HomeMy WebLinkAboutPermit Plumbing 1991-3-5
IINSPECTlON LINE
726-3769
I
CITY OF SPRINGFIELD
COHBIrlATlON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater__
Ranqe
ValuE of flork:
t
INFORJlATlON LINE
726-3753
Sq. Ftq: 1.la;n
~q. Ftg. l\ccess.
Sq. Ftq. Other
Ilew P.dd A Iter f!ep,
--Fence Demo Change/Use
.1 Other- -
~
~
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Job Address 41'2:23" ~rP"tW 5~=/
Legal Description/7_t!:>:7_'=1:;:>_'32 ....,.~
Owner' .MGk&W.'?/&-&b/ Up_
Address "2~z./ ;1;?zA~~ _<1?'J:!'o~~
~k&/~~~,5'/X --
. ';-/-.c-7>A .tGB'9-c,l~/
Address
DESIGN TEAI1
(name)
Phone
(address)
BuilGinQ Permit Info: Describe Work(i.e,. Build Single
Familv nesidence With Attached Garaoe)
11?,.>>Y;lp/h'l!:A .::9~"", ~ -'f~~
;$-.//~~;r;~L
~.z> Wtf?1i'E#z:>~€
flies. no.) (exoires)
(ohone no.)
Primary
.
Structural
lW'
~
V--
Eleclrical
Mechanical
CONTRACTORS
(namel
(address l
(1i(':~. no.)
(PHdrpc.\
(.,h""p fln \
Genera 1
. _ ~'7/ J4r.": ~~n-e ~./y-"
Plumbino L.l? .~.~~_~. <?7~'::? /
Electrical
??~~./~ P}I-9Z
.,.,*..J"":: /9:7
- - - -
Hechanical
PLUflBING
ELECTRICAL
MECHANICAL
--1JQ."
FEE: CHARGE Nn.-
12
Each single fixture
Residence of
... rlJAl!G!. ..l!O.....
II)
/";4:)
SQ. FT.
furnace/burner to
BTU's
~~L ..cHAR!iE.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
,
~,.. - .,
I SERVICES
I
Iremporary Construction
IChange in existing
ree; j 1e}'lcP_
Imultifamily, COIl1T1. or
lnrlue;trial
IOf amps.
ICO~1./INO. FEEDERS
1 Install/alter/relocate
die;trib. fepdpre;
IOf amp~
1
I
I
;I~ TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
Recessed wall
~n~rp hp~tpr ~~rl V~n~
Sewer
Appliance, vent
e;eoaratp
S-ta-tionary evap.
cooler
V'ent fan wi th
sinole duct
Vent system apart from
heatinq or A.r..
Mechanical exhaust
hnnd ;,nd t1urt
Water service
V Storm Sewer )'5"iIf) <:. 150 ;rp
Wood stove/heater
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
I SSUANCF OF PFRIIlT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
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 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 110 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 ORS 7nl.055 will be used on this project.
IJAl.IE(please printlCro; <t
t'le.--FG n bo~ l__n__SIGIIATURE~
FOP. OFFICE USE mIL Y
TYOe/Const~C;~~Un;ts Sq. Ftg.
Bedrooms Occy Load~;t Sq. Ft9.
Stories / Occ:V Group_Ji'-2 Sq. Ftg.
f).Jt~~h
,
DmJ-Y2L-
Zone CL.
Fire Zone
Flood Plain
r1ail'l x Value
Access x Va 1 ue
Otherlte--_19/~ Value
TOTAL VALUATlDrI
BUILDING PERfIlT Plan Ck. Conm/lnd
Charges anc ------------ 65%1B1 do Ppr Fee
Surcharges PI an Ck. R-es
30%/Bldo Per Fee
PLU'1BING PERMIT l.6.tP ., Fence
Charges and --- -_..:_---
Surcha rges $. 6(7 De~o
ELECTRICAL PERIIlT Sidewalk
Charges and ------------
Surcharges A/c P~ving .-
MECHANICAL PERMIT " "
Curb Cut
Charges and ------------
Surcharges
Systems Development
Charqe (1.5~)
Jo~~l.Comb, rermit
TOTAL
r;6'8: ~
,
'F
COMBINATION APPLICATION/PERMIT (CAP)
I. ApplIcant to furnish
A. Job Address
B. legal Description
1, example- Tax Lot 100, lane County Map Reference
II uj 43
2. exam~le- lot 1. Block 3, 2nd AddItion to
SprlngfIeld Estates '
C. Name', etc. of"owner and'constructlon le~der
0, Energy Sources . ._ . .
1. examEle..: heat/electrical cei-linq/or forced'air Qas
2. exa~le- waterheater/electr;cal/or solar
E. Square footage or valuation, etc:
1. example- 12S0 sq. foot house, SOO sq. foot garage
2. example- if new project. check new - if addition,
check: add. etc,
F. Building permit information:
1, exam~le - construct single family house with an
a ttathed 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 TEM1 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 appl;icant 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 c'onserve 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,
V. FOR OFFICE USE ONLY
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
II. :
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PERMI~ VALIDATION
ICff~/"7.16 .3'
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Permit Clerk ~~~ ,&~
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Permit appl i'cant exempt from regi strati on with the Buil der I s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name_UR;1jI~H .t!"Z:~ignature~~
I
,p:::;'_~date 7-:<8-9-/
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