HomeMy WebLinkAboutPermit Plumbing 1985-02-20INSPECTION LINE
726-37 69 COHS!
rY OF SPRINGFIELD
ION APPLICATION/PERMIT INF0Rr,ITfO[-Enf
726-3753
Job Address 7?.
Legal Description
Hea tEIIERGY SOURCES
[,later Heater
Ranqe,.a)
Owner
Sq. Ftg. Access._
Sq. Ftg. Other
lier_nEE.-
Change/ U se
Sq. Ftq. l.iai
Address o
dence
tI Wo rk
Ga
e., Build Single
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Constructif,n l(nae"
Addres s
n
M
AO
c
Va\
Pni ma ry
Structura I
E I ectri ca I
Hechani ca l
name addres s lics. no.exD r res ohonp no
cenerat &Lr/)4.Lzt t
PI umbi nq
ttlecha ni ca I
PLUtlB I NG ELECTR I CAL MECHAN I CAL
FEE CHARGF NO FFF l^HAPNF NO FFF CHARGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTLI's
Relocated buiiding
(new fix. additional)New circuits alts
or extensions
Floor furnace
and vent
S, F. Res'i dence(l bath)SERV I CES Recessed wal I
Soace heater and vpnt
Duplex (1 bath) each
Additionai bath Temporary Construct ion Apol iance vent
sepa rate
l.later servi ce ge in existing
dence
Chan
resi Stati onar-v evap.
coo I er
Sewer Indrrstrial
multifamily, cornm. or Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
h*I c4 /1)i7 coMt'r./IND. FEEDERS Mechan i caI exhaust
hood and duct-
l)I n sta I I /a I ter/ rel ocate
di stri b. fpeders l'lood stove/heater
0f
ISSUANCF OF PFRt.lIT
/00'TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I.JHERE STATE LII.I
sha l I not be val i.l
REQUIRES that the Electrical work be doneuntil the label has been signed by an E)ec
by an Electrical Contractor, the electrical portion of this pernittrical Supervisor and returned to the Building Division
llAl'lE(please print)IGNA -)6
Ci ty
made
NE tD he comp trml and dorfoontcaap!')DE ce rt t tha a fo rman tfy hereoonhereb.y n s trueandcorrectIandfu rther certi f tha t ndv perfowork rmed haa be edon n coac cerdan thwl t he nances0rdi f theefidthandSofn9LaeofwstateheStpriany
of 0e rta n to workthe crldes hebed re dan tha t0regonng NC wlOCCUPAIICY beructtwlurethtaofouthessoofnnypermrButhedDisvl0nnghefurtcerrtthatfytra0ntitht,r'l the der sulmyregBoardsfulnfoandrcefectefasred7010Rs0s5tthafrequ i by the ba s fors t onexempt s hereonnoted and thatexemponubcontrs'ac1y to andrs awhoemp0yee re n wlance 0r?sthcomD 7ot 0 55 l,I be 0nused th s toroj ec
Ftg
Ftg
Ftg
Value
0ther
Zone x
Group Sq
q<x ueVal
st. Uni ts So
Fire Zone Bedrooms 0ccy Load
ToTAL VALUATI0N--
Val ueFlood Plain Stori es
. l'lain
. Acce
Plan Ck. Conrn/Ind
65%/Bldq Per Fee
Svstenrs Deve
Charqe (1.51 0pmmtBUILDING PERI'IIT
Charges and
Surcha rges Plan Ck. Res
30%/Bldo Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges
J_o_ry_
Dgno
S'ldewal kELECTRICAL PERIlIT
Charges and
Surcha rges A/C Paving Total Comb. Fermit
Curb CutI{ECHANICAL PERMIT
Charges and
Surc harges
qo/i5z/o
10r^L /D
Value of l,lork:
tsur Icilr
Fami l v
Je- I i .12-,-t*z-
Phone a
LAI.l cYnt rpq (r tnnp no
EI ectri ca I
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f 4- 6q azo
PERMIT VALIDATION
Permi t Cl erk
^{
n//'r
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
SEFinETield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air gas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.l. example- 1250 sq. foot house, 500 sq. foot garage
?. example- if new project, check new - if addition,
check add, etc.F. Building permit information:
1. exampie - construct single family house with an
attached garage
?. 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
Division Staff must be able to contact appropriate
persons regarding design information or job site
II corrections, etc.
Abbreviated PIumbing, Mechanical, &A. Except where blank spaces occurportion of the Mechanical and E
the applicant need fill-in oniy
Electrical Schedules'in the description'lectrical Schedules,
the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, 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 onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF I^IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theeiectrical contractor for signature by his electr.icaisupervisor. The generai contractor is not authorizedto sign the electrical label.III. Applicant to sign and date
Whenever possible, the initial application will be used asa worksheet only. l^lhere possible, Building Division Staffwili prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his
s i gna ture.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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Informat'ion:
PLANS REVIEWED BY:
datenameS1gnature