HomeMy WebLinkAboutPermit Plumbing 1985-07-25a> \e^jd'
INSPECTiON LINE
726-37 69
CITY OF SPRiNGFIELD
COMBI TIATION APPL ICATION/PERMIT
N RIlA
7?6-
Job Address TH EIIERGY SOURCES:
Hea t
tlater Heater
in
5q. Ftg. Access._
Sq. Ftg. 0ther_
_l'lewJddal ter_Rep.
_Fence_Demo Change/Use
-other-----
mc
(A
0t.
t--
l-eqa1 Descri ption
Value of tlork:
Owner a
T Phone Builciin
Fami I y
q Pernrit Info: Describe l,,iork('
llesi dence l.li th Attached Garaqe
;e., Build Single
o302 f
(
Construction Lender
Addres s Phone
DESIGN TEAI4 name ress lics. no.exot res 10ne no,
Primary
Structura l
E I ectri ca I
Hechan i ca I
CONTRACTORS name lics. no-)exol res ohone no- )
Genera I
Plumbinq
I'techani cal
PLUI.IBI NG ELECTR I CAL MECHAN I CAL
FFF CHARGF NO FFF .HAACF NO FFF CHARGF
Each single fixture Residence of
sQ FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional)New ci rcui ts al ts
or extensions
Floor furnace
and vent
S. F. P.es i dence
( l bath)SERV I CES Recessed wal I
Soace heater and vcnt
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
sepa rate
l,later servi ce Chan g
resid
e in existinq
Pnap
Stati onar.v evap
cool er
Sewer multifamily, comm or
Industrial
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern
heatinq or A
apart from
,. c.
hcf-$I-e"o COMI'I./IND. FEEDERS Mechanical exhaust
hood and du.t
)rrotr-.ttre^Insta l I /al ter/rel ocate
di stri h- fppdprc l'Jood stove/heater
\o-^r,',r-,lp C)c>0f s.
c'4o
ISSUANCE OF PFRI,lIT
TOTAL CHARGES TOTAL CHARGES IOTAL CHARGES
WHERE STATE !-,lt,l REQUshalI not be vali:l untiI
IRES that the Electrical work be done bythe label has been signed by an Electri,
an Electrical Contractor, the electrical portion of th.is pernitcal Supervisor and returned to the Building Division
NED the comp app ca on for DC rml t an d do he reb,y ce rt I fy tha t a I 1 I 'I on hereon '|s trueandcorrectandIfurthercert'I fy that any and a1
State of Oregon
sion of the Bui
I work per fo rmed s ha I I be don e I n acco rd an ce wl th t he Ordi na of t he c 1 tyfspr
any
rd
'I ng fi e 'I d a nd the Laws f th nces
o e 0e rt a t n 'I ng to t he work descri bed he re 'I n an d that NO 0ccuPAr'rcY I I I be madefstructurewlthoutthepermlsdingDiV1s'I on I furt he r ce rt 'I fy tha t my reg 'I s tra ti on tJI th t he ut I deBoais in full force and effect 'I red by 0Rs
r s
a s requ 7 0 1 NE 5 tha t '|,f ex emp t the ba s 1 s for exemp t 'I on 'I s not ed hereon an d thatonlvsubcontractorsandernpIoyeeswhoare'I n comD I I a nce W'I th 0r?s 70t 0 55 w1 I I be used n thi s proj ec t
llAl'lE(please print IGNATURE )
Zone Const.ts Ftg. l4ain x Va lueFire Zone Bedrooms 0ccy d Ftg. Access x Vai ue
Flood Plain Stories 0ccy Group Sq. FtS x I
ToTAL VALUATIoN_
0ther
BUILDING PERI1IT
Charges and
Surcharges
Plan Ck. Conrn/lnd
65%/81dq Per Fee
Svsterns Deve
charqe tl.5c opmmt
Plan Ck. Res
30%/81dq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
/c,@
e,tt f)r I Ll
Fence
D6mo
ELECTRICAL PERIlIT
Charges and
Surcha rges
Sidewal k
A/C Paving Total Comb. Perm'i t
I,IECHANICAL PERMIT
Charges and
Surc ha rges
Curb Cut
TOTAL rc-fu
a,;
Address ;f, \
E l ectri ca l
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Lega'l Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, Znd Addit.ion toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1.)
E. Squa
example- heat
example- wate
Lre footage or
e c a fo rced a r ga s
e o r sol ar
VA ua t o n1. example- 1250 sq. foot house, 500 sq. foot garage?. example- iinew project, check-iEw - .if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into fam.ily room3. exempE'- convert single iafrily-residence inio
iElTt-urant ( 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
Divjsion Staff must be able to contact appropriate
persons regarding design information or job site
II correct ions , etc.
Abbreviated Plumbing, Mechanical,A. Except where blank spaces occuportion of the Mechanical and
the appiicant need fill-in onl
&Eri
EIeyt
lectrical Schedules
n the descriptionctrical Schedules,
he No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbjng, Mechanical, and Electrical Schedules
are available at the Building Division1. 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 theful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label
Applicant to sign and date
Hhenever possibie, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
signature.
Fees and Charges
PIan check fees are due and payable at the time of theapplication, 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.
III.
IV.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
v OQ
ch (
* bSoe)
Permit Clerk A-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name s'l gn ature date
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