HomeMy WebLinkAboutPermit Plumbing 1980-01-26lusprcircl iEt,D-_. -_726-37 69 --..- COIIBI',{ATIOI'I APPLICATIOi{IPERMIT
iNFORIIATION LiNE
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Job Address iiIERGY SOURCES
Hea t
l,later Heater
Ranqe
Sq. Fto. l'lain_
Sq. Ftg. Access._
So. Ftg. 0ther--
Jlew_=.AddJl te r_Pep .
_Fence_Demo Change,/Use
0ther
l-ega1 Description \
Val ue of l'lork:
0wner
Address Phone DU I
Fan
'I dinilv o Pernri t I nfo: Descri be l'lork (
llesidence l'Jith Attached Garage
:e., Build Sin_qie
? ),La{-na ,isl zx+s
C";t"*t,il Lender
Addres s Phone
DESIGN TEAII name address (lics. no.exDl res no
Primary
Struc*,ura I
El ec tri ca'l
l''lechanicai
CCIIiRACTCRS naiire address i I ics. no.pYnt rPs i (nhone no- )
Cener^a i
?l unbinq 8t trn cf-
ilectrical
Iechanical
PLUIIB I iiG ILECTR I CAL I.,IECIiAN I CAL
i tJO -I FFE i CHAPGE l:0.FFF I C}lARG:
ii::ci srn0le |rxiure
irii!
Residence cf in E-
furnacelburner to
BTLI' s
I
Reiocaterj bui id ing
(new fix. additjonal )
New ci rcui ts al ts
or extensions
Fl oor furnace
and vent
l
I
S-i. iesrdence(l oatn)S ERV I CES
Recessed r*al i
Soat:e heater and vent
0up1ex (1 bath) each
Addi tional bath Tempora ry Constructi on
Apoi iance vent
seDarate
j
I
irJater:ervice Change i n exi sti ng
rps.i darrce
Stationary evap
cooi er
Sewer multifamily, comnn. or
Tndrrst-rial
Vent fan with
sinole ciuct
Storn Sewer 0f Vent system epart from
heatino or A.C.
I
COi4I'I./IND. FEEDERS
iilechanical exhaust
hnod and duct-
Instal I /a I ter/re i ocate I
I
Idistrih. fFcders l'Jood stove/heater
0f amps
-T I
i
I
I
I
ISSUANCT OF PFRIlIT
TOTAL CI{ARGES TOTAL CHARGES TOTAL CI]ARGES
x"HEilE STATE L{,.1 REQUIRSS that the Electrical r.rork
shall not be valil until the label has been signed by
be do
an El
ne by an Electrical Contractor, the e.lectrical portion-of this perriit
ectrlcal Supervisor and returned to the Building Di.vision
the com0 I e a pp C dL i n for Derm t an o d 0 he reb.y rt i fy tha f a I I j nfo rna a i on h e i S rue
a nd co rrec t o nd fu rt he r cert '1 fy tha t a ny a n0 a I I l^rO r k oe rfro rmed ha I I be d one I n acc0r da nc wi th the 0rd i na es of the ci ty
r'l bed here i nd th t t'l c OCC UPANC Y W1 1 I be madefSor'i ngil e I d a nd the Laws of the 5 ta te of 0re g on DE rta 'l n 1 ng to the wo rK d e s C n a a
of any re w'i thou t the perm s1 o n of th e u.i I d 'I ng D 1 vr on i fu rt he r cer ri fy th d t rn.y reg I tra t I on vn th the Bu '|I der S
Eoard S i n rU I 1I fo rce and e ffec t as req u i red by ORS 7 U3 5 tha t 'I I exemp t t he ud5 i fo r exemD t i on 'I s not ed he reon a nd tha t
on I -v subco ntr'acto rs and emD I oyee s who a re I n c0m I ,i a nc e wl +k 0i?s 7 n 05 5 be U sed o n rh .I S pro.j CC I
iC rcr /-26- fAl.lAl,1E(please orint R IGiiATU
FF
Zone T'Yoer'Con s t Uni ts 5q
5q
. Ftq
. Ftg
. Ftg
l'la i n x Value
Fi re Zone Bed rooms Load . Access
.0ther
al
Flood Plain Stories Group 5q X Value
TOTAL VALUATION
BUILDING PERI.IIT
Charges and
Surcharges
P.l an Ck. Comm/ Ind
65%/81dq Per Fee
Svsteiis Develocment
clarqe (1.51)
Plan Ck. Res
30iilBldg Per Fee
PLUI4BING PERMiT
Charges and
Surcha rges
tn Fence
Demo
ELECTRICA,L PERI|IT
Charges and
Surcha rges
Sidewalk
A/C Pav i ng
Curb Cut
TotaI Comb. Permit
iIECHANICAL PERI,IiT
Charges and
Surc ha rges TC|TAL
!t
1r rtl (1{'l )A
( nI
S
I
/n 4r+/ e/- lel
COMBINATION APPLICATION/PEPJ4IT (CAP)
I. Applicant to furn.ishA. Job AddressB. Legal Descrjption1. exarnole- Tax Lot 100, Lane County Map ReferenceITTT":
PERMIT VALIDATION
CITY OF SPRINGFIELD
2. elslple- Lot 1. Block 3, Znd Addition toSEFI;!--rr'etd Estates
9. Name, etc. of owner and construction lender,D. Energy Sources
I. examole- heat/electrical c!iling/or for (u
E. SquaiE-?6oTage or valuati;rffi
I gx?ry]L i?s0 sq. foot house, 500 sq. fcz. examoie- if new project, check-riew _ if iitEIEEI'-i-acJ, etc.F. Suilding perrnit irrformation:l. examp.le - cons t.ruct single fami l,v i16u56dttached qaraae2- exarnole --"e,,-,6del existing -oarage into fi3. efimtia - convert single iaiiiy'res.iOencerescaurant (change of use)(:- Vaiue of work as defineo .in Section 303 (a) o theSt!.uctural Specialty CodeH. DESIG;,i TEAiI AIID CCII1RACTORS
To avoid design or conslruction delays, BuildDivision St.aff n:ust be able to contali'apprcor tepersons.reoaroing design information or jtl iicorrections, etc.
Abbrevia."eo plunbing, i.iechanica.l , & Elect!^ical SchA. :xceoE il,here blank sDaces occur in the descriopor-:ion of the |lecnanicai and Electrical Schedrihe appiicant neei fiil_in only rhe No. Bcxes i
^ :o_rhe-aooropriate iren(s) to 6e installeetr. ruil ptumbtng. l,iechantcal, and Electr.ica j Scheoare availabie at the Buildinq Division1. To conserve space on the permit iorm the schave been abbreviated2. If the rtem(s) to be installed are not coverthe abbreviatecj schedujes you should consultfull scnedulesC. tsUILOIiiG OIVISIOiI ST;FF I^JILL FILI OUI ALL FEES AC!{ARGES Oil THE SCHEDULESD- As nored on the CAp, the label must be deliveredelectricai contractor for signature Oy tris etectrsuoervisor- The general coniractor ii not author- to sign the electricaI iabelApplicant to sign and date
l,{henever oossible, the initial appjication wilj be usa..!.rorksneet only. l.Jhere possible, Building Oivision .wl il.prepare a type written copy ano rerurn it to cheapplicenc aE, the time rhe actual permit .is .issueo forsi gnature.
Fees and Charges
Plan_cneck iees are due and payable at the t.ime of theappiication. .and_19 plans r.ritt-Oe proceiiJo untit thesrees a!-e oaid. All other fees and charges are due andpayab l e when the pemi t i s .i ssuerj -
FOR OFF:CE USE C:,ILY
CirY Holl
SPringfield' Oregon
o"ooi-"ir of Public works--'orFtclAL REcEiPT
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Recei ved For:TI
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\ Amounl Received
sFELloi turiluLL
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SIGNAlURE
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
nTtPe t't a I ci na tp e X ft romnY ci tremp a t no iW h!L tneg he uB I.I d e r S Bo a becrd t u eS
Additional Project Information :
PLANS REVIEI{ED BY:
name da teSignatu re
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