HomeMy WebLinkAboutPermit Plumbing 1988-6-13
I INSPECTION LINE
726-3769
.
CITY Uf SPRINGfIELO
COMBIIIATION APPLICATION/PERMIT
E!lERr,y SOURCES:
Heat
!~ater Heater
Range
ValuE of f1ork:
~
INFORlIATlON llNt
726-3753
Sq. Ftq, Hain
~q. Ftg. Access.
Sq, Ft9, Other
New Add Alter Pep.
--Fence Demo Change/Use
-Other - -
I
D\J
~
(S)
~g? c;- fl11.V":'
Legal Description / f) 0 ::J_ ~ I t.J I
# ' //.
Owner ;:u;mA. I dwI../ ~./J
SrlJmJ2-.
Job Address
o dF)f)()
Address
/l
lro.; __, ')
- ~~ne -.
7'10
'55'3>7
Construction Lender
Buildina Permit Info: Describe Work(i~e" Build Single
Ff);;~~~t~A~tached;~ ~C
I' 7
<---
Address
UtS I tiN TEAI1
lnamel
Phone
(address)
(lies. no.) (exoires)
(ahane no.)
Primary
Structural
'b~~ C~P:)(j
A
~A
?-~
Electrical
Mechanical
CONTRACTORS
( n..., )
(address)
(lir.s. no. (exoires)
(nhOM no. )
Plumbina
l+m
L
/' "
tl J'raChuXl
Genera 1
PlIlllIlIIIG
ELECTRICAL
d;X=<.n .T P
11/ )
r"~r NO,
,
Electrical
v
~1echan; ca 1
MECHANICAL
NO,1
Each single fixture
Fff
r."ARr,E
Nn
."
.. L J:HARliE.
Residence of
SQ. FT,
furnace/burner to
BTU' 5
Relocated building
(new fix.' ad1litiona 1)
S,F, Residence
(1 bath'
Ouplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
~Ia ter service
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~yt
SERVICES
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
COMfI,/IND, FEEOERS
I Install/alter/relocate
.di<;trih_ fpprlprc;.
IOf amps.
I
I
I
amps.
Appliance vent
"'eo!,! fil. tp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood i'l.nd rlurt
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
rps.;dpfl('~
multifamily. camm. or
Tnrluc;;t.ri"l
ISSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,'I~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this perr.tit
shall not be valid 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 1 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 rm OCCUPAI~CY will be made
of any structure ~thout 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
:~::,:::::~:~ '7 ::\ 'f:~:r;'~:ic :::,~:.~27 ZO M' / /-: k"
FOR orFICE USE DIlLY ~ / ~
Zone> Type/Const. Units Sq. Ftg. t1ain x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERHIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fee
------------ Plan Ck. Res
30%/Bldo Per Fee
'S .0'0 I Fence
--------$1 Demo
I Sidewalk
------------, A/C Paving
I Cu"rb Cut
____________1
Systems Development
CharQe (1. 5~)
PLUt1BING PERMIT
Charges and ~
Surcharges '::>
I
I
ELECTRICAL PERfm
Charges and
Surcharges
/lECHANICAL PERMIT
Charges and
Surcharges
Total Comb. Permit
I TOTAL
I lIS. 7 S I
,
..
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B. Legal Description
I, example- Tax Lot 100, Lane County Map Reference
1703 43
2, examEle- Lot I, Block 3, 2nd Addition to
springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project, check-new - if addition.
check add, etc.
F. Building permit information:
1. exam~le - 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 TEAf! 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 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.
((700
~ -(3-rl
V. FOR OFFICE USE ONLY
Permit Clerk
Ce-.
.
PROJECT CONDITIONS TO BE SATISFIED 8EFORE OCCUPANCY:
Permit applicant exempt from registration with the 8uilder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date