HomeMy WebLinkAboutPermit Plumbing 1980-01-26IIISPt26-LiIIE C
corlB I i,rA APPL I CAT I II 7?6-37s3
Job Address ilr ir EIIERGY SOURCES
Hea t
l'trater Hea ter
Ranqe
9.n
Sq. Ftg. Access.--
Sq. Ftq. Other_
l,lew Add Al ter Peo.
_1ence_Oemo Chli"gelUse
0ther
S.
\,
$\
l-egal Descriprion
Val ue of l'lork
Owner
Addres s Phone Builclinq Perntit Info: Descrjbe I'lork(
Farnily Residence I'lith Attached QqLaqq
.€., Build Singie
? s,ta,tnq ,Agt zr43 FX-,I
Cons tructi Lender a.(.r [-0 t.l fr )A,
Address Phone
DESIGN TEAI1 name addre s s exo l res ( phone/no
Primarv
S truc tura I
E l ectri ca I
l.lechanical
narne address 'lics. no.)( pxo i res ohcne no.
Genera I
prurnutnq C[ I
rical
PLUIIB I iIG ELECTRIc^L MEC}iAI,IICAL
r.,1. I i Fii rr:l.iARGE tJo i FEc I lPqor:,'i ll0. i I FFtr i CHARG'
Each single fixture Residence of I
SQ. FT
furnace/burner to
BTLI' S
Peioca:eo buiid:ng
(new fix. additional)New ci rcui ts al ts
or extensions
Floor furnace
and vent
S.F. lesidence(1 barh )SERV I CES Recessed r.ral I
Soace heatpr ind vPnl-
Duplex (l bath) each
Addi tiona'l beth Temporary Constructi on Apol iance vent
seoa rat e
tlater service Change in existing
res i Cence
Stati onarl,/ evap.
cooi er
Sewer multifamily, comm. or
Industrial Vent fan with
sinole ciuct
Isto* s.n""0f amps.Vent systern apart from
heatino or A.C.
I cor4r.r./IND. FEEDERS i\lecnanical exhausc
hood and duct
Instal I /a I ter/rel ocate
distrib. feeders l'Jood stove/heater
I
I 0f rrnpE
i
l
TOTAL CHARGES
ISSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CI]ARGES
-HHERE STATE LII.J REQUIRES thAt thshalI not be va.liI untiI the labei h
e Electrical work be done by an Electrical Contractor, the eiectrical portion of this pernitas been signed by an Electrical Supervisor and returned to the Building Division
I
and coof Sorof any
Board
only sr
Y EXlll t IIED the c 0rnp I e ap p ca ti on for DE rmi t and d hereb.y ce rt i fy t ha t a I I i n forma t 'I o n he reo n i s lrue
the City
be made
I der"'s
and that
t nd I fu rtherreca r c ert i fy t ha t any and alof Oregon
1 wor k Der fo rmed s ha 1 I be don e I n acc0 rdan ce wi th t he 0rd I n an ces o fngfield and the Laws of the State Derta 1 nt ng to the work descri bed here ,l n an d tha t NC OC CUPAN CY wl 'I Istructure wi thout the permission of the Bu ding Divisio I further c
exempt t
055 r.ri I I
e rt 'I fy th a t trty regi s t ra t i on t/ l th the Bu iis in fuil force and effect as requ 1 red by 0 RS 7 01 0s5 t ha t I he ba s i s for exemp t I on I s noted hereo nubcontractors and emnloyees who are in comc l ance with OnS 70 h6 u sed 0n th 1 s nro.jec t
l
odrtr/-2d- lOl.lAi.lE(please print ,,</C s iGirA
U 0i,l
Zone nst. Units So. Ftg. l4ain ValueFire Zone Bedrooms
Flood Plain Stories
Occy Load Ftg. Access
Ftg. 0ther
xr Value
Group q lue5
BUILDING PERI,IIT
Charges and
Su rcha rges
Plan Ck. Conrn/Ind
65%/8ldq Per Fee
Systems Deve
Charqe f1.5q
opment
Plan Ck. Res
30%/Bldq Per Fee
Fence
Demo
ELECTRICAL PERI|IT
Charqes and
Surcha rges
Sidewalk
A/C Paving
Curb Cut
Total Comb.-Permit
IIECHANICAL PEP.HIT
Charges and
Surcharges TOTAL
l'ec I'l n i
-7
ToTAL VALUATIoil--
PLUI4BING PERMIT
Charges and
Surtharges
/Cff
| , , ..,1.1
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. examole- Tax Lot 100, Lane County Nap ReferenceI7l: ,r3
2. examole- Lot l. Block 3, ?nd Addition toffiilField EstatesC. Name, etc. of owner and construction Iender.0. Ener-oy Sources
l. I&!efS- heat/e-.Eqtllcgl-g-q.illlg/or ror (u1. examcte- waterhealer/ejectrical/or so-TaE. Square footoge or valuation, etc.l. examole- 1250. sq. foot house, 500 sq. fc2- glllrole- lT-iew proJect, check new - if titifiEEk-i-dd. etc.F. Bui lding permit informarion:1. examole - consCruct sing.le family housedtfialEb garase i?. examole - rernodel existing garage into fi3. q,amllE - convert single iai.ily"residenceEiiiuFant (change of-use)G- Value of work as defined in Section 303 (a) o (ie
Structural Specialtv CodeH. DESiGI.I TEAI.I AtID CCII1RACTORS
To avoid design or construct.ion delays. Build.Division Staff must be able to contact apDroor ce- persons regarding design informat.ion or job sicorrections. etc.
Abbrevia:ec Plumbing, iiechanical, & Electr.ical SchA. Sxcect r.rhere blank spaces occur in the cjescrip i;po.!jon of the i'lechanical and Electrical Schecr
CITY O F SPRINGFIELD
CirY Holl
Sp ringlield,Oregon
DePodment of Public Works
oFFlcl AL RECEIPT
PERMIT VALIDATION
iI
4
9
Ho.
SIGilATU R E
eucEiE or t"or
-,-qA,B b-rl.uir
t
(,
R d
II.
III.
IV
€
Fo
Amou nt Recei ved
(!
/E\ir
tArts
6
ihe applicant neeo fill-in only the No. Boxes ato rhe approoriate item(s) to be installedB. iull Plumbing, l,lechanical, and Electrical Scheiare avaiiable at the tsuildinq Division1. To conserve space on the permit forn the sc
have been abbreviated2- If the item(s) to be instaliecj are not coverthe abbreviated schedules you shouid consultfull scnedulesC. BiJILDIiiG DIVISION STAFF WILL FILL OUT ALL FEES A
CI{ARGES Oi'l THE SCHEDULESD. As noted on the CAP, the labei must be deliveredelectrical contractor for signature by his electrsupervisor. The general contractor .is not authorto sign the electrical label.
Applicant to sign and date
lJhenever oossible, the initial appJication will be usa worksneet only. l^there possible, Building Division .will prepare a type written copy and return it to theaPPIic:nr ag the t.ime rhe actual permit is issued for
s i gne ture -
Fees and Charges
Plan cneck fees are due and payabie at the time of theapplicatron. and no plans wiil be processed unt.il tnesfees are paid. AII other r-ees and charges are due andpayabie wnen the permit is issued.
Y. FOR OFFICE USE OI{LY
(on
(
{z-
(Ir€Ltoi'tuii!uLL
f
A{,
lt,,(
PROJECT CONDITIOIIS TO BE SATISFiED BEFORE OCCUPAIICY:
J
Pernit applicant exempt from negistration with the Builder's Board because:
Additional Project Information:
PLANS REVIEI.IED BY:
da tenameSignature
(
(
i