HomeMy WebLinkAboutPermit Plumbing 1985-10-1
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I INSPECTION LINE
726-3769
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.Job Address
CITY UF SPRIN6FIEl.D INFOIU1ATION liNt
COMBINATION APPI.ICATION/PERMIT 726-3753
ElIERGY SOURCES: . - Sq. Ftg. Hain
Meat ~q. Ftg. Access.
Water Meater Sq. Ftg. Other
flew Add A I ter Pep.
Range --Fence Demo Change/Use
ValuE of Work: Other-- --
Owner' p{f/j \./<!{/y'L/A.l5~~~-o/~/'W<- .... .. .
Address I~LA- ~ . ~ 'ill.~ BU11cilnQ Pentllt Info: Descrlbe Worklloe., Build Slngle
?~4:S /~~~~ ......-.:~ !?~0Ii,"" Familv nesidence liith Attached Ganoe)
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Construction lendel" ,0 fi'~"':'~ ~ .
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lot
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l.egal Description
Address
Ut~16N IUIn
lnamel
Phone
{address}
(lies. no.l
lexoiresl
.
(Dhonl~ no.
Primary
Mechanical
CONTRACTORS
(nawe)
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Structural
Electrical
(address)
(1 itS. nn.'
(pxoirpsl
(I)hnn~ nn ,
Gen~ri'l: 1
Plllm~iflO
Electrical
~1echanical
Pl\J!1llllG
EI.ECTRICAI.
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I ~j:'j:' 1 rl-l~.RG.E-' ~ln
MECHANICAL
NO.
FFF I fHARr.F
Np
SQ. FT.
,
furnace/burner to
BTU's
It't't'
'<:HARGE.
-:<
Each s;ngle fbture
5- /~.
Residence of
"
Relocated bu;ld;ng
(new fix. add;tional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(I bath)
Duplex (I bath) eacb
Additional bath
~~Iater senice
/::iJd, ~ewer
~/'
SERVICES
Recessed wall
Sn~rp np~tpr ~nrl vpnt
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Temporary Construction
Change in existing
rps i riPJH~P
multifamily, comm. or
Tnrill<.t.riill
Appliance vent
Sf!oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust I
hond and dud
~lood stove/heater I
I
I
I
-L.:::;5 7WA::>"'" rJA~cC..
I' I
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I
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~s
/~. SI. ·
Of amps.
ICOMH./IND. FEEDERS
l'Install/alter/relocate
riic:trih, fppripr<.
IOf amps.
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I
I
ISSUANCF OF PFRl1lT
Storm Sewer
TOTAl. CHARGES 41_4)' TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\lI REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
shall not be ~ali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 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 NO OCCUPAI~CY will be made
of any structure -nthout 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and enployees who are in compliance with ORS 7nl.055 will be used on this project.
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IWIE{please print} ~~. SIGNATUR~ --
-- FOr. OFFIC~ ONLY
1,,,,,/Const. Units Sq. Ftg. llain
Bedrooms Occy Load SQ. Ftg. Access
Stories Occy Group SQ. Ftg. Other
DAT'E /~ - / -.IF"
Zone
.X
Value
Value
Value
Fire Zone
Flood Plain
x
x
TOTAl. VAI.UATION
BUII.DING PERIIIT
Charges an::
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
Plan Ck. R-es
30%/Blda Per Fee
Systems Development
CharQe tI.5~) .
PI.UHBING PERMIT
Charges and
Surcharges
_____tl5:_~_ Fence
/. fi't:> DllRlo
I'Sidewalk
I A/C Paving
I'Curb Cut
I
I
I
Irotal Comb. rermit
I
I TOTAL
C/6Stp
EI.ECTRICAI. PERmT
Charges and
~u;c~arges .. I~
MECHANICAL PERMIT
Charges and
Surcharges
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.V OF SPRINGFIELD
City Hall
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Sprlngftald, Oregon
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'.l~.!i~/"~', Department 0' Pu~l.lc Work~ '~r., ~'.l.~''';~
OFFICIAL RECEIPT
( No. B
Oate tA::r: I; 19 ~
C Rac'd From P411 j~/A/,S~ ~&>. lj
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Address ~ tj??7Yl4:/.I<I ~r:,. .......---- Cor.> -
( !... - - ---'
\~eceived For: )t!J"$ #' ~t:> B. r~
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65382
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription " ".
1. ~xample- Tax Lot 100. Lane County Map Referen~e
11 OJ aJ
2. examole- Lot I. Block J, 2nd Addition to
',,0 ~.. ~""'. J ::ipr1l1gtield Estates .' '",' .' ~
; C. Name, etc. of owner and construction lender .
D. Energy Sources .". _..., ~ . '. . ..... .
1. example- heat/electrical ceilinq/or forced air Qa:'
2. examole- waterheater/electrlcallor SOlar
E. Square footage or valuation, etc. -' (;;\
1. exam~le- 1250 sq. foot house, 500 sq. foot garage . .
2. example- if new project. check new - if addition.
cneck. add I etc.
F. Building permit information:
I. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family roan
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
full schedules
C. BUILOING OIVISION 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. ---
Ill. 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.
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V. FOR OFFICE USE ONLY
Permi t Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
signature
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date /07-~
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