HomeMy WebLinkAboutPermit Plumbing 1988-06-20I NSP
726-LINE CITY OF SPRINGFIELD
COHBI IIAiION APPLICATION/PER}4IT 7
ruJob Address .a EIIERGY SOURCES:
Hea
liater Heater
l''la i
Sq
Sq
Ftg Access._
0therFtc
llew Add A
-Fence Demo
1 ter_Pep.
Change/Use
Othe r
c0
,ac
ut
Legal Description
YaTue of l{ork:
Owner
Addtess 75 2n *{2 ru 5z Srar-=*? P$B?<.e erm llor
Fami e
.e., Build Single
,/rwz z-,/ 2 2' OF srcZa h- g-
Construction Lender 2?/,*= .4or> / 4/74r Dq;: a-
Addre s s Phone
DESIGN TEA"naIIe addre s s tcs. no.exol res ohone no.
Pri
Structural
El ectri crI
Hechani cal
Pl umb i
PLIIJTIBIIG ELECTRI CAL MECHAN I CAL
F[E CHARGE NO FFF CHARGF N0 FFF
Each s,inqle f,ixture Residence of
SQ FT
furnace/burner to
BTU. S
Relocated hu,ilding
(ner f,ix. afit'imal)
New ci rcui ts a'l ts.
or extensions
Floor furnace
and vent
S. F. .Pesidlence(1 bath)SERV I C ES
Recessed wal I
Soace heater and veni
Duplex (l bat"h) each
Additional bath Temporary Constructi on
Apol iance vent
sPoa rat-e
llater service Change in existing
rp< i dpncp
Stati onar.v evap
cool er
Sewer multifamiIy, conrn. or
Tndrrqtrial
Vent fan w'ith
sinole duct
l72 Storm Seler fQn 0f Vent systern apart from
heatinq or A.C.
c0Mr.1./IND. FEEDERS
Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
dictrih- feeders l'Jood stove/heater
0f s.
ISSUANCF 0F pFRt{IT
TOTAL CHARGTS
6B TOTAL CHARGES TOTAL CHARGES
I.IHERE STATE l-1tI REQUIRES thatliC until the labe
tlre E 'I e ctri a I w0 rk be done by an Electri
an Electrical SuPervi
ca I Co ntra ctor t he e I tri L a I po rt 'I 0 n of th 1 S perm''I t
ha 'I I t be va I has been s 1 gned by so r and returned to the Bu i I d 1 n9 Di vl s 'I on
s no
Y EXAIl comp 'I e apr)ca ti on for DE rmt t and do hereb.y ce rt fy tha t a I I 'I n t 'I on he reon i s true
the City
be made
I der' s
and that
0rdinances ofand correct, and I further certify that any and al l work oerformed shall be done in accordance with the
wl I Iof Spri
of any
Board i
only su
ngfield and the Laws of the State of 0reqon oerta n 'I n s to the wo rk de scrl bed here i n and th a t NO OCCUPAI,ICY
tructure vl tho'ut. the permissi
nd effect as
ernployees who
0 n of the Building Divi
by ORS 701.055
s 'I 0n I furtherf exempt
.055 wi l 1
certi fy tha t m.y req 1 S tra t I o n url th the Bui
s
'I t he ba 'I fo t'i 0n I s noted hereons in fr.rll force a req u t red tha t s r ex emp
bcontractot"s amd are 'I n comc I i ance W'I th 0l?s 70i be u sed on th 'I s proj ec t
GI'lAtlE(please print)Ker-:r Gu tl S DATE
-Zo
zone,rV4??, tyoelConst. Units SQ'Ftq. l'lain x Val
Ftg. Access- x Val
fr.g.Orn""-@ul
TOTAL VALUATI
Fire Zone oms cy Load
Flood Plain Stories Group Sq.
BUILDING PER,'IIT
Charges and
Surcha rges
Plan Ck. Conrn/Ind
65%/B1do Per Fee
Svsteris Deve'
Charqe (1.51.opment
Plan Ck. Res
30%/B1dq Per Feq
PLUi4BING PERMIT
Charges and
Surcha rges
ft cQ
2 -!e
Fence
Demo
ELECTRICAL PERI!IT
Charges and
Surcharges
St dewa I k
A/C Pav i ng Tota'l Comb. Permit
HECHANICAL PERMIT
Charges and
Surc harges
Curb Cut
TOTAL 5a.m
ttac
rJ
#tfl
-i_-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. gla[ple-_: Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, 2nd Addition toSpTffig'field Estatesq. Name, etc. of owner and construction lenderD. Energy Sources
1. exampie - construct single family house with anattached garage,^. examp]e - remodel exist.ing garage into family roomr. exampte - convert s.ingle family residence intorestaurant (change of use)G. Value of work as defined in Sect.ion 303 (a) of theStructural Specialty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid leslS-n or construction delays, BuildingDivision Staff must be able to contalt appropr.iitepersons.regarding design information or jbU iitecorrections, etc.
Abbreviated Piumbing, Mechanical, & Electrica.l SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedulei,the appticant need fill-in only the No. Aoxei-idJii.nt
_ to-the appropriate item(s) to -be installedB. Fuil piumbing, Mechanical; and-ile;irical Schedulesare available at the Building Division1. To conserve space on the permit form the scheduleshave been abbreviated2. II ttg item(s) to be instal.led are not covered onthe abbreviated schedules you should .onrrit-it"full 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 thee'lectrical contractor for signatur. Ov f,is eteci"iiai -
supervisor. The generai contractor ii not authorizedto sign the electricai labelApplicant to sign and date
l,lhenever possibie, the initiai application wi.l .l be used asa.worksheet only. tJhere possibtb, guitainS Oivision-itaiiwiil.prepare a type written copy ind ."trin it to theappr'rcant at the time the actual perm.it is issued tor trissignature.
Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and.no plans wijt-Oe p"oc"iieA until theseTees are paid. All other fees and charges are due andpayable when the perm.it is issued.
FOR OFFICE USE ONLY
II
III
IV.
v
exarnple- heat/
example- water
re footage or
exampl e-
examp I e-
check add
JT-new
2 r e
I
2
F
1i forced qir gas
or solaF, etc.
house, 500 sq. foot garage, check new - if addition,
eI ectri ca
E. Squa val uation
1250 s q. foot
project
, etc
Building permit information
PERMIT VALIDATION
[(1s2
Permit Clerk
,(q
A-70
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
cant exempt from registration with the Builder,s Board because:Permit appl i
Additional Project Information:
PLANS REVIEWED BY:
name ates't gnature c^