HomeMy WebLinkAboutPermit Plumbing 1986-12-10
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'CITY OF SPRJrlGFIELD
COIIBIIIATlON APPLlCATlON/PERMlT
E!IERGY SOURCES:
Heat
Ha ter Hea ter
. RanrJe
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IIISPECT 1011 LlIIE
726-3769 .
Owner
-:s 30 S- fY1()~
Legal De"ription 11 (J;2 ~ I ~ J
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'\~drcss! 0L/31 ~...//1 Phone 1l(J
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Built';inq Penllit Info: Describe \.jork.(Le.. Build Single I~
Fami1 v nes 1 dence 1.lith /'l.t tathed r.a raae) \::::)
az;a-.2A.i- rJ.. Y-1--t.J() ~t:, I
INF0R11ATION UI'lt
726-3753
Sq. Ftq. Hain
~q. ~tg. Access.
Sq. Ftg, Other
Uew Add Alter ~eD.
--Fence Demo Change/Use
Other - -
Job Address
ValuE of ('Iark.:
Construction lender
Address
[Jt.~llirj rtAr-1
( name)
Phone
(address)
f 1 ics. no.)
(exnires)
(ohane no.
Primary
Electrical
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J.YJ'i'y.:::-
p-- ~
Structura 1
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r1echanical
CONTRACTORS
{name l
(address)
(lies. no.)
fexnirE's)
(nhnnp nn.)
Genera 1
Plumbina
DtJJI1P/V
,
Electrical
A't tJ.ll
pv- N'
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\,
t.lechanical
PLUlIB JrlG
, FFF 'rHARr,F I Nn
ELECTRICAL
MECHANICAL
110.;
lEach single fixture
I Relocated building
(new fix. additional)
IS,F. Residence
(I bath)
IDuplex (1 bath) each
IAdditional bath
I
I Residence of
SQ, FT.
I New c;rcu~ts alts.
or extenSlons
I SERVICES
I H'~
I rJ..jll.Rr.~' t.J() I
I rU!lQr.t""
furnace/burner to
BTU's
I t"n=
I
Floor furnace
and vent
Recessed wa 11
Sn~~p hp~tpr nnd vpnt
::J
~Co
IOf
ICOI~'I./IND, FEEDERS
I Install/alter/relocate
rlic:.trit-L fppdprc;
amps,
Appliance vent
seoarate
Stationary evao.
cooler ~ ,
Vent fan wi th
sinale duct
Vent system apart
hell. t i no or A. C.
Mechanical exhaust
hnnd and dur:t
from
~!ater service
Temporary Construction
Change in existing
reo;. i dpnl'p
multifamily, COI1ll11. or
lnduc:.tri<il
Sewer
Storm Sewer
YeS-DO
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TOTAL CHARGES IS. &01 TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Wood stove/heater
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",",
Of
amps.
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15 tJ7J
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ISSUANCf nF PFR!11T
/6-,60
thi s pernit
IIAI.IE(please print) DA lG-
I HAVE CAREFULLY EXArlINED the completed application for ~ermit. 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 Oregon pertaining to the work described herein, and that 1m OCCUPArlCY 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 comoliance with OP.S 701.055 will be used on this oroject.
~ lZlL au I { SIr,!IATURE [j
FO~ OFF I CE USE miL Y
Sq. Ftg. f1ain
SQ. Ftn. Access
Sq. Ftg, Other
D~TE/2.-/O-g,
Zone
Fi re Zone
Type/Canst.
Bedrooms
Stories
Units
x
Value
Value
Flood Plain
Occy Load
Occy Group
x
x
Value
TOTAL VALUATION
BUILDING PERIIIT
Charges anG
Surcharges
Plan Ck, CommlInd
65%/Blda Ppr Fpp
--------------p:j"dn Ck. R-es
30%/Blda Per Fee
-' //--. Dr? I Fence
______0_____
,&0 D~mo
Syste~s Development
Charqe (1.51,)
PLUt1BING PERMIT /
C1111 rges and l:J
Surcharges
ELECTRICP.L PERI:IT
Charges and
Surcharges
Sidewalk
I A/C Pavi ng
( S. 00 I Curb Cut
--------~Z~-I
ITotal Comb. rermit
11ECHAN I CAL PERM IT
Cha rges and \ 1\
Surcharges '.f'
I
I iOTAL
~(.20
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100, lane County Map Reference
11 oj 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examyJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. . example- if new project, checkfl"ew - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole - 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 TEAM 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 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 OIVISION STAFF WILL FILL OOT ALL FEES ANO
CHARGES ON THE SCHEOULES
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:
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PERMIT VALIDATION
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: g{o~53d---
, 17/ (o,f{o
Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
J
date
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