ELECT-
I.tEEH.
NESffN-
NT:PT CAT TE31
SHQ-REAUIRHTI PEE}.JITS_.-*---*---EEE.SURCHAREE-t'ATE-EECEIPT-PERI',IIT*--_----UALUE.--
68.50
':1'f ri r-\
15.00
44.53
NO PROfiRE$$
8907 I ?
8907 r?
8907 I 3
8907 1 ?
3.43
1.13
0.75
0.00
1 4374
I 4374
I 4374
L437 4
$
$
s
$
7r500
0
o
0
{iTJN-.H IN II'1UI-I INSPEf,T IONS + HETIU IRHIIENTS--.-..- -----EXP NATE.--ACT NATE.
OOl_04?.ROU6H ELEITRIC
OO?-O31.EOUGH MECHANICAL
003-006.-EnAl,iING
OO4-O09- IN$ULAT IfiN
OO5-049-E INAL ELECTR ICAL
OO6-039.T INAL I,IECHAN ICAL
0O7-064*E INAL F IHE NEPT
OOS-019-T INAL EU ILTI INfi
sEn*- INSPHCT ICINS----.---C0l'ti"lENTs-- "-----nATE*--*AESULT-- INsP*-.-