HomeMy WebLinkAboutPermit Plumbing 1985-01-28PECT I ON
-37 69 COMBI LI
Legal Description
Job Address EIIERGY SOURCES:
Hea t
l,later Heater
-lAddress
0wner Value of l.lork:
Sq. Ftg. Access
Sq. Ftq. Other
I'lew Add AI ter-TeD. -1e n-e_Demo_c h a n ge 7 u s e
0ther
F 'I
Construc ti
Address Phone v
\
\
o
V()c
n
Mechani ca I
Electrical
Structura I
Pri mar
PLUIlB I NG ELECTR ] CAL MECHAN I CAL
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU, s
Relocated buildinq
(new fix. additional)New ci rcui ts al tsor extensions
FIoor furnace
and vent
S. F. Residence(l uatn)SERV I CES Recessed wal I
Soace heater and vent
Dup'lex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seDa ra te
[,later servi ce Change in existing
res i dence
Stationar.v evap.
cool er
Sewer multifamily, cornm. or
Industrial
Vent fan with
sinqle duct
Siorm Seweq 0f Vent systern apart from
heatinq or A.C.
I A,J{Uu 0e;I )6fi I
COI,II.I. / IND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
di stri h- fppdprs I'Jood stove/heater
,amps0f
ISSUAI.]CF r)F PFRIlIT
TOTAL CHARGES )oK)TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAtl REQUIRES that the Electricat woshall not be vali'l until the label has been signed
rk be done by
by an Electri,
an Electrical Contractor, the electrical portion of this permit
cal Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI'IINED the completed apolication for oermit, and do
the State of Oreoon oertaining to the work described herein, and that NC OCCUPANCY will be mae Building Division. I further certify that my registration vlith the Builder,s
llAl'lE(please print)s I GNATURE
ty
de
Boa by
hereb,v certify that all in formation hereon is true
and correct, and I further certi fy that any and all work performed shall be done in accordance with the 0rdinances of the Ciof Soringfield and the Laws of
of any structure without the permission of thrd is in full force and effect as required ORS 701.055, that if exemDt the basi
I i ance wi th 0l?S 701.055 vri l I be used
s for exemption is noted hereon, and thatonly subcontractors and employees who are in comc on this Droject
Fire Zone Bedrooms 0ccy Load Sq. Ftg
TOTAL VALUATION-
x
x
Fto. l'lain
Ftg . Other
ts
lue
Flood Plain Stories 0cc.y Grou
Zone Type/Const Val ue
Value
Acces s
Plan Ck. Conrn/Ind
65%/B1dq Per Fee
teris Deve
rqe (1.52
Svs
Cha
0pmeotBUILDING PERI'IIT
Charges and
Surcharges Plan Ck. Res
30il/B'ldq Per Fee
FencePLUI,IBING PERMIT
Charges and
Surc ha rges 0 D6mo
Sidewal kELECTRICAL PERI1IT
Charges and
Surcha rges Total Comb. PermitA/C Paving
Curb Cut . (cslo. -
TOTAL
I{ECHANICAL PERMIT
Charges and
Surcharges
e
res q exnl rpc ( ohone no.-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal DescriPtion1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot I. Block 3, ?nd Addition to
SFFTngf,ield Estates
C. Name, etc. of owner and construction lender
PERMIT VALIDATION
p 64tYY
D. Energy Sources or forced air gas /x"1. example- heat/electrical ceiling/2. examiTre- waterhEETEITeJEETil cITo
E. Square footage or valuation, etc.
r solar
I J-
example- 1250 sq
example- if new
check add, etc.
foot house, 500 sq. foot si
a rage
project, check new -'i f add tion,
II
F. Building permit information:
1. exampie - construct single family house with an
attached garage
Z. example - remodel existing garage into family room
3. examflle - convert single family residence into
iElflFant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays' Building
Division Staff must be able to contact appropriate
persons regarding design information or iob site
corrections, etc.
Abbreviated Plumbing, Mechanica'1, & Electrical Schedules
A. Except where bjank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the 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 availab'le at the Bu'i)ding Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be instal1ed are not covered on
the abbreviated schedules you should consult the
fu'l I schedul es
C. BUiLDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for
supervisor. The general
signature by his electrical
contractor is not authorized
to sign the electrical label.
III. Applicant to sign and date
Hhenever possible, the initial application will be used as
a worksheet on1y. Where possible, Building Division Staff
will prepare a type written copy
applicant at the time the actual
s i gnature.
Fees and Charges
and return i t to the
permit is issued for his
IV.
v
Plan check fees are due and payable at the time of the
app'lication, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
FOR OFFICE USE ONLY Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registrat'ion with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
t ture date ,/- Z f- fr-