HomeMy WebLinkAboutPermit Plumbing 1989-4-20
~ III~I'[CTIOII Lilli: . CITY IIr SPRINGfl[LO . INFO/UIATlON LHll II
, 726-3709 COIIBIII^TION ^PPLlCMION/PERMIT 726-3753
\ \.....~'" ~ ' C :I.... E'IERr,y SOURCE<' Sq, ~tg, "ldin.iU."iL1 )- "r':\
'" ^ddre<S"\..,_L~~\~'" ,,~'S"e.e:, lI~at' J, ~q, :t9, ^cce<s, :sJ
)al DescriP.::on~~~~ ~\ ?...:"b\::l:::) Hater lIeate.' Sq, Ftg, Other
Rangeu, !lew Md ^lter rep. 1"'\)
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Valuf of Hark: Oltll'1" .
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\'hulI:'t\r)/ .aMi BUllt;\nQ Penult Info: Ilescrille Hork(l,e., Build Single
1.:\(.\Q:'JILn Fal:lilv nC'sidencc IH th /lltclched r.araoel
____._ -- V(>,"'fv~r;:::K)P\ \ ~'Ir<>\\ C'~\e\l-.::l
\\\'\~ Qp~\."
I'holl('
(aLldl't~<;s) (lies. no.) . {exniresl } {phon!! no.'
11\
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Owner (~:',--\:_:0",'~\~,,(
".1.1,'<" l..\l(..~_~~ "\u, ~
con'trucL~~~~r\ rY_
"Jdl'l'~S
Ul~Il;1I lI.A/I
lll<lll1eJ
Primary
Structural
(lcctrica 1
!1cchan;cal
CONTRACTORS
.,.;:
(nallle)
lM!dr'css)
W-,L-D.Q..J
(e xUr.Cj)
(..nhone no.)_
Genera 1
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PlumbiM
,<
[lect.'ic.tl
~l~chi\nical
I
PLlIl1lllllG
ELECTRICAL
MECIIANIC^L
r.dch sin~lle fhlurc
__ _I:H._ _CUIIKliL .110._ ___
I~es idcncL' of
....____ ___..__ sq,
_ElL .C1IA1lGE _lliL
.ilL .CIIJ\RGL
...J!Q.
fT,
furnace/burner lo
aTlI' ,
Rclocdte<1 buildinl) I
(new fix. i1dcli tiOllol 1')
- -SY-r.es (,i~l-cC"'" ..----.
_-'I balhl...
Duplex (1 balh).'(!a~.h
New ci.'ct/its alts.
\. 01' exten~;,i{)IIS
.:.\-~ --.--.--.
---~-
Floor furnace
dnd vent
SCRVIC[S
Recessed wall
Snace hpi\tl'r il.nr! VI'llt
-~
Appl LInce vent
seuari'ltp.
Stationary cvap.
cooler
- -Vl'nt fan with
sinnle duct
- VCnt system apart from I
hC'atino or A.C.
t-lechanical exhaust
hoorl ,1nd dill"' t
Addition,,1 bath
Tel1lrorary Constr'uction
.------
service Char.\f)e ill cxi$liu9
___..__._ ___ ___ __ .r!:.'jJ~cnCI:
-rjlUll i fami I.y, COIlIll. 01'
_______ ____ ____. __ JrltlliUd;tl
\-Iater
Sewer
Storm Sewl~r' Of .___._alllfls.
\;~~.:~---..._- ---- = COl~I./I;;;;:'r[[O[RS
~ _ 'Sro l'.'stall/.tller/relocate
~~_~'-,\,__ __..... _h.~.._ __ ,~.I,S.lL1b,._!j,e<JCr5
Of ..___._...__.__.._______ilmps.
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I
I
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l
?.? .'f0
1-
Hood stove/hellter I-
. - --Cl\5-
_~\....~\ ~\,C",__~,-
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TOTAL CII~,RGr.S -----..--- '-T;;cj:) TOTAL CIIARG[S
_______ .___L---_____.__
WIt[I~( ~TATE L 'I~ Il[llUlIl[~ that tll~ Electric,1l 110rk bl"! done hy an
'.shall not be vdli.J until the lahel has b~en si~llled by an [Icclr.ical
"^ \\.\-~y..~~ \s,rJ=
-.0
\~.
