HomeMy WebLinkAboutPermit Plumbing 1986-9-10
jINSPECTION LINE
726-3769
Job Address 54, ~
Legal Description
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CITY UF SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range___ _ _____
ValuE of Work:
'~dO
. INFOR/IATION liNe
726-3753
Sq, Ftg. 1'la;n
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Pep,
--Fence Demo Change/Use
, Other- -
MA-IN ":".,
Address
UESIGN TEAll
(name)
Phone
(address)
flies. no.)
(exoires)
w
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".,. "' ~
Owner ~o:.w~ .s.m~~
Address Po l!v.CJ\( S2.~
(Y .J-A CMA-M I~'::" 0 Ii:
IAJ(, '
Phone
BuilriinQ Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached GaraQe)
Construction lender
Primary
f1echanical
CONTRACTORS
(name)
(address)
fl ;ts. no.)
_ A
lexDiresl'~one
no. )
Structural
Electrical
Genera 1
Plumbino
MI/;:~S. ( ~AJ'" 4)UAM1~II.%IUL Pl>
f? TI-O
IfO?;'li''1 Lj-I"j-T7
BpYJ-I:lJ<J.J.. 7..1~-~D<;{>8 'l\'.~1-'ll'7
Oil. "1:)'2...'1-
.Jg-:>-7J.~
Electrical
Mechanical
PLUflBltlG
ELECTRICAL
MECHANICAL
NO,
FEF CHARGE Nn
FFF rH~ NO,
FFF 1-.C..I:iAR.GI.'
SQ, FT.
furnace/burner to
BTUt S
:3
Each single fixture
7.$'0 2"2,'?
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bathl
Duplex (I bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
C;pno'lro'ltp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood ~nd durt
Sewer
Temporary Construction
Change in existing
r~o;idf>l1ce
multifamily, comm. or
Inrlustri~l
~Jater service
COMM./IND, FEEDERS
Install/alter/relocate
di stri h. fpprlprs
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
zz .S"" TOTAL CHARGES
ISSUANCf OF PFR!IIT
TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the Laws of the Sta te of Oregon ~erta i ni n9 to the work descri bed herei n, and tha t rw OCCUPAHCY wi 11 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
UAl'iE(please print) JAMeS ~, ;f4ue.e<;. JR, S IGrlA TURE j~)'h.~j" DATE '1-)0 -ft.
FOr. orFICE USE ~Y II l '
Zone Ij ~
Type/Canst, Units So' , riain x Value
Fire Zone Bedrooms Occy Load Sq, Fto, Access x Value
Flood Plain Stories Occy Group Sq, Ftg, Other x Value
TOTAL VALUATION
BUILDING PER/lIT Plan Ck, COIl1ll/! nd
Charges and ------------ 65%/Bldo Ppl" ~"'P
Surcharges Plan Ck, Res
30%/Bldo Per Fee
PLU!lBING PERMIT 7"Z_50 Fence
Charges and ------------
Surcha rges ."J(!;> Dt1mo
ELECTRICAL PER!HT S1dewalk
Cha rges and ------------
Surcharges A/C Paving
MECHANICAL PERMIT I Curb Cut
Charges and ------------ I
Surcharges
Systems Development
Charoe (1,5~) ,
I
Irotal Comb. Permit
I
I TOTAL
:2 3'. 7"~
.
r
I
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample~ Tax Lot 100, Lane County Map Reference
J/ 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add. etc.
F. Building permit information:
1. example ~ construct single family house witr. an
attached garage
2. exam~le - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid.design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate ;tem(s) to be installed
B. Full Plumbing. Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s} to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application. 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.
5 &7{)50
q-lo-rt(P
V. FOR OFFICE USE ONLY
Permit Clerk ~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.date
9-/b-~G:
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