HomeMy WebLinkAboutPermit Plumbing 1987-08-17ol Description
Volue of Work:
Job
-Other
TNFOBMATION IINE
7263,753INSPECIION tINE
72&.3769
CIIY OF SPRINGT]ETD
COMBINATION APPUCATION/ PERMI
ENERGY SOURCES:
U^-.
Woter Heoler --..-..-.......... .--
Sq. Ftg. Moin
Sq. Ftg. Access.
Sq. Frg. Other
-New-Add-Alter-ReP.
-Fence-Demo-Chonge/
U se
lnfo: Describe Work (i.e., Build SingleBuilding Permit
ched GoFomily Residence With !!!qaaa,.rt473
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PhoneAddress
DESIGN TEAM
no.)no.)(odd ress)(nome)
Primq
Electricol
Mechonicol
Electrico I
Plumbi
MECHANICAL
CHARGENO.
ETECTRICAI
CHARGEFEENO.
PTUMBING
CHARGEFEE
furnoce/burner lo
--BTU'S
Residence of
fr.Eoch single fixture Applionce vent
seporqle
New circuits, olteroiions
or extensionsRelocoted building
(new fix. qdditionoD
Stolionory evop
oolerSERVICES
S.F. Residence
(l both)Vent fqn with
single ductTemporory ConslruclionDuplex (l borh) eoch
Vent syslem oport from
heoting or A.C.Amps.Additionol both
Mechonicol exhoust
hood ond ductWoter service
Wood slove/ heoter
Sewer
Heot PumpTEEDERSStorm Sewer Air hondler to
r0.000 crMAmp:
Air hondler over
r0,000 cFM
ISSUANCE Of PERMIT
TOTAI. CHARGESTOTAT CHARGESTOTAT CHARGES
vnlidbe ounlillhisofshollnolConlroctolElectricolrhepermitaleclricolbeworkdonerheportionthethotElectricolbyATEST,wtA REQUIRESWHERE
rhe eloclricollo ponel.ottochedondElectricolonControctorhoslobelbeensignedby
SIGNATURE DATE P'r z'tr
Springfield ond
the permissionony
to lhe
Oregon
further
thot oll informqtion hereon ir lrue ond correct, ond I furlherfor permil, ond do herebY certifYI HAVE CAREFULLY EXAMINED the completed opplicotion the Lows of the Stote ofn ocordonce with lhe Ordinonces of the City ofsholl be done iond oll work performedsertify thol of rhe Building Division. Istructure wilhoutOCCUPANCY will be mode of onY
in full force ond effect os requiredwork described herin, ond thoi NOperlqining by ORS 70I.055, thol if exempt lhe bosis {or exemption is notedstrotion with, the Builder's Boord iscertlfy thot my regi .055 will be used on ihis proiect.ore in complionce with ORS 701subcontroclors ond emPloYees whoheron. ond thot onlY
Bosis for Builder's Boord exemptionr
NAME (pleose
FOR OFFICE USE ONIY
Fire Zone-Bedrooms occy Lood Sq' Ftg' Access
x
--Yolue
x Yo lue
x
-Yolue
TOTAT VATUATION
Flood ploin Stories-Occy Group-Sq. Ffg. Ofher-
nils -.-.-Sq. Ftg. MoinZone
-TYPe/Const,
(r.5%)
DevelopmentSyslems
Chorqe
Plon Ck. Comm/lnd
65"/olBlds Pet tee
Plon Ck. Res
3O%/ Bldg Per Fee
BUITDING PERMIT
Chorges ond
Surchorges
Tolol Comb. Permit
PTUMBING PERMIT
Chorges ond
Surcho rges
Demo
ELECTRICAT PERMIT
Chorges ond
Surchorges
Sidewolk
TOTAT
MECHANICAI, PERMIT
Chorges ond
Surchorges
Curb Cut
Fe nce
coMBtNAT|ON AppLtcATtoN/pER, (CAp)
Applicont to f urnish
A. Job Address
B. Legol Description
l. exompls-tox lor I00, Lone County Mop Reference I7 03 432. exomple-Lor l. Block 3,2nd Addiiion to Springfield Estotes
C. Nome, elc. of owner ond construction lender
D. Energy Sources
2.
exomple-heot,"electricol ceiling /or forced oir gos
exompte-woter heoter'electricolT'or solor
E. Squore footoge or voluotion, etc.I. exomple-1250 sq. foot house,500 sq2. exomElE-iT new proiecr, checl new-ii
odd, etc.
F. Building permit informotion:
foot goroge
oddition, check
l. exomple-construct single fomily house with on qiloched
goroge
2. exomple-remodel exisling goroge into fomily room
3. @-convert single fomily residence into
restouront (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of rhe
Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Division
Sroff must be oble to contoct oppropriof" p"rro--n, regording
design informotion or iob site corrections, elc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in fhe description portion
of the Mechonicol ond Electricol Schedules, rhe oppiicont
need fill-in only the No. Boxes odiocent to the oppropriote
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Divisionl. To conserve spoce on the permit form the schedules
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the obbrevi-
oted sc,hedules you should consult the full schedules
C. BUITDING DIVISION STAFF WItL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. .Appliconl to sign ond dote
Whenever possible, the initiol opplicotion will be used oro
worksheet only. Where possible, Building Division Stoff will
prepore o lypewritten copy ond return it to the oppliconl ot
the time the octuol permit is issued for his signoture.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot fhe time of the opplicotion,
ond no plons will be processed until these fees ore poid. Alt
other fees ond chorges ore due ond poyoble when the permit
is issued.
IV. FOR OFFICE USE ONLY
PERMIT VATIDATION
Permit Clerk
PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY:
Additional Proiect lnformotion:
PLANS REVIEWED BY:
signolurenome dote
I