HomeMy WebLinkAboutPermit Plumbing 1987-8-7
Owner I~ ~
Address ;;L 3M J'71./~
con~r (YL y') <(77
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P"2/l-7l'dl
, CITY Uf SPRINGFIElD . INFOR/rATION UNt
cormIllATlON APPlICATION/PERMIT 726-3753 1,,_
E!IERr,y SOURCES: Sq. Ftg. 1.lain ,\
Heat ~q. Ftg. Access. ~ \
Water Heater Sq. Ftg. Other ~
Ilew Add Alter Rep. \>
Ranqe -Fence Demo Change/Use
VJ.+u€ of Hork: -Other- - U\
"fI c:</OOO R-...
BUllolna Penl1lt Info: Descrlbe \~ork(l.e.. BU11d Single I \J'
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I IrISPECTION liNE
726-3769
.
Job Address ~ 3 J'v au, " ~ ,
Legal Oe<cription /7- iJ ? 7":' I{, - <f 1- c:; 13cl1
Address
UESIGN TEAI1
(name)
Phone
(address)
flies. no.)
(exnires) (ohone no.)
Primary
~
~~
~
tY ......
0)~\lb
OJ"), iAlq
\,) ,
Structural
Electrical
r~echanical
CONTRACTORS
(name)
(address)
(1 ics. no.)
(pxniresl (ohonp nn_ )
General
Plumbino ~~ ~~
()
'1O<.f!M II~ /!),
t7
g.,,~
o
..?/L /7c;PJP.
,!,.'<.' 'n - G/.:J,/x-Y 3'7'''I-19~::(
,
Electrical
~lechani cOa l' .&.. -:
(!
. -
PlUIIB ING
ElECTRICAl
MECHANICAl
NO,
FEE CHARr,F Nn
~~~ r~A~r.~ NO_
!:"~r: fl-l.ll.Qr.r:
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
I
each I
I
I
I
Storm Sewer I
~~ I;[t-D
- I /'1
/1
S. F. Res i dence
(1 bath)
Duplex (1 bath)
SERVICES
Recessed wall
So~rp hp~tpr ~nrl vpnt
Of
amps.1
Appliance vent
""pat! ra tp
Stationary evan.
cooler ~ ,
Vent fan with
sinole duct
Vent system apart from I
hea t i no or A. C.
Mechanical exhaust
hood and dud.
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
rF>S i dJ'J'rp
multifamily, camm. or
Tnrlustrii'll
~Iater service
\
COMM,/IND. FEEDERS
I Install/alter/relocate
n;c:;trih, fppdpy'c;
IOf amps.1
I
I
I
ISSUANCF OF PFR'lIT
r,
"
TOTAL CHARGES TOTAl CHARGES TOTAL CHARGES
WHERE STATE L;\\~ 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 EXM1INED 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 Ore~on pertaining to the work described herein, and that IW OCCUPAIKY 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 ORS 7Ql.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGIIATURE"" f)eyv ~
,- FO~ Or"FICE USE 0111. Y
Sq. Ftg. t1ain
Sq. Ft!J. Access
Sq. Ftg, Other
DATE f- 7-71/
NAI,IE(please print) (}f) tv' ,/lro I!1f N
-,
x
Value
Value
Value
x
x
TOT^" VALUATION
BUILDING PERNIT
Charges and
Surcharges
Plan Ck.
65%/Bldo
------------ Plan Ck.
30%lBl do
/ s-: O-GJ Fence
___L__..L_____,
, ;1' -=:; I Demo
I Sidewalk
I A/C Paving
I Curb Cut
I
ConmlI nd
P..er Fep
Res
Per Fee
Systems Development
Charoe (1.5~)
PI.UI1BING PERMIT
Char..ges and
Surcharges S?()
ELECTRICAL PERI~IT
Charges and
Surcharges
/lECHANICAl PERMIT
Charges and
Surcharges
Total Comb. Permit
I
I TOTAL
< ~ -
~ /~< 75
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. example- lot 1. Block 3, 2nd Addition to
.Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. examale- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam~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 ANO 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 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
t8trf7~b
IYpY
II
P,rnit Cl"k/~~~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date