HomeMy WebLinkAboutPermit Plumbing 1985-8-23
., INSPECTION LItlE
1726-376g
t
~ ~"Y&! L
CITY UF SPRINGFIELD ~
COMBltlATION APPLICATION/PERMIT
/ EilERGY SOURCES:
Heat
Hater Heater
~.
Owner !:HUM.. St!f; tlItWO/{P.(l.!
Address 4;;;;:; 7 M~ :#- 8
( ~p ()('Mner 'iff-/I~)
'Constluction Lender -:? 41'- -::s I,.,;;'
Range
Valu€ of Work.:
INFURllATION L1Nl
726-3753
Sq. Ftg. 1.lain
~q. r:tg. Access.
Sq. Ftg. Other
Ilew Add A Her Pep.
--Fence Demo Change/Use
Other -. -
I
~
::)
~
~
.
Job Address
4;2;J. / /Y!t/;--J -.#-k-
Description 17 () d . -=?;:)qOl o/qOo
Legal
Address
Ul~j(;N JlAf~
I'/ff) _ Bui loino Permit Info: Describe \Iork( Le.. Build Single
Phone jr~ Family nesidence With Attached Garaael
6D5<_ t~ .q-/)ii>>1fJr:Td~
~-hand ~ d4td
to-NL ~ S~ n-/c
(name)
Phone
(address)
(lies. no.)
{exniresl
{ohane no.
Primary
Structural
<.
}L
'1
Electrical
Mechanical
CUNTRACTDRS
(namel
(address)
11 lcs. no.)
(exoires)" (ohnnp nn.1
Genera 1
Plumbina
Electrical
~'echanical
PLUIIB I NG
ELECTRICAL
MECHANICAL
NO.
Each single fixture
FEE rHARr,F NL EEL' J:JiAIlG( NO.
Residence of furnace/burner to
SQ. FT. BTU's
EEL J:JiAIlG(
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath 1
Duplex (I bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Jt~
;;( Sw..JW u
Sao
500
Of
COMM./IND. FEEDERS
Install/alter/relocate
di~trih" fppdpr~
amps.
Apoliance vent
~poaratp
S-tationary evap.
cooler
Vent fan with
sinol!=! duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd and dur:t
Sewer
Temporary Construction
Change in existing
rps i d_Pflr:p
multifamily, COlTlT1. or
tnrluc;trial
~Iater service
Wood stove/heater
Of
amps.
'-(0(",
4V
TOTAL CHARGES ('t>. ~ TOTAL CHARGES
WHERE STATE LAH REQUIRES that the Electrical work be done by an.
shall not be vali1 until the label has been signed by an Electrical
ISSUANCf OF PFRlfIT
TOTAL CHARGES
Electrical Contractor, the electrical rortion of this penmit
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 Ore~lOn pertaining to the work described herein, and that rm OCCUPAI~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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 701.055 w~b:,used on this project.
IIAI-1E(pleaseprint) Q,eor-Cje.. Dml"NOR SIr,IIATURE,>fL1~/c;1J/4........ DATE?ft':Th..-~
FOr. OFFICE USE orlLY , ' I / (
Sq. Ftg. riain x Value
Sq. Ft9. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION
Zone
Tvpe/Const.
Bedrooms
Units
Occy Load
Occy Group
Fire Zone
Flood Plain
Stories
BUILDING PERffIT
Charges and
Surcharges
Plan Ck.
____________ 65%1Bldn
Plan Ck.
30%lBlda
IV.oo I Fence
------n~lio-I DtI'1o
I'Sidewalk
lAIC Pavi ng
COIl1l1/1 nd
Ppr Fpe
R"es
Per Fee
Systems Development
Char~e (1.5~) .
PLUI~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Charges and
Surcharges
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
lOr Y-D
,
e
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 oj 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ!or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 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. exam~le - construct single family house with an
attached garage
2. example - 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. OESIGN TEAM ANO 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. BUILOING OiVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
O. 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. ---
ill. 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.
a ~5 ( ~ ~
g___ ;f3~~5
~,o
V. FOR OFFICE USE ONLY
Permit Clerk
nD/
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