HomeMy WebLinkAboutPermit Plumbing 1981-08-31INSPECTTON ltNE
72&.3769 CITY OF SPRINGFIETD
CO}IBINATION APPIICATION /PENMII INFONiIATION I.INE
726-3753
lDe -oz-I
ENERGY SOURCESI
Woter Heoler
Heot
Volue of Worl:
Sg. Ftg. Access.
-New__.Add_Alter_Rep.- -Fence__Demo_Chonge/Use
--Orher
Sq. Ftg. lt{oin
Address
Singlewirh
Building Permit lnfo:Describe Work (i.e., Bui
Address
Phone
k
.\.)\0
N
DESIGN TEAM (nome)(oddress)
no.)
Residence of furnoce/burner lo
PI.UMBING
ETECTRICAT
MECHANICAT
FEE CHARGE NO.FEE
Eoch fixture tt.
Electricol
Mechoniol
Relocoted building
fix.New circuits, olterotions
or extensions Applionce vent
ro teS.F, Residence
(r
SERVICES Sio tio no ry evoP.
eoch T Conslruction
Additionol both system oport from
A.C.
Woter Mechonicol exhoust
Sewer
Storm Sewer FEEDERS Heot
Air hondler to
CF,lt
Air hondler over
10,000 cF
^
ISSUANCE OF PERMTT
TOTAI. CHARGES TOTAT CHARGES TOTAT CHARGES
STAIEWHERE tAw REQUIRES rhethot workElcctricol donebe tho Electricalby Conlroctol rhc cleclriccl of thisportion nol:hollpermit validbalobel ohssSsenonrignedConlroclorElertricslbyottochedondrheloeleclricslnel.Po
t 1,+ RPET t SIGNATURE DATE {4-'>t-P/
EXAMINED the completed
oll work performd sholl
de of ony
s required
HA'CAREFUVE ,YLT for ondopplicotion dopermit,lhot Ioherebycertify hereoninformotio n ts lrue ond ndcorrect,furthertholsndcertifyonybelndonewithoccordoncethofOrdinoncestheofCitytheondLowsSpringf ield of Stotethe oftolhedescribedworkperloiaingondherin,NOthot willOCCUPANCY mobe withoutstr ucture lhe ofsSronpermi Buithe Division.lding
Oregon
furtherthotcertlfythewithBuilder'sregislrotionmy Boord tnt5 forcef ull effeclond q oRsby 701 thdt if.055,theexempt bosis Ior ts notedexemptionqndthotheron,ondsubcontroclors whoonly tnore with 701oRsemployeesomplionce .055 beil u*d on this proiect.
Bosis for 8uilder's Boord exemption:
NArl{E (pleose print)GVaR Lr/
FOR OFFICE USE ONLY
tire Zone-Bedrooms Occy Lood Sq. Ftg. Access
FloodPloinstories-OccyGroup-sq.Ftg.other-a-fq|g3
TOTAT VATUATION
Sq. ftg. MoinZone
-Iype/Const. -Units
x Volue
x Volue
| ,rrr"., D"r"lopr"nt
I choroe (1.5%)
BUITDING PERATIT
Chorges ond
Surchorges
Plon Ck. Comm/lnd
PIon Ck. Res
Per Fee
Totol Comb. Permit
PTUMBING PERMIT
Chorges ond
Surchorges
Demo
PERMIT
SidewolkChorges ond
Surchorges
TOTAI^
ECHANICAL PERII{|T
Chorges ond
Surchorges
Curb Cut
CHARGF
--==_-BTU'S
Vent fon with
single duct
Amps.
Wood stove/heoter
Amps.
until
Fe nce
a/a Pavinn
CoMBINAT|ON AppLlcATlON/PERMlT (CAP)
l. Appliconr to furnish
A. Job Address
is issued.
V. FOR OFFICE USE ONLY
i:t:l.H::IXi",., r00, Lone coytly Mop.Rererence r7 03 43
i: Hffiff-i"ii. irt'i's,lia raaiiion to sprinsfield Estotes
No-", "I. of owner ond construction lender
B.
c.
D.
E.
Energy Sources
i.' "iJ - pf
"-
h eor /el ectri colg{ilg'io.l f o rc,ed o i r so s
;. affi-wJer-r''eoterT@gl7 or solor '-
souIEJiJoge or voluotion' etc'
i:;;;;i;:iiso 'q' foot house' 500 sq' foot sorose
i: H#lEkl,:* ..d';i;t,Ii"il **-ii oddition' check
odd, etc.
F. Building Permit informotion:
I. exomPle-tt..'l;;;';;sit'+o-itv house with on ottoched
goroge' 'nto fomilY roomZ. i*o-pl"-remodel existing goroge.rr
i: ffi"-.on'"'t sing-le fo.mily residence inlo-- ffint (chonge of use)
G. Vqlue of work o' dJfined in Section 303 (o) of the
- Stiucturol SPecioltY Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid d",ign-o'-t;;t'uttion deloys' Building Division
stoff must be oble to contoct oppropriote Persons regording
;;;ig; informotion or iob site correclions' etc'
ll. Abbrevioted Plumbing' Mechonicol & Electricol Schedules"' ;. ;;."01 where uton-t 'pot"s occu-r-in the description portion
of the Mechotl:;i';;i;l;ctricol Schedules' the opplicont
need fill-in .tt;;'It:'s"'"t odiocent lo the oppropriote
irem(s) to be instolled
B. Full Plumbing, Mechonicol' ond Electricol Schedules-' ;;; oroitoUtJ or the Building Division
l. To consert" tp"t"-trr-the"permit form the schedules
hove been obbrevioted r ^- rL^ ^kkr2. lf the it"rnt'iil'il'instolted qre not covered on 'th'e obbrevi'
oled sohedui;;;; ;"'ld consult the full schedules
C. BUILDING DlvlslOi'l STAFF WILL FILL oUT AtL FEES AND-' iilncrs oN rHE scHEDuLEs
tll. ApPlicont to sign ond dote
Whenever possible, the initiol opplicolion will be used os o
worksheet ."rr. t"ii'erI ;;;;iil:E;ilciins Division stoff wiII
prepore o typ"*tiiiJ; tLpt ond return it to the opplicont ot
thetimetheoctuolp",.itisissuedforhissignoture.
lV. Fees ond Chorges
Plon check fees ore due qnd poyob.le ot the time of the opplicotion'
ond no plons will [";;;;;tiJliiit-tt'"'" fees ore poid' All
other fees ona .nJiJ" "i" a'" ond poyoble when the permit
PERMIT VALIDATION
Permit Clerk
PROJECT CONDIIIONS TO BE SAIISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
signolurenome dote
PLANS REVIEWED BY: