HomeMy WebLinkAboutPermit Plumbing 1987-12-4
Job Address
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~ CITY UF SPRINGfIELD ~ INFDmlATIDN LINt
...., COMBIIIATlON APPLlCATlONIPERMlT 726-3753
E!IERGY SOURCES: Sq. Ftq. 1.lain
Heat ~q. Ftg. Access. ~
I'/ater Heater Sq. Ftq. Other V'O-
Ilew Add Alter Rep. _ ..,
Range -Fence Demo Change/Use ~
Va I u( of Hork: I Other - - \::)
Building Pennit Info: Desc~ibe Hork(Le,. Build Single ~
Familv Residence With Attached Garaae) ~
_~.n / ,!L/f ~?::?: /e,".L'..6~ e.... ~
D< hill/l nffl'v\ r 1s..t1W10-----7 -
I
Phone
(address)
(lics.
*
no. )
(exoires)
(ohane no.')
I INSPECTION llUE
726-3769
Legal Description
/ / / _I
Owner I~
Address 5;;) 7 S,
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Construction l~d~
~tl1.-d'
? tzA/C Phone '11.(7
G!35LJ
Address
OeSIGN TEAl.1
(name)
Primary
Structural
,
(fl'-' S~ QV
O' I
Electrical
f1echanical
CONTRACTORS
(name)
(address)
flies. nn.)
(plCoirp(;,\
(I)hnl'lp on )
General
Plumbina
"
t2W /1J!JJ
~'1: ,
Electrical
~'echanical
PLUllBI NG
ELECTRICAL
MECHANICAL
NO.
FFF rHARr.F Nn
"-ELIJ:.IlAB.liE. NO
~n' rl-l~
.:::L _Each single fixture 19 /S (/U
Relocated building
(new fix. additional)
Residence of
SQ. FT.
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp kp~tpr ~"~ vpnt
Storm Sewer
Of
amps.
Appliance vent
<;.p.oaratp
Stationary evap.
cooler
Vent fa'n with
sinole duct
Vent system apart from I
hp.atin(l nr A r
Mechanical exhaust
hnnd and rlurt
Sewer
Temporary Construction
Change in existing
rp~ j r1J'Jlrp
multifamily. comm. or
Tnrlu"t.rial
~Jater service
CO~~.IIND. FEEDERS
Install/alter/relocate
r1ic:.trih fppf'1prc:
Wood stove/heater
Of
amps.
C; II!-
,75
':P'
ISSUANcr OF PFRlIIT
TOTAL CHARGES
WHERE STATE LAH REQUIRES
shall not be vali" until the
If), rJ5 TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an..Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1lNED 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 UO OCCUPAllCY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7~1.055 will be used on this project.
gel bU-1 -liowr'\f?:j~ SIr,IIATURE~)f(/~~ATF)<./:?/.-P;
FO~ OFF I CE USE miL Y / ' -
NAt.IE(please print)
Zone
Fire Zone
Flood Plain
Tvoe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ft9, 1lain
Sq. Ft!J. Access
Sq. Ftg. Other
x
Value
Value
Value
x
,
TOTAL VALUATION
BUllOING PER/lIT
Charges and
Surcharges
. Plan Ck. Conrnflnd
65%/Bldo ppr ~pp
------------ Plan Ck. Res
30i/Bl do Per Fee
r ~ . ~ Fence
_-nnn~7S=1 Demo
I Sidewalk
I AIC Paving
I Curb Cut
------------1,
Systems Development
Charge (1.5~)
PlmiBING PERMlT<
Charges and
Surcharges
I
I
I
ITotal Comb. Permit
I
I TOTAL
I
:,S.7S
ELECTRICAL PERI~lT
Cha rges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcharges
~
..
..
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
II UJ 43
2. example- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy. Sources
1. examole- heat/electrical ceilinqfor forced air qas
2. example~ waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1_ examole- 1250 sq. foot house, SOD sq. foot garage
2. examDle- if new project. check-new - if addition,
check add, etc.
f. Building pennit information:
1. exam~le - construct single family house with an
a ttached garage
2. examEle - 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
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.
)0030
Il-L(-81
V. FOR OFFICE USE ONLY
Permit Clerk
(}L/
. ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
t
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date