HomeMy WebLinkAboutPermit Plumbing 1989-11-13e
l-egal Description
Job Address EIIERGY SOURCES:
Hea t
Val ue f l,lork
l,later lleater
Ra
!q. Ftg. Access._
Sq. Ftg. Other__
_llew-Add_A1 ter_Pep.
Fence Demo Change/Use
n
_otn er-
Owne r
DescrtI
Fam
n 'e., Build SinglePhoneAddres s e
C-rzwp %'6,F7> Dz>r- B-kConstruct.i on Lender
$'
N
0il
f,-
-7_Addre s s Phorre
ohone no.I i cs. no.addressDES I GN TEAI'I name
Pri mary
Struc tura I
El ectri cal
Mechanical
nhonp nn- )exDt res'address'(n ameCONTRACTORS
Genera l
Plumbinq
Electrical
l'lechani ca I
MECHAN ICALEL ECTR I CALPLUI{B I NG
FFF CHARGFFFFCHARGFNOCHARGFNOFIEfurnace/burner to
BTU' s
Residence of
FTSQEach si ng l e fi xture
Floor furnace
and vent
New ci rcu'i ts al ts
or extens.ions
Relocated building
(new fix. additional )
Recessed wal I
Snacp heatpr and ventSERVICESS. F. Res i dence(l bath)
Duplex (l bath) each
Apol iance vent
seDa rateTemporary Construct ionAddi tiona l bath
Stationary evap.
cool erChange in existing
res'i dencehlater servi ce
Vent fan with
sino'le ductTndrrstrial
rnultifamily, comm. orb*/4 (.*..
Vent systern apart from
heatino or A.C,0fStorm Sewer
Mechan ical exhaust
hood and ductc0r,1r.1./tND. FEEDERS
l'Jood stove/heaterInstal I /al terlrel ocate
distrih- feeders
0f amps.
ISSUANCF OF PFRI1IT
TOTAL CHARGESTOTAI- CHARGESTOTAL CHARGES 4'G
QUIRES that tlre Electrical work be done by
il the Iabel has been siqned by an Electri
an ilectrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Building DivisionWHERE STATE LAI.I REl
sha l I not be val i'l unt
inddohereb.ycertifythataIIinformationhereonistrue
and correct, and I further certify tnit any and all work periormed shall be done-in accordance with the Ordinances of the City
of Springfield and the Laws of thl State oi oregon oertaining to the work described herein, and that N0 OCCUPANCY will be made
or ahy structure withoui ihe permission of the Building Diviiion. I further certify that my registration with the Builder's
Board is in full force and efiect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and ernployees r^iho are in conroljance with 0l1S 701.055 will be used on this oroject'
tlAt'lE(please print)TE t t /rs /87SI GNATUREl(scGoo- E
Sq. Ftg. Access x Value-0ccy Load
:Va 'I ue
Occ.y Gro
TOTAL VALUATION
Zone Tyoe/Const. Uni t
Fire Zone Bedrooms
. Ftg. l4a i
Fl ood Pl ai n_Storie up Sq. Ftg . 0ther--------------I Val
Svstems Deve
charqe (1.52 opment
65%/B1dq Per Fee
Plan Ck. Conrm/lnd
Plan Ck. Res
30%/81dq Per Fee
BUILDING PERNIT
Charges and
Surcharges
Fence
Demo
PLUI,4BING PERMIT
Charges and
Surc ha rges
6__-
a€
4>
Sidewalk
Total Cornb. PermitA/C Paving
ELECTRICAL PERtlIT
Charges and
Surcharges
Curb Cut -z/_*TOTAL
HECHANICAL PERMIT
Charges and
Surc ha rges
INSPECTION LINE
726-37 69 COI1B I IIATI ON APPL ICATION/PERMIT 726-37
S
tlr
re WorkI Garao
PERMIT VALIDATION
Permi t Cl erk
w#6'lq
COMBINATI ON APPLICATION/PERMIT ( CAP)
I. Applicant to furnishA. Job Address
D. Energy Sources
B. Legal DescriP1. exampl e-
17 03 432. example- Lot I' BIock 3' 2nd Addition to
SpiiilTield tstates
C. Name, etc. of owner and construction lender
tion
Tax Lot 100, Lane County Map Reference
E
1. example- heat,
2, example- wate
Square footage or1. example- 1250 s
?'. @JT-new
check add, etc.
/electrical ceilinq/
ina.-t-.;-:7eTectrt.;fZo
val uation-, etE.-
or forced air ga5
r sofar
q.foot house, 500 sq
project, check new -
foot ga
if addit
rage
i on,
II
III
IV.
F. Bu'ilding pernrit information:
1. gAr-PfS. - construct single family house with an
attached garage
2. example --remodel existing garage into family room
3. examFIE - convert single family residence into
FEEGIFant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural SPecialtY Code
H. DESIGN TEAM AND CONTRACTORS
To avoid des ign or construction delays ' Bui Iding
Division Stafi must be able to contact appropriate
persons regarding design information or iob site
corrections, etc.
Abbreviated P)umbing, Mechanical, & Electrical Schedules
A. Except where blink spaces occur in the description
portion of the Mechanical and Electrical Schedules'
ifre applicant need fill-in only the No. Boxes adiacent
to the appropriate item(s) to be installed
B. Full Plumbinb, Mechanical, and Electrical Schedules
are available at the Bui lding Divis'ion
l. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fuli schedules
C. BUILDING DIVISION STAFF l.llLL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
e'lectricai contractor for signature by his electrical
superv'isor, The general contractor is not authorized
to sign the electrical label.
Applicant to sign and date
l,lhenever possibie, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gna ture .
Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the Permit is issued.
FOR OFFICE USE ONLYV
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
permit applicant exempt from registratjon with the Builder's Board because
Additional Proiect Informatjon:
PLANS REVIEWED BY:
date
name slg nature
/lular*,-