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
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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
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III
IV
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PERMIT VALIDATION
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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