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Home My WebLink AboutPermit Plumbing 1988-04-11TI_TY OF SPRINGFIELD COMBI NATI ON APPLICATION/PERMIT Job Address e /EIIERGY SOURCES Hea t l,later Heater Ranqe Sq. Ftq Sq. Ftg Sq. Fts I'lai n_ Acces s 0ther lleur Add A -Fence Oerno -0ther- rGT-[EF. _Change/Use N,lc) lw lc> l-o Legal 0escription /,Value of l,lork: Owner Address"qe,T A/; ttztt Phone n .e., Bu!d Single c/ Constructi on Lender 'r d' Addre s s Phone name lics. no.ohone no. Pri ma ry Structura l C X) El ectri cal Mechani cal CONTRACTORS name (lics. no.exDt res ohone no. Genera I PI umbi W l.lechani cal PLUI{B I NG ELECTR I CAL MECHAN I CAL FFF CHARGF NO FFF .HA PG F l.l0 FFF CHARGF Each single fixture Residence of SQ. FT furnace/burner to BTLI' s Rel ocated bui 1 ding (new fix. additional ) New circuits alts. or extensions Floor furnace and vent S. F. Residence ( I bath)SERVICES Recessed wal I Snaap hpatpr and vpni Duplex (l bath) each Additional bath Temporary Construct ion Apol iance vent seDa ra te l^later servi ce Chan res i ge in existing dence Stationar-v evap. cool er Sewer mu1 ti fami 1y,comm. 0r Tndrrstrial Vent fan with sinole duct Storm Sewer 0f c Vent system apart from heatino or A.C. c0Mr.1./rND. FEEDERS Mechanical exhaust hood and duct I n sta I I /a I ter/ rel oca te di stri h. fepders ['lood stove/heater 0f s. tq)t/ ISSUANCE OF PFRIIIT TOTAL CHARGFS TOTAL CHARGES TOTAL CHARGES WHERE STATE LAll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereb.y certify th, and correct, and I further certify that any and all work Derformed shall be done in accoidan,of Springfield and the Laws of the State of 0reoon pertaining to the work described herein, ,of any structure without the permission of the Building Diviiion. I further certify that m.y Board is in full force and effect as required by ORS 701.055, that if exempt the baiis for e:only subcontractors and employees who are in compliance with Ol?S 701.055 will be used on thi at all information hereon is true ce with the Ordinances of the City and that NC 0CCUPAI,ICY will be made registration vrith the Builder's xemption is noted hereon, and that ect. I'lAt'lE ( p1 ease pri nt )F,ro*b-Cn <4 rn r+^t S IGN Zone Const. Uni ts So.Ftg Ftg Ftg l'la i n x Value Fire Zone Bedrooms Load Acces s x Val ue Flood Plain Occy G r0up alue TOTAL VALUATI Stori !q . 0ther BUILDING PERNIT Charges and Surcha rges Plan Ck. Conrn/Ind 65%/Bldo Per Fee Svsterns Deve' clrarqe f1.57' opment Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and /Surcharges S o,@r' 50 Fence D6mo ELECTRICAL PERI1IT Charges and Surcharges Sidewal k A/C Paving Tota'l Comb. Permit T4ECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 31" so C0MBINATI0N AppLICATToN/PERNIT (CAp) I. Applicant to furnishA. Job AddressB. Legai Descri ptionl. example- Tax Lot 100, Lane CountyI7-TTrr:2. example- Lot 1. Block 3, 2nd AdditSpringfield EstatesC. Name, etc. of owner and construction ID. Energy Sourcesl. example- heat/electrical ceiling/o2. examil-e- waterheaterTETedTFTEfVorE. Square Tootage or valuation; etc. Map Reference ion to ender r forced ajr gas sol ar l. exampie- 12!0 sq. foot house, 500 sq. foot garage2. example- JT-iew project, checkl-ew - if additio;, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage2. example - remodel existing garage into family room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Speciaity CodeH. DESIGN TEAIU AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical,A. Except where blank spaces occuportion of the Mechanical and the applicant need fill-in onl &Erri Eleyt lectrical Schedules n the descriptionctrical Schedules, he No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumb'ing, Mechanical, and Electrical Schedules are avai Iable at the Building Divisionl. 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. BUILDING DIVISION STAFF WILL 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 electr.icalsupervisor. The generai contractor is not authorizedto sign the electrical label.III. Applicant to sign and date [,lhenever possibie, the initial appl'ication wi'l'l be, used as a 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 signature.IV. 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. V. FOR OFFICE USE ONLY PERMIT VALIDATION ll)32 ' u1-(( -g y Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s'ignature date