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HomeMy WebLinkAboutPermit Plumbing 1985-02-13CITY OF SPRiNGFIELD COHBI NATI ON APPLI CATION/PERHIT 726-3753 Job Address I I ? S, lrl o EIIERGY SOURCES: llater Heater Ranqe . Ftq. l'la n_ Sq. Ftg. Access._ Sq. Ftg. 0ther_ _tlew_Add Al ter_Rep. _Fence_Demo Change/Use 0ther \A \9 a lrl U.: Legal Description \ Value of l,/ork#rsc.owner fY\4 cl T\r* b"Ur* ru.H^0rp-,^4^2, Addres s Phone t In Descri be e., Build Single Fami I Construction Lender RP U&L,-^(. Addres s Phone DES IGN TEAI,I name addre s s exo I res phone no. Pri mary Structura I El ectri cal Hechani cal CONTRACT RS name address'Iics. no.'exDt res (ohone no- l Genera I PIUmbinq '- 1s-utv-tt- " EI ectri ca I l.lec ha n i ca I PLUI'tBI NG ELECTR I CAL HECHAN ICAL FFF CHARGF NO FFF CHARGF N0-FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S . F. P,es i dence(l bath)SERV I CES Recessed wal I Soace heater and vFnt Duplex (l bath) each Additional bath Temporary Constructi on Apnliance vent sepa rate l.later servi ce Chang resid e in existing ence Stati onar-v evap coo l er Sewer multifamily, corm 0r Industrial Vent fan with sinole duct Storm Sewer 0f -amps. Vent systern apart from heatinq or A.C. COMI.I./IND. FEEDERS l4echanical exhaust hood and duct Instal I /al ter/rel ocate di ctni h fccdcr<['lood stove/heater 0f amps ISSUANCE OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I.IHERE STATE LlN shall nor be valiC REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penirituntil the label has been signed by an Electrical Supervisor and returned to the BuitOinl Division I HAVE CAREFULLY EXAIIlNED the como'leted apn'lication for oermit, and do hereb.v certify that and all work performed shall be done in accordance all information hereon is true with the 0rdinances of the City L that tlO 0CCUPANCY will be made and correct, and I further certi fy that any State ofof Spri ng st field and the Laws of the 0regon the Bui oertaining to the work described herein , andof any ructure without the permission of lding Divi sion. I further certify that my registration vrith the Builder,sBoard is in full force and effect as required by ORS 701.055 , that if e xempt 5 wilI the basis for exemption is noted hereon, and thatonly su bcontractors and employees who are in comcliance with 0l?S 701.05 be used on this Droject. l,lAl'lE ( pl ease pri nt)-Nou.c,O|-lB lE SIGNATURE its So . Fto. l'lain lue Fire Zone Bedrooms Load Sq. Ftg. Acces Val ue Flood Plain Stori Group Sq.xrVa lue ToTAL VALUATIoil_ es Ftg. 0ther BUILDING PERI'IIT Charges and Surcha rges Plan Ck. Conm/Ind 65%/81rlo Ppr Fpp terns opmen Plan Ck. Res 30%/B1dq Per Fee PLUI,IBING PERMIT Charges and Surcha rges Fence Demo ELECTRICP.L PERIlIT Charges and Surcha rges Sidewal k A/C Pavi ng Curb Cut Tota'l Comb. liermi t t,.IECHANICAL PERMIT Charges and Surc harges TOTAL #/o fD U -/0rQQ---- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition toSlFifr-qField EstatesC. Name, etc. of owner and construction IenderD. Energy Sources 1. 2.L. 5qua 1. 2. exampJe- heat/electrical ceil ing/o examp I e- waterheater/e I eiTilca I /orre footage or vaiuation,GTEl-- example- 1250 sq. foot house, 500 r example- if new project, check-new check add, etc. r forced air gas sol ar sq. foot garage - if addition, F. Building permit information:l. example - construct single family house with anattached garage 2. example - remodel existing garage into family room3. example - convert single family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI'I AND CONTRACTORS To avoid design or construction delays, Building Div'ision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedulesare available at the Building Divisionl. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electricalsupervisor. The generai contractor .is not authorizedto sign the electrical label.Applicant to sign and date l.Jhenever possible, the initial appl.icat.ion will be used asa worksheet only. Where possible, Buitding Division Staffwill prepare a type written copy and return it to theapplicant 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 theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY II III IV v PERMIT VALIDATION r Ld btq (, (, Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s'l 9na ture da te