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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