HomeMy WebLinkAboutPermit Plumbing 1987-12-21
INFORllATION LINo
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
,I -Other- -
BuilriinQ Permit Info: Describe Work{i.e., Build Single
Familv nesidence With Attached Garaae)
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.
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Legal Description I () ():J ~::) ~ d
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4194 m~
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.
JINSPECTION LINE
726-3769
Job Address
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOORCES:
Heat
O(S6{ IMer Heater
Range
ValuE of Work:
Owner
Address
Phone
Luh ~
Construction lender
-'
Address
Ut~lliN I tAr~
Phone
(address 1
[name)
(lies. no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lic~. nn.'
General
PI
Il /flm~
CI
.v
"
f / '
~
o
Plumbina
c\l(! r
Electrical
"'echanical
PLUllBI NG
ELECTRICAL
NO,
FEF r.HAR~F NO
~~~ rHARr,~ Nn_
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
S.F. Residence
(1 bath)
Oup!ex (1 bath) each
IAdditional bath
I ~Ia ter servi ce
I Sewer
I Storm Sewer
I
I
I
I
I ""'~
I
SERVICES
Temporary Construction
Change in existing
rpsidpnr:~
I'multifamily, comm. or
Tnrlll<:.trial
Of
amps.
I
I
I
I
I
.-hI'"
~ ,01'
I
COI~l,/IND. FEEDERS
l'Install/alter/relocate
rl i <:. trit'L fpprlpr<:.
IOf
I
I
I
amps.
"
~
~
---Q
~
(~xoires)
(ohone no.)
'12,"'1. C;)o 0
Jr~
0/
~")..
I Jr- -.
(pxo;rps)
(ohonp no,)
MECHANICAL
~r!:' r\.lAQr.~
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinl;J or A.C.
Mechanical exhaust
hood and rlurt
Wood stove/heater
ISSUANCf OF PFRiHT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L;\\~ REQUIRES that tile Electrical work be done by an'"Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~1INEO 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 performed 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 OCCUPAr~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 OP.S 701.055 will be used on this project.
HAI,IE(please print) LA (2.(2.. Y fV\.l LLE r2- SIGNATURE ~lLu f? l '7YI,J jJ~
FOr. OFF I CE USE OIlL Y
Sq, Ftg. 11ain
Sq. Ftg, Access
Sq. Ftg. Other
Zone
Tvpe/Const.
Bedrooms
Units
Occy Load
Occy Group
Fi re Zone
Flood Plain
Stories
BUILDING PERfHT
Charges and
Surcharges
PLU'~BING PERMIT Is. <'YO
Charges and C; ----- ...:_--
Surcha rges . 7 c:;
ELECTRICAL PERmT
Cha~esand ------------
Surcharges
, Plan Ck.
65%/Bldo
Pl an Ck.
30%/B1do
Fence
COIllllII nd
PJ"r Fpp
Res
Per Fee
D_
/1ECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
A/C Paving
I Curb Cut
I
DATE/J.-;</- RZ
Value
Value
Value
TOTAL VALUATION
x
x
x
Systems Development I
Charoe tl.5~) .
I
I
I
ITotal Comb. Permit
I
I TOTAL
/S,75
,
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrlcalJor solar
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house. SDO sq. foot garage
2. example- if new project. check-new - if addition,
Checl< add, etc.
f. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. exam~le - 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 CDNTRACTORS
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
fu 11 schedu 1 es
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.
I [) 7/ t
/2--2(--91
V. FOR OFFICE USE ONLY
Permit Clerk
Cr
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date