HomeMy WebLinkAboutPermit Plumbing 1991-2-12
E!IERGY SOURCES:
Heat
Hater Heater
Range
ValuE
INfORlIATlON liNt
726-3753
Sq. Ftq. l'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
ot\o~f\)- ~~~~~_Dema_Change/Use
BUlloinQ p~ lil Into: Describe l4ork(1.e.~ Build Single
Familv nesid nee With Attached Garaael
.
I INSPECTION LINE
726-3769
.
Job Address ~ ~ l\.. 1\ \1m Q f\ \.~) ,
Legal Description \ <') 08,,~\"3 "\No \oen
.--.... , -
Owner'. '0(\ f\ ,\.CLf\ '( q (\Sr5Y\..)
Address --, 4 ~ n ~\ '0 ~ Phone
const~~~~\~ ~~1f~~
CITY Uf SPRINGfIELD
CmlBIIIATlON APPLICATION/PERMIT
-CJ
~
~
Address
Ut:::dbN II:.Ar.'
(name)
Phone
{address}
~~,~~~,~/
j.
~b
~
,y "
(ohone no. \
Primary
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(address)
(lies. no.) (exniresl
(ohnnp nn.)
General
Plumbino ((1 ~f\Q .Q..J
Electrical
~1echanical
PLUllBI NG
ELECTRICAL
MECHANICAL
-1!Q.,.1
Each single fixture
FFF rHARr,F fin ""L J:I!ARliE Jill....
Residence of furnace/burner to
SQ. FT. BTU's
n~ r~~
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wan
~nnC.P hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
SPDaratp
Stationaryevap.
cooler
Vent fan with
sinale duct
Vent system apart from
heating or A.C..
Mechanical exhaust
hood and duct
Wood stove/heater
~Ia ter servi ce
Temporary Construction
Change in existing
reo; j de.nee
multifamily, COIT1T1. or
Induo;trial
Sewer
COM/.I./IND. FEEDERS
Install/alter/relocate
dio;trib. fppdpr,
Of
amps.
\' ) (U J7) !iP,.J21. ~
.. ( U V ISSUANCf OF PFRIUT
TOTAL CH~G~S TOTAL CHARGES TOTAL CHARGES
WHEP! stATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penoit
shall n~e vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 Oregon pertaining to the work described herein, and that- rw 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subco~tractors and employees who are in compliance with OP.S 7Q1.055 will be used on this project.
IlAf.lE(p1ease pri~ /__-.-...---.--
<F-"'\
hype/Const.
I Bed rooms
SIGlliiTURE/?'R.',V ";J;..A;";,>,p'-7
FOP. OfFICE USE mlLY
Sq. Ftg. tiain
Sq. Ftg. Access
Sq. Ftg. Other
O~.TE .,r- ).,f-9,1
Zone
Flood Plain
Stories
Units
Occy Load
Occ,V Group
x
x
Value
Value
Value
Fi re Zone
x
TOTAL VALUATION
BUILDIIlG PERfIlT
Charges and
Surcharges
Plan Ck. Comm/Ind
______.....:_____~/Blrlo Per Fep
Plan Ck. Res
30%/B1do Per Fee
.-L5.J.Q.!--_ Fence
. 0-5 Oemo
Systems Development
Charqe (1.5%)
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT Sidewalk
Charges and ------------
Surcharges A/C Paving
Total Comb. Permit
TOTAL
1lc!J, 15-'
/1ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
.'
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. examEle- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
.1. example- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/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,
cneck add, etc.
F. Building pennit infonnation:
1. example - 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. 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
fu 11 schedul 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.
6)_(Qrq/
# tQc94/--
I
V. FOR OFFICE USE ONLY
Permit Clerk
~/JtJ_)
.
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