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Home My WebLink AboutPermit Plumbing 1984-02-16I E COMBI 0r'r L T RI.I I T 7?-3 Job Address EIIERGY SOURCES: Hea llater Heater e Sq Sq . Ftg. I'la n_ Ftg. Access.---- Sq. Fto. Other_ _l{ew_Add-AlterlGp. - _Fence_Demo Change/Use _other- d) -Po qJ C Lega l Description \I I t A Va l ue of llork Owne Add res s Phone nq Re t n t'l Desc'I s denc ith Attac Ga ra .e., Build Single )(,{u t r/<lc/ Construc on e Ider (./..0 0 Addres s Phone DES I GN TEAI.,I name address ics. no.exD I res ohone no. Primary Structura I EI ectri cal l''lechani cal CONTRACTORS name addres s I ics- no- )(pxnires I (nhonp nn Genera I El ectr i ca I t'techani ca l PLUIIB I NG ELECTR I CAL MECHAN I CAL N0.FEE CHARGF NN FFF al..ta PcF NO FFF CHARGF Each single fixture Residence of SQ. FT furnace/burner to BTLI' s Relocated bui lding (new fix. additional)New circuits alts or extensions Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent separate Hater service Change in existing res i dencp Stati onar.v evap coo l er Sewer multifamily, comm. or Industrial Vent fan with sinole duct Storm Sewer 0f Vent systet"r apart from heatino or A.C. c0t'1H./IND. FEEDERS Mechanical exhaust hood and duct Insta l | /al ter/rel ocatedistrib. feeders tlood stove/heater 0f -amp s. ISSUANCI OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES HHERE STATE LAt.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valil until the label has been signed by an Electrical Supervisor and returned to the Buildin! Division I HAVE CAREFULLY EXAMINED the completed apnlication for oe perfo rmi t , and do hereb.y that a I information hereon is true and correct, and I further certif-v that any and all work rmed shall be done in accordance with the 0rdinances of the Ci ty madeof Springfield and the Laws of the State of Oreqonof any structure without the permission of the Buil oertaining to the work described herein, and that NC OCCUPANCY will be di ng Division. I further certify that m.y reqistration u,ith the Builder's 701.055, that if exempt the basis for exemption is noted hereon, and thatBoard is in full force and effect as required by ORSonly subcontractors and employees who are in comcliance with 0l?S 701.055 will be used on this oroject I'lAl.lE (pl ease pri nt )S I GIIA DATE +ie I Zone /const)Un it /s Sq.'Ftg. t,lain x Val ;7 Fire Zone Bedrooms 0ccy Load Acces s. 0ther Value Flood Plain S to ri es Group Sq X Val Ftg Ftg BUILDING PERNIT Charges and Surcha rges Plan Ck. Conrn/lnd 65%/B1dq Per Fee Svster:rs Deve charqe (1.51 0pment PIan Ck. Res 30%/Bldq Per Fee PLUI,IEING PERMIT Charges and Surcha rges /Fence Dgmo ELECTRICAL PERI|IT Charges and Surcha rges Sidewal k A/C Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL /c4c \L TOTAL VALUATION- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County l,lap Reference 17 03 43 ?. example- Lot 1. Block 3, Znd Addition to SF'Fin!"field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. 2.E. Squa example- heat example- wate re footage or /electrical ceili or forced air gas ter e ec tr ca or sol ar va luation, l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, EIEER-add, etc.F. Buill. ding permit information: example - construct single family house with an attached garage II. 2. example - remodel existing garage into family room3. examFTE - convert single iailily-restaence inio restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural 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 sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrica'l SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be instailedB. 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 on the abbreviated schedules you should consult theful l schedu lesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the e'lectrical label Appiicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staffwill prepare a Lype written copy and return it to theapplicant at the time the actual permit is issued for his s i gna ture. Fees and Charges PIan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. All other fees and charges are due andpayable when the permit is issued. III. IV V. FOR OFFICE USE ONLY PERMIT VALIDATION (rL'JqLl ,I-r+B+ 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 sig nature date