HomeMy WebLinkAboutPermit Plumbing 1982-3-19
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I INSPECTION LINE
726-3769
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CITY UF SPRINGFIELD
COMBINATION APPLICATIDN/PERMIT
"112 IJ EIIERr,y SOURCES:
D Heat
I/ater Heater
Range_
ValuE of Wo'rk:
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INFORllATION liNt
726-3753
Sq, Ftg, 1.lain
~q, Ftg, Access.
Sq, Ftg, Other
New Add Alter P.ep,
-Fence Demo Change/Use
-Other- -
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1?0,
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Job Address tJ..3S-0 ~ t+'U
Legal Description J7-()'-- 32.- ~ I
1J.2. '3 b-o
Owner H, ~ tt R.."oS, j; IlIl/eSJr~
Address
Phone
BuildinQ Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached GaraQe)
A~P, PJ""",J,::..<. c,~ Co.... ~lcI:
Construction lender
Address Phone
Ut'I"N TEAH (name) (address) (lics.no.) (exDires) (Dhone no. )
Primary ~
Structural ~~
Electrical ~
Mechanical
CONTRACTORS (name) (address) (lir:o;, no, 1 (pxoirps) ( ohon,. nn \
Genera 1
-ru//~IV " rlo. ~CSD ''''..JarsJJ_ z,o-'1b s--n 6,/3-1,+ \If
Plumbina TZ.IV_S
Electrical <r
~1echanical
PLUlm I NG
ELECTRICAL
MECHANICAL
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-.till."
FEE CHARr,E Nn
<" rl:!ARliE ..llil.....
I.HL~
5'
Each single fixture
Residence of
!)5, tj )
SQ, FT,
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
~n~r:p hp~tpr ~nrl vpnt
~Ia ter serv; ce
ITempOrary Construction
IChange in existing
resj ~~.nce
Imultifamily, comm. or
Industrial
M)()
10f
ICO~4,/IND. FEEDERS
I Install/alter/relocate
dif;trih, fppdprf;
IOf
I
amps.
Appliance vent
"f>oaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood and duct
Sewer
Storm Sewer
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I
1/%1
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TOTAL CHARGES , ~0 J /)() TOTAL CHARGES TOTAL CHARGES ., ,
WHERE STATE L\li REQUIRES that the Electrical work be done by an.'Electrical Contractor. the electrical portion of this pernit
shall not be va1iJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Wood stove/heater
amps.
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ISSUANCE OF PERlnT
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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 oerforrned 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 OCCUPAIICY 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 7nl.055 will be used on this project.
rW,lE(please print) R ,~L....Jl E, be..~~...
SIr,IIAT~- q,r// /r-.dL.
DATE 3-/'/- ffz..
FOP. OFFICE USE DIlLY
Zone Tvpe/Const. Units Sq. Ftg,
Fire Zone Bedrooms Occy Load Sq, Ftg,
Flood Plain Stories Occy Group Sq. Ftg,
fiain
Access
Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERfIIT
Charges and
Surcharges
. Plan Ck, ConmlInd
____________~/Rldo P.flr FpF!
Plan Ck, Res
30%/Bldo Per Fee
Systems Development
CharDe tl. 5~) ",
PLW1BING PERMJT
Charges and
Surcharges
VJ,!), J:) ,()'()
),00
Fence
ELECTRICAL PERI~IT
Cha rges and
Surcharges
D~AlO
'Sidewalk
MECHANICAL PERMIT
Charges and
Surcharges
A/C Paving
I Curb Cut
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I
ITota' Comb. Permit
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I TOTAL
~Db/Dc\
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
f; ~ 2.3S-
I. Applicant to furnish
A, Job Address
B, Legal Oescription
I, example- Tax Lot 100, Lane County Map Reference
11 oj 43
2. example- Lot 1, Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceilin~/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1, example- 1250 sq, foot house, 500 sq. foot garage
2. examJPle- if new project. check-new - if addition,
cneck add, etc,
F. Building pennit information:
1. exam~le - construct single family house with an
attacned garage
2. exam~le - remodel existing garage into family room
3. examole - 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 TEAll 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.
11, 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
0, 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 penmit is issued.
V, FOR OFFICE OSE ONLY
Permit ClerkJ:),~i:~~~:
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name
signature
date