HomeMy WebLinkAboutPermit Plumbing 1990-9-13
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I INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORl1ATION LINt
726-3753
Sq. Ftq. "lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
-Other - -
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Job Address
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S,,,F..D
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work:
Legal Description
Owner
C~~iI'''~/
\ \ a.l"\ mo.. \ f'\
~1"lc..J {J"Q '17l.1'7'
~~ldinq Permit Info: Describe Work(i.e., Build Single
Phone '21.-(!t "'i'!lmilv nesidence Hith Attached Garaael
Address
Construction Lender
\
,
:3 c..c"".,. Si I\\:
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\\~1\~ I~'^,\ .t....,,'t
Address
DESIGN rEM
(name)
Phone
(address)
(lies. no.)
(exnires)
-1Ohone no. )
Primary
Mechanical
CONTRACTORS
(name)
(address)
A
>>-
(lies. no:\)l (~)mires)
(ohnn,:. nn. )
Structural
Electrical
Genera 1
Plumbino
(\LA-"N..,7'1J
Electrical
~'echani ca 1
PLUllBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO,
"F
rlJARliE. NO.
SQ. FT.
furnace/burner to
BTU's
"I
12-
Each single fixture
\() '20- -
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~trr ~nrl ~pnt
-I
I
I
I
I
Storm Sewer
Of
amps.
Appliance vent
seo!l-rate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond and dll~t
Wood stove/heater
~Ia ter servi ce
Temporary Construction
Change in existing
rPs i dJ'nrp
multifamily, conm. or
Industrial
Sewer
COMM,/IND. FEEDERS
Install/alter/relocate
di~trih. fppdpr~
Of
amps.
ISSUANCE OF PFRlIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be vali1 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 I further certify that any and all work performed 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 OCCUPAIlCY 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 subco~tractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project.
HAI,IE(please print)
SIGIIATU~~a.4.~
DATE~..d,13, I~ll
FOR' 'OF'FlCE
~
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
!.f;E 011l Y
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDIIIG PER/lIT
Charges an':
Surcharges
. Plan Ck.
, 65%/Bldo
------------ Plan Ck.
30%/Bldo
( !.(:).<-V
\ ~ ex::.>
CommlInd
PE'r Fpp
Res
Per Fpp
Systems Development
Charqe (I. 5~)
PLU!~BING PERMIT
Charges and
Surcha rges
Fence
D~mo
-.
ELECTRICAL PERI~IT 'Sidewalk
Charges and ----------__
Surcharges A/C Paving
Total Comb. Permit .
tlECHANICAl PERMIT
Charges and
Surcharges
,. TOTAL
~ \ _.CO
Curb Cut
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp.le- Tax Lot 100. Lane County Map Reference
17 03 43 ,j.... J . ,."
2. example- Lot 1. Block 3, 2nd Addition to" -" . .,
Springfield Estates ....' i
C. Name. etc.~of owner and/construction lender
D. Energy SOt-!rces ~. :. . .\ . / (
1.. 'e.xaniole- heat/electric"al bf!iTinq/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project. check new - if addition,
check: add. etc.
F. Building pennit information:
1. examole - construct Single family house with an
attached garage
2. exa~~le - remodel existing garage into family room
3. examjple - 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
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. ---
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 penmit 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 penmit is issued.
, I.
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V. FOR OFFICE USE ONLY
P'noit ""'~~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
":., :i'. .P.,e,sm,it, appl icant exempt from" regis.tration with the Buil der' S Board because:
Additional Project Information:
.
PLANS REVIE~ tlY:
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