HomeMy WebLinkAboutPermit Plumbing 1988-12-15
Job Address
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CITY Uf SPRINGfiELD
CD/1BIIIATION APPLICATION/PERMrT
EilERGY SOURCES:
Heat
I-Ia tel" Hea tel"
Range~___ .~
Valu' of l'lork:
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INFOR/1ATION LINt
725-3753
Sq. Ftq. I.'ain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add A Her Rep.
-Fence Demo Change/Use
Other- -
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~
fINSPECTION LINE
726-376g
Legal Oe5cription
Address
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Mc<-~ (1.4
Owner
Construction Lender
....
~~v'Y'1
Phone! :2 Co
Id. qq
Builtiina Permit Info: Oeser be Work(Le" Build Single
Family Residence With Attached Garaae)
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Address
DES I GNI EAl1
(name)
Phone
(address)
(lies. no.)
(exnires)
{ohone no.
Electrical
1'::1" I,
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Primary
Structural
f1echanical
CONTRACTORS
(name)
(address)
(1 ice;, no. \
(pxoirps)
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fohone no. \
Genera 1
'1
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Plumbino
Electr; ca 1
~lecha n i ca 1
PLUI1BI NG
ELECTRICAL
MECHANICAL
-1!Q
FEF rHARr,F '![l
~rr rH~ NO
J:'j:"r rHM.G.[
sq. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
IRelocated building
(new fix. additional)
Is.F. Residence
(1 bath)
IDuplex (1 bath) each
IAdditional