I SSIJAtICF OF PrR!1IT
TOTAL CIIARG[S
r.lectrical Contl'dctm', tile electrical portion of this pCl"lilit
Suhel'visor and rctul'ncd to the Building Oivision
I IIAVE CAIH~rULLY r.XN1W[ji--Ge-colllpleted i1Pfll{caU;i;lufol' !wnniL, 1111<1 do hert~1J.v cCI'lify lIJdt all infonnation hereon is true
and correct, ilnd I further certify that ilny c\l,d all 11or'k .perf0J111f!t1 shilll be dOlle ill ,\Ccm'dance with the Ordinances of the City
of Springfield and tllr. L.uls of the Stilte of Oreoon pcrt,dlling to tilt! work descrihctl herein, and that UO OCClIPAUCY \'1ill be made
of any structurp without till' pr.rmissioll of the Ollildi'l~1 flivision. I further' c{~rtify that tlJy rcnistration \o1lth the Buildel-'s
Board is in full forcr. and effect as required h.y Or.~ 7(n.o~!), that if exempt the hasis for exemption is noted hereon, dnd tlidt.
only subcontractors illld ('mploypes ,...ho arc ill com:di.lIlCC \1lth Ol!$ 7rll.O!i!i ,.sill be used Oil this projcct.
UAtI['(ple3Se pnnt).., (2u:i./'Z2.L~_~.___.._SIr.;IATl!R[ ~~ omll<2.0ffi
I O!~ OffiCi: IIS[ DIlLY r 1
Zonc._,._.._... _... .._._. T.VPI!/COns. t. . _._._..__.._.__Urli t5... ._.____m______Sq.
Fire 70ne Bedrooms Occy lflild Sq.
flood PIa i-I.;...._...~~ ~:, Sl(jr'il~\,...:': ~.~.:,_~~~~~.=~~occ.v ~rOt~2r~~.:.~Sq.
Ftf!. f1ain , __x Value -.'.--
flQ. ^cccss -..-.-.--. x Value ...----- -.-.
flq. Othcr..___ .---1- Value
TOTAL VALUATION
'. ~ <Qk:.~__:.'_~~;~~~~g.j~'~~~~_'..5CO . '2.~
\.,\ 'Ob PIa" Ck. Ile'
.:..\,c,_ ...:J.Q;L~I.!!9J'grJ:!!L-..
\ '" ex:> , fence
-- ~~------
'" <::. De"'o
n_.____..4..~.__.\...J_.. _.... .._._.... .-
'L() , <::'0 Sldow"II;
_ ___ ~_ _\J_ ___ _._____.
\. \ -.;.. A/C i'.winq
,- .--n--C:i~_-- -- "n
~~;~~~;C~~/[RlI\T _ _ _\.~_._ _ _ _~ _ Curb..!:~l~_____
SurcharlJ~s ~ :s
aUILDlllG PERfllT
Ch.,rges an~
Surcharges
I$YSl($lS Developmcnt I
Charoo (1.5~)
PlUI~BING PERHI T
Charges and
Surcharges
5.C:O
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,_ ~".\~'\C~~o.c
EI.ECTRICIJ. PEf.:I~1T
Charges and
Surchdrges
Total Comb. Permit
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
U, Legal Oescription
1. .example- Tax lot 100. lane County Map Reference
'11 03 43
2. exam~le- Lot 1. Block 3. 2nd Addition to
sprlngtie1d Estates
C. Name. etc. of owner and construction lender
D. Ene~9Y Sources
1. examplc- heal/electrical ccilinjJ/or forced .,ir <J~1~
Z.. eX,1mp I e- wa tcrhca""'l'CrTelcc frTcfll/or ~(ir.]r
[, Square footage or valuation. cleo ------
1. .~.:1!..~~lt:.. 1250 sq. foot house. 50Q sq. fooL ~,.1ra9C
2. example- if new project, check new - if addilion,
check. add. etc.
F. Building permit information:
1. example - construct single family house wilh an
attached garlJgc
2. exame'e - remodel existing garage into family room
J, exanyle - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
II. DES I GN TEAI'I AND CONTRACTORS
To avoid design or construction delays-, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab site
corrections, etc.
I I. Abbreviated Plumbing. Mechanical, & Electrical Schedules
A. Except "./here blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjoccnL
to the appropriate ilem(s) to be installed
8, Full Plumbing. Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the pel-mi t 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
CIIARGES ON TIlE SCIIEDULES
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. -
IJI, 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 p~id. All other fees and charges are due and
payable when the permit is issued.
V, FOR OFFICE USE ONLY
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PERMIT VALIDATIDN
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PROJECT CONDITIONS TO DE SATISFIED DEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Duilder's Doard because:
Additional Project Information:
PLANS REVIEWED BY:
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