HomeMy WebLinkAboutPermit Plumbing 1989-10-11COMBI L RMIT 7?6-3753
Job Address
Legal Description
EIIERGY SOURCES
Hea t
llater Heater
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tg n
Sq Ftg
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Sq
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_Change/ Use
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Owner
Address n
am
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Constructi on(}enoer \
Addres s Phone
name address exD res
Pni ma ry
Structura I
E l ectri ca I
Hechan i ca I
CONTRACTORS name a ddrps s (lics. no.)(pxni res ohonp no-
Genera I
a I{'qElectrical
l.lechanical
PLUI.IB I NG ELECTR I CAL MECHAN I CAL
FEF CI{ARGF NO FFF CHARG F NO FFF CHARGF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU. s
Relocated building
(new fix. additional )
New ci rcui ts a l ts.
or extens ions
Floor furnace
and vent
S. F. Res i dence
( I bath)SERV I CES
Recessed wal l
Snaap hpetpr and vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
[,later servi ce Chang
resid
e in existing
PN'F
Stati onar.v evap
cool er
Sewer multifamily, comm or
Tndrrctrial
Vent fan with
sinole duct-
Storm Sewer 0f Vent system apart from
heatinq or A.C.
COMTI./IND. FEEDERS
Mechanical exhaust
hood and duct
Insta l I /al terlrel ocate
di cfri h fppdprs ['lood stove/heater
0f s.
ISSI,,ANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAtl REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXANINED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correct' and I further certify that any and all work rrerformed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon pertaining to the work described herein, and that t,l0 OCCUPAI'ICY will be madeof any structure without the permission of the Building Diviiion. I further certify that m.y registration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the balis for exemption is noted hereon, and thatonly subcontractors and employees who are in compliance with 0l?S 701.055 wi'll be used on this project.
llAl'lE ( pl ease pri nt ,>b G*.1*-I GNATURE DArE lo1-q
Zone_________Tyoe/Cons t. Un its Ftg
Ftg
Ftg
l'la i n
Acce
r x Value.
Fire Zone Bedrooms
Flood Plain Stories
Load S q x Val ue
Group Sq lue
TOTAL VALUATION
0ther
BUILDING PERIIIT
Charges and
Surcha rges
Plan Ck. Corm/Ind
65%lBldo Per Fee
Svstems Deve
Charqe (1.57 opment
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Lt Fence
D6mo
ELECTRICAL PERIIIT
Charges and
Surcha rges
SldewaIk
A/C Paving Total Comb. Permit
I,IECHANICAL PERMIT
Charges and
Surc harges
Curb Cut
TOTAL \Sra
'+
COMBINATI0N APPLICATI0N/PERI'|lT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
?. example- Lot l. Block 3, 2nd Addition to
Sp-[fii6-fieta Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
1. example- heat,/electrical ceiling/2, example- waterheater/electrical/o
Square footage or valuation, etc.
or forced air gas
E
r soTar
1. example- ]3!9 sq. foot house, 500 sq. foot garage
2. 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. example - convert single family residence into
restaurant (change of-use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
0ivision Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.II. Abbrev'iated Plumbing, Mechanical, E Electrical SchedulesA. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and E)ectrical Schedules
are available at the Building Divisionl. To conserve space on the permit form the schedules
have been abbreviated?. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF ltIILL FILL OUT ALL FTES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
e'lectrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical 'label.
III. Applicant to sign and date
lJhenever possible, the initial application will be. used as
a worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gna ture.IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, 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.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
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*
Permi t Cler
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registratjon with the Builder's Board because:
Additional Proiect Information :
PLANS REVIEWED BY:
name sig nature date
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FIRE DEPARTMENT INSPECTION
ISPRINGFIELD
OCCUPANCY NAME
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BUILDING OWNER
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CLASS
BUS. PHONE
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ADORESS
CODE SECTION VIOLATIONS
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ITHE ABOVE VIOLATIONS :
h.i
DATE
NOTI TO
co.
A xt-"-LYL<,*.,NUMBER
INSPECTOR ABATED
VIOLATIONS: Noted
YOU ARE
SIGNED:
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