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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