HomeMy WebLinkAboutPermit Plumbing 1988-10-14
I INSPECTION LINE
726.3769
.
CITY OF SPRINGFIELO
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Heater
.
INFORlIATION LlNE
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
Fence _Oemo _Change/ Use
_Other
~I.o~
Phone
Builciino Pennit Info: Describe Work{Le..
Familv nesidence With Attached Garaae)
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p~vt;;-\- -J
YKlM..-' (lics. ~VR.~e~1
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Build Single
I(l)
())
o
00
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Job Address
~ 11 '1-3 M 14,,0..) :,,\,...
Description 17 -DOl -: <3.1 -45 c:::5~02..oo
Legal
Owner
~m GlZ-I}-l n
Address d '1 (1.""-. OJ A-I ~
~ O. f)(L
LVEl.J:2LA.. )""'t
-:5-r
Cll4-iB
Range
ValuE of Work:
Construction Lender
Address
Ot> lliN ItAI.1
Primary
Structural
Electrical
f1echanical
CONTRACTORS
Genera 1
Plumbina
Electrical ~
~techanical
In~~1
Phone
(address)
(OhOM no.
^...JfI
1~V-';-
(namel
(address)
(l in. no.)
(pxnirpsl
(ohnnp nn..)
\ly(l
PLUlIB I NG
EtECTRICAL
MECHANICAt
NO.
Each single fixture
FFF fHARr.F Nil.....- ~H' rl-l~ ~m
Residence of furnace/burner to
SQ. FT. BTU's
H~ r~
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bathl
Duplex (1 bath) each
Additional bath
ISERVICES
I
Recessed wall
<:'r"!;"'.a, hiD;>"iD" "'",r1 II"""'''
I~Jater service
I Sewer
lStorm Sewer
I
I
I
IHir'l. ~M.i t I
p..... Von rK.ol>rC-
IS.QC
ITemporary Construction
IChange in existing
,r~~irje.nrp
Imultifamily, comm. or
, Industrial
10f amps.1
ICOMM./IND. FEEDERS
Ilnstall/alter/relocate I
di~trih. fppdpr~
IOf amp~1
T
I
I
Appliance vent
seoariltp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood ilnd durt
Hood stove/heater
"' ,
?V\.
I SSUANCf OF PFRlIIT
00
TOTAL CHARGES l'6 - TOTAL CHARGES TOTAt CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAtllNED the completed app 1 i cat i on for permit, and do hereby certify tha t a 1.1 in forma t i on 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 UO OCCUPAr~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 subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IWIE(please print) /Coclvrev. ;e. SdAJ 1ft.. SIr.rlATURE~--D~ ~ DATE 104 <I. <6~ I
-.-:...:_1.'....
FO~ OfFICE USF QllL Y
Zone Type/Const. Units Sq. Ftg. t1a;n x Value
Fire Zone Bedrooms .Occy Load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL V ALUA TI ON
Plan Ck. Comm/lnd
65%/Rldo PPf Fee
------------PTan Ck, lies
30%/Bldo Per Fee
~~~~:~~Ga~~RMn...-~ ____i~.:9Q.__ Fence
Surcharges ~ . '15 I DeRlO
ELECTRICAL PERI:IT I Sidewalk
~~~~~:~g:~d ------------, AlC Paving
MECHANICAL PERMIT I Curb Cut
Charges and ____________
Surcharges I
BUILDING PERNIT
Charges and
Surcharges
Systems Development
Charqe (1.5~) .
t
ITotal Comb. rermit
I
I TOTAL
J
1'5.15
.
.
l
I
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. tegal Description
1. examole- Tax tot 100, tane County Map Reference
II OJ 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
Spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole. heat/electrical ceilinq!or forced air qas
2. examyle- 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, check-nfw - if addition,
thee k add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exa~le - 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 schedu 1 es .
C. BUILDING DIVISION STAFF WILL FILt 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
'\2r-~. . t- 12585 _
Permi t C~rk 0,. GZ? }. n, -
/ /) -I.,L -&'t"
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
, name
signature
date