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HomeMy WebLinkAboutPermit Plumbing 1983-12-07INSPECTIO 726-37 69 COIlB I ON ICATIO ERI"lIT 726-3753 J EIIERGY SOURCES: Hea l.la te r S-o Sq Sq Ftg Ftg Ftg l"lai n_ Acces s 0ther I ce Chan ge/ Use U s (,-J a> ?>J \ Legal Description \ varue or ''tr3l,q Address Phone t Info: Descri Fami s ra 'e., Build Single Snrtnl ..-tOl',qa11 4 +- Const Addres s Phone DES I GN TEAI.I name addre s s ohone no. Pri ma ry Structura l Electrical l''lechan i ca I name addres s lics- no-)pYn rhone no- \ E l ectri ca l l'lechanical PLUtlBI NG ELECTR I CAL MECHAN I CAL NO FFF CHARGF NN FFF CHARGF NO FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTLI' s Relocated building (new fix. additional) New c i rcu i ts a'l ts or extensions Floor furnace and vent S. F. Residence(l bath)S ERV I CES Recessed wal I Snace heatpr and vpnt Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate [.later servi ce Change in existing res i dence Stationary evap. cool er Sewer multifamily, cornm 0r Industrial Vent fan with sino'le drrct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C. COMI{./IND. FEEDERS Mechanical exhaust hood and duct I ns ta I I /a I ter/ rel ocatedistrib. feeders I'Jood stove/heater 0f amp s. ISSUANCF OF PFRI{IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAl,l REQUIRES that the Electrical workshall not be vali'l until the label has been siqned by be done by an Electrical Contractor, the electrical portion of this permit an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAIIlNED the completed apol ication for Dermi t rfo rmed , and do hereb.y certify that alI information hereon is true and correct, and I further certi fy that any and al I work oe State of 0regon oertaini shal'l be done in accordance with the Ordinances of the Ci ty deof Springfield and the Laws of the ng to the work described herein, and that N0 0CCUPAI{CY will be maof any structure without Board is in full force a the permission of the nd effect as required Building Division. I further certify that my reqistration r,rith the Builder's by ORS 701.055, that if exempt 055 wilI the basis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with 0l?S 701 be used thi proj I'lAl.lE ( pl ease pri nt )S I GNATU RE Zone Const.Uni ts Scr Fu). {4ain (al ue Fire Zone Bedrooms Occy Load Ftg Acces s 'l ue Flood Plain Storie 9cc.y Gro up Sq. FtS x Val ue TOTAL VALUATION .0ther BUILDING PERI.IIT Charges and Surcharges Plan Ck. Conrn/Ind 65%/81do Ppr Fpc Svsterns Deve' Charqe ( 1.57. opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rges -40---Fence Dgmo ELECTRICA.L PERI|IT Charges and Surcha rges Sidewalk A/C Pavi ng Tota'l Comb. Permit I,IECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL \b 40 AYNl TA< COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 PERMIT VALIDATION 2 examp) e-sililgri Lot 1. Block 3, 2nd Addition to el d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1l. example- heat/eiectrical ceil ing/2. example- waterheater/electrical/o Square footage or valuation, etc. or forced air gas E r solar 1. example- 1250 sq. foot house, !!9. 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 garage 2. example - remodel existing garage into family room3. examp.le - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the illilbqb Structural IH. DESIGN TEAI"I Specialty Code AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact a persons regarding design information or corrections, etc. ppropr i a tejob site II Abbreviated Plumbing, l"1echanica1, & Electrica'l SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanical and Electrical Schedules, the app)icant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumb'ing, Mechanical, and Electrical Schedules are 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 on the abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF l.lILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label Applicant to sign and date l,Jhenever possible, the initial application wilI 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 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. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III IV. V Permit Cler PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit appf icant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY name S'I gnature date 00st N-r-w