HomeMy WebLinkAboutPermit Plumbing 1983-12-07INSPECTIO
726-37 69 COIlB I ON ICATIO ERI"lIT 726-3753
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Legal Description \
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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-
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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
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