HomeMy WebLinkAboutPermit Plumbing 1987-07-187
ECTION LINE
37 69 726-3753
Job Address EIIERGY SOURCES
Hea t
l,later Heater
Ran
Fto. l.lain_
Sq. Ftg. Access.--
Sq. Ftq 0ther
_f{ew_AddrAlter Rep.
_Fence_Demo_C han gel U se
0ther
to
-l
C)
(r]
u
t1
Legal Description 03 1
Vaiue of l,lork
Owner
Address 2 c Phone BuiIci'in
Farni I y
q Permit Info: Describe llork('
llesidence I'li th Attached Garaqel
.e., Build Single
//On / rt/ffl) Q-z,tut)
co n s tru c t i orrllerfalr 4)
Addre s s Phone
/
DESIGN TEAI.{name addres s l.ics. no.pxni res 'Dhone no.
Pri ma ry
Structura I
E I ectri ca I
l''lec han i ca I
name addres s )Iics- no-exD l res ohone no.
Gen
Plumbin o 0
PLUI.IB I NG ELECTR I CAL MECHAN I CAL
FEE CHARGE NN FFF CHARGF NO FFF CHARGF
Each single fixture furnace/burner to
BTU' S
Relocated building
(new fix. additional)
New ci rcui ts a'l ts
or extensions
Floor furnace
and vent
S. F. Residence(l bat-h)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seDa rate
l,later servi ce Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily, comm. or
T ndus tri a I
Vent fan with
sinole duct
Storm Sewer 0f amps.
Vent systern apart from
heatinq or A.C.
c0Mt'1./rND. FEEDERS
Mechani cal exhaust
hood and duct
I n sta I I /a I terl rel ocate
di stri h^ feeders I'Jood stove/heater
0f -ampa
aq
ISSUANCE OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE Lltl REQUIRES that the Electrical work be done by an
shall not be valil until the label has been si-qned by an Electrical
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
EXAI1INED the comp ete ap!')ca on for oermit, and do hereb.v certify that all information hereon is true
oerformed shall be done in accordance with the Ordinances of the City
ining to the work described herein, and that NC OCCUPAHCY will be made
Division. I further certify that m.y registration r,rith the Builder's
.055, that if exempt the basis for exemption is noted hereon, and that
wi th 0l1S 701 .055 r.r.il I be used on th is pro.ject.
and correct, and I further certify that any and all work
of Springfiejd and the Laws of the State of 0regon oerta
of any structure without the permission of the Building
Board is in full force and effect as required by ORS 701
only subcontractors and ernployees who are in comcliance
t'lAt'lE( p1 ease pri nt)o\^IGiIAT DATE 1 7
SE
Zon 'yoe/ Con s t.Uni ts Fttt
Fto
Ftg
l'lain x Value
Fi re Zone Be d ro oms Occy Load Sq Acces s.
0the r
lue
Flood Plain Group Val ue
ToTAL VALUATI0N_
Sto ri es
BUILDING PERNIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/8ldo Per Fee
Svstems Deve
Charqe (1.5c opment
Plan Ck. Res
30%/81do Per Fee
PLUI4BING PERMIT
Charges and /Surcharges b
6f..50
q,-az
Fence
DEmo
ELECTRICA,L PERIlIT
Charges and
Surcha rges
5idewalk
A/C Pavi ng Total Comb. Permit
IlECHAI'IICAL PERMIT
Charges and
S urc ha rge s
Curb Cut
TOTAL 8L.u2-
c0r,!Br ilATr 0N AppL I cATr0N/pERMIT
A(: I0RS
Res idence of
sQ. FT.
coMBINATT0N AppLICATT0N/PERMrT (CAp)
I. Appl icant to furnish
A. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to
Spri ngfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. examp_le- heat/electrical ceiling/oZ. example- waterheater/electrical/orE. Square fooGge or valuationl-ETdI-
r forced air gase@-
1. examp.le- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - if addition,
check add, etc.F. Bui lding permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family room3. exampje - convert single famiiy residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI'I AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design informat.ion or job sitecorrections, etc.
Abbreviated Plumbing, 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 adjaientto the appropriate item(s) to be .installed
B. Full Plumbing, Mechanicaj, and Electrical Schedulesare available at the Building Divis.ioni. 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 thefull schedulesC. BU]LDING DIVISION STAFF l^IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor ii not authorizedto sign the electrical iabel.Applicant to sign and date
lJhenever possible, the initial application will be used asa.worksheet only. Where possible, Bu.ilding Division Staffwill prepare a type written copy and return it to theappiicant at the time the actual permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. Al l other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
PGraqT
1-2-r'r1
II.
III.
IV
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Perm'it appl i cant exempt from registration with the Bujlder's Board because:
Additional Project Information :
PLANS REVIEWED BY
name Si gnature da te