HomeMy WebLinkAboutPermit Plumbing 1990-11-15
iii INSPECTION LlIIE
'1726-3769
.
CITY OF SPRINGFIELD . INFDRltATIDN UNt
COMBINATION APPLICATION/PERMIT 726-3753
E!lERGY SOURCES: Sq. Ftq. 1.la i n
Heat ~q. Ftg. Access.
Water Meater Sq. Ftg. Other
--1~ew__Add__Alter-c~ep.
Range ) __Fence__Demo Change/Use
valu1'\ I~: " . _Other
BulldinQ- 'Tr!nfo: Describe Work.(i-.e.. Build Single
Familv Re idence With Attached Garaoe1
.a
D
-
:b
'~
Job Address L\-\ (J~'<:\ 'f\\\\'~ f\
legal Description \f\()~~cC)nO\N')
Owner Tf){'(\ \ A )\ \ ~OY\.
Address A-J /)9 ~ yy\ ()I -11\, Phone
.....~II:t fJJL ~'Qr41t)
construct~r\ler I
Address
Ut~ 1 (jN r f:.Ar~
(name)
Phone
{address}
~Jn\~~) ~ \\\Jf\
flics.no.)
(exoires)
(ohone no.
Primary
Electrical
~-~
....c~~.
Structural
Mechanical
CONTRAC!gPS Inamel\...
GenehI1.;;~ffiJ\~
Plumbina
~\nJ\ s... ,
(addri='ss)
(lieo;;. nn.)
(pxoirpc;.l (nhnnp nn. \
Electrical
,
Mechanical .........
PlUI.IBING
ELECTRICAL
MECHANICAL
NO,I
Each single fixture
, FEF I l":HIlB.G.L ~n I I H~ I rl-l8.R6.E NO. I
Res idence of furnace/burner to
SQ. FT. BTU's
I !:'n' lrl-lARG..E..
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~~P hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
se:oarate:
Stationary evap.
cool€!f
Vent fan with
sinolp- duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hnod i1nd dud
Sewer
Temporary Construction
Change in existing
rp'iir!YJ1rp
multifamily, conn. or
Tnrlu<;.trial
Water service
COMM./IND. FEEDERS
Install/alter/relocate
rlic:trih_ fppdpr,
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE lAW REQUIRES
shall not be vali1 until the
ISSUANcr OF PFRr11T
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this perQit
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 Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that NO .0CCUPAr~CY will 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project.
1lAf.IE(please p~"",^ ({_f'...,~r<+ ,SIGIIATUREKc.V\cJl0 C. f-(.rl,c..czJ-
/\,., FO~ OFF I CE USE DIllY
/
'Tvpe/Const. Units Sq. Ftg. t1ain
Bedrooms Occy load Sq. Ft9. Access
Stories Occy Group Sq. Ftg. Other
DATE ((-/S--9()
Zone
Fi re Zone
Flood Plain
x
Value
Value
Value
x
x
TOT ^l V AlUA TI ON
BUILDING PERmT
Charges and
Surcharges
Plan Ck.
65%/Bloo
------------ Plan Ck.
30%/BldQ
L0 (jU Fence
-- ---?T~ Demo
, - I ,-) .
I'Sidewalk
I A/C Paving
I Curb Cut
I
Conm/lnd
Ppr Fpt)
Res
Per Fee
Systems Development
Charoe O.5~)
PlUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
11ECHANICAl PERMIT
Charges and
Surcharges
Total Comb. Permit
TOTAL -; CO, ~~l
-
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
11 oj 43
2 .examp) e- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
'I. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electricalJor 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 pennit infonnation:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam~le - 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 item(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 ather fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY:
.
I
PERMIT VALIDATION
P'mit Cleek rIt ~
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date