HomeMy WebLinkAboutPermit Plumbing 1984-6-20
I INSPECTION L1IIE
726-3769
CITY Uf SPRIrlGFIELD . INF0R11ATlON UNt
C0I1BIIIATlON APPLICATION/PERMIT 726-3753
EIIERGLSOURCES: Sq. Ftq. 1.lain
Heat (":'.1 {";(''''t'' ~q. Ftg. Access.
!1ater Heater\-"I (.:;" Sq, Ftg. Other
,- ~ Ilew Add Alter Pep.
Ranges-l r-;r ~_ -Fence Demo Change/Use r/'t
Va I u~ of Hork: -Other - - ~
Owner 5,;Or,t:,.,IJ ChI1;j n-?ihe Bre+hrek.. .q5(c.1 t>-VO t'I\
n " .f. ,-BUilriinq Pennit Info: Describe l~ork(;.e.. Build Single f""\
Address /0 ;7 /I1"';n.5-. (",,"'....+;efo\.Phone71fl,-227 Family nesidence I~ith A.ttached Garaoel '-oJ
1 -4 I? /1loL.,.:., }(;jt~'" ~ r' ~
OjJM..f.J:u;.j)~ cI ...pe,., !~ ...(1.~' '.' ". \f'
Phone ..ff/~ ~ y.::>~ <f f?~#V-<>
(address) r.,ics.....nb.r (exoires'il~ (ohane no.
.3<# " 8mul'::J,r;.;:::t'lf" It~t. *" ,fl,-D"'L
I
Job Address /Ob2. Ha,'n .s;<J-
Legal De,cription \'1 {)":l., ':l.'3, \.\. \ I
Sr 1':j'C'4 IJQ
'4. a. ('Y")
Construction Lender
/1..6^-e.
Address
UI:.~lur4 rE.Ar~
(name)
Primary
h'nrOJ.J Ar,,/';.f.ec.-b:
Structural
Electrical
Hechanical
CONTRACTORS
(namel
(address)
(1 ;('" no.)
(pxnirpc;.)
(ohol'lp !"In \
General
Plumbina
Electrical
~1echanical
PLUllBING
ELECTRICAL
MECHANICAL
NO.
FEE r.HARr.F NO
"re r"ARG.E..JJlL
HI=" r~l1RG.E.
'1
Each single fixture
S~~
Residence of
SQ. FT.
furnace/burner to
BTUI S
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~rp hp~tpr ~nrl vpnt
Of
amps.
I
I
I
I
I
~~ c;;p.
Appliance vent
SPD~ratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and duc.t
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp$5 rtf'nrp
multifamily, camm. or
Tmtll<:;,j:rial
Of !1u~'i:.
I I
amps.~- ~
Water service
Storm Sewer
CO~1./IND. FEEDERS
Install/alter/relocate
rlic:t.rHL fpprlpr..
ISSUANCF OF PFR!I1T
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be yali1 until the
~ ~ c;:Q. TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion .of this permit
Supervisor and returned to the BUilding Division
I HAVE CAREFUllY EXMlINED the completed application for permit. and do hereby certify that all infannatfon 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 OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OP.S 701.055 will be used on this project.
!lA/IE(please print) N,'rJ" ~ L. E'I k e AI he I?RY SIGrlATURF "11~:O, o(? E'.:J( ~ DATE L, -'J..6.(11(
ZoneJ;:....r
Fire Zone ------
Flood Plain -----
Fon OFFICE USE OIIL y
TYOe/const~ ~r~;rnits \'L Sq. Ftg. liain
Bedrooms Occy load Sq. Ftg. Access
Stories \ Occy Group'\L- \
x
V
Value
Value
Value
BUILDING PER~lIT ____~O.- Pl an Ck. COIl11l!1 nd
Charges and 65t/Blrln Pj'r Fpe
Surcharges '2.. ,",0 Plan Ck. Res
30%!Bldo Per Fee
PLUI1BING PERMIT ___.:o~. - Fence
Charges and
Surcharges \ . l..\C> Demo
ELECTRICAL PERI~IT ---~~'-=-- Sidewalk
Charges and
Surcharges \.~D A/C Payi ng
/lECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Sq. Ft~. Other
. t.'l.Cf7'i
wf,f:j 6''JI~<{
.,v,?, 9. (){) pj
x
x
n (1'/ TOTAL VALUATION ..
)' Systems Development \) "-
Charqe (J.5~) 1l.... ~
Total Comb. Permit
~
TOTAL
\ ~'5. 12.0
.
I
COMBINATION APPLICATION/PE~~IT (CAP)
PERMIT VALIDATION
b 3'01 q
(f {)J.
WJ~J?t/
I II.
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, Lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrlca (lor solar
E. Square footage or valuation, etc. ------
I. example- 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. example - construct single family house.with an
attached garage
2. exam~le - remodel existing garage into family room
3. examOle - convert single family residence into
restaurant (change of use) o.
G. Value of work as defined ;n Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM1 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, Mechan;cal, & 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 I es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
O. 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. ---
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
signa ture.
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.
r
p
"
V. FOR OFFICE USE ONLY
Permit Clerk
CVu
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because':
Additional Project Infonnation:\st ~~c.,,","~\.\\C~L \.\t=."-\\.\\.~,"\('o,,,, \~"\C".
~F \."')~'~LLE~ ,,\..""\ "\<"\,('"\~E""-" ~Qt=:~ ~~ ~~~,,~,C"\\..""\Q..l
-PE"Q.~\\ 'b\.~~LL 'C\.1c vl2Q.\"I,,,r-~
PLANS REVIEWED BY:
nam~\\~~~I.."
"'"') .'
signatu~.... r\. ~ _____'----date G-~<s..-~L\