HomeMy WebLinkAboutPermit Plumbing 1980-10-17INS
726 c0t1B I ON APPL RI4IT 726-
DAIo
B
Job Address Z EIIERGY SOURCES
Hea t
l,later Heater
Ranqe
So. Ftq. liain
sq. Fts. Acceil--
S-0. Ftg. 0ther
I'lew Add A1 ter--IEo. -JenEE_oEfrb Change/Use
0ther
l-egal Description
Value of l,lork:
Owner
Phone 'e., Bui ng e
Construction Lender f
Addre s s Phone
name address (exoi res phone no.
Pri
Structura l
El ectri ca I
llechani ca I
CONTRACTCRS n afie 'a ddres s {lics. no.)ex0 i res -phqne no. )
Genera l
Plumbino
il ectri cal
PLUIlB I I]G ELECTRI CAL MECI1AN I CAL
FEE CI.,lARGE I NN FFF CHARCF NO FFF CHARGF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTLI' s
Relocated buildinq
(new fix. addi tiona l )
New ci rcui ts al ts.or extensions
Floor furnace
and vent
S. F. Res idence(l bath)SERV I CES Recessed rval I
Space heater and vent
Duplex (l bath) each
Additional bath Temporary Construction Apol iance vent
sepa rate
Change in existinq
res i dence
Stationar-v evap
cool er
Sewer multifami ly, comm. or
InCustrial
Vent fan with
sinole duct
Storm Sewer 0f -amps.
Vent system apart from
heatinq or A.C.
c0Mr.1./IND. FEEDERS Mechanical exhaust
hood and duct
Instal I /aj terlrel ocate
di stri l-r- feeders l'lood stove/heater
0f
ISSUANCF OF PFRI',iIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I^IHERE STATE LAN REQUIRES that tlre Slectricat work
shal I not be val i,l unt'i I the 'label has been signed by
be done by an Electricai contractor, the electricai portion of this permit
an Electrical Supervisor and returned to the Building 0ivision
HA E comr)I eted a pl")i cati n Derm 'I t an d do he reb.v rt .I ty t ha t a I nf,o rrna t l on hereon .I s truendcorrectandIfurthrcert1fythat any and al1te of 0reqon
n of the Bui l
work performed shall be done in accordance with the 0rdinances of the Ci tyofSDrtngfieIddtheLawsoftheSLdDe rta 'I n 'I n g to th e t.rork des
fu rtherf exemDt
.055 viII
crt bed he rel n and tha t NC OCCUPAI,IC w'l I 'I be madoftructwthotheanySureutperm'l SS 1 o d 1 n9 D 'I 'I s 1 on I ce rt 'I fy t ha t my reg i stra t .I 0n v/1 th th e 'I
I dBoa rd 1 s 'I fr I I fo nd eff i red by ORS
u r 5nurceaasreq u 701 055 tha L 'I the ba s s for e xempt 'I n 'I no ted hereon and tha tIonvSubcontractorsandemrl1oyeeswhoare'I n c0mD an ce wi th 0tls I 0 1 be u sed 0 n thi s pro.j ect
l,lAt'1E ( pl ease pri nt )S IGiIATURE TE
Zone oelConst. Uni ts Ftg. l4ain Val
Fire Zone Bedrooms Load Ftg. Access x Val
Flood Plain Group Sq. Ftg.0the r Val ue
TOTAL VALUATION
Stori es
BUiLDING PERMIT
Charges and
Surcha rges
Plan Ck. Conrm/lnd
65%/Bldo Per Fee
Systens Deve'
charqe f1.52'
opment
Plan Ck. Res
30%/81dq Per Fee Slcrr tSq;=uq.f tar-,,40
PLUI4BING PERMiT
Charges and
Su rcha rges
Fence I
Dgmo
TLECTRICAL PERI1IT
Charges and
Su rcha rges
Sidewalk 5.co
A/C Paving
Curb CutI,IECHANICAL PERMIT
Charges and
Surcha rges TOTAL 15 <o
bul lc,rno Penntt Info:
Farni lv lles i dence l.li th A
Addrtiss 3", n/t) s re l{o rk (
I Garaop
r vr 1'
IJL5lbN ILAI.'!
":chanical
l,later servi ce
Total Cornb. Permit
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Rel17-I3-T:?. example- Lot l. Biock 3, Znd Addition toSFrinqfield EstatesC. Name, etc. of owner and construct.ion lenderD. Energy Sources
l. examplq- heat/electrical ceilinq/or forc,z. Examofe- waterfEl'fri7ETEEElIil7b. ro-iIFE. squaiFT66Tage or vaiuation;-eE. -
I example- 1?50 sq. foot house, 500 sq. fo2. example- if new project, check-new _ ifiIEER--aad, etc.F. Building pern'it information:1. example - construct singie family houseattached garage
Z_. exarnple - remodei existing garage into f3. examole - convert single family residencFE!raurant (change of-use)G. Value of work as defined in Section 303 (a)Structural Specialty CodeH. DESIGN TEAII AND CONTRACTORS
To avoid design or conStruction delays, BuilDivision Staff must be able to contact appr(persons.reqarding design information or jobcorrections, etc,Ii. Abbreviateci pl umbing, l.lechaniA. Exceot urhere blank spacesportion of the l,lechanical
tne applicant need fill-ito the appropriate item(sB. Fuil Piumoing, Mechanical
(nc clTY oF SPRtNGFtEID
City Holl
Springfteld, Oregon
D.portilcot of publlc Wor*rOFFICIAI. RECEIPT
PERMIT VALIDATION
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IIo. B 54938
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Recei ved For:
(
e
("
cc
cal, & Electrical !
occur in the desct
and Electrical Scl
n only the No. Boxr
) to be installed
, and Electrical S,
,qC
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are available at the Building Div.isionl. To conserve space on the permit form th pr.have been abbrev.iated2. if the item{s) to be installed are notthe abbreviated schedules you shouid coful I schedulesC. BUILDII{G DIVISIOI,I STAFF l^lILL FILL OUT ALL F (I'
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delielectrical contractor for signature by his ,cssupervisor. The generai contractor is not {f,oto sign the electrical Iabel
(
(III Applicant to si gn
le,
and date
the initial aoplication willlJhenever possib
a worksheet oniy.Where possibie, Bui)ding 0ilwritten copy and return itwili prepare a type
ap
si g na tu re.
pl icant at the t'ime the actual permit is issr
G;
Amount Received
AY
IV. Fees and Charges
PIan check fees are due and payable at the t
app I
fees
ication, and no plans wi
are paid. All other
1 I be processed Lrltr5s
ttm(r rY
unrl'i l
fees and charges are due and
issued.
aurxoRrzEo srcxrruE
PRtBTtts . EUGEta. oF '7ao! 56!t!-6
Permi t Cl erk
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payable when the permit is
FOR OFFICE UsE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with tle Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
da tenameSignature
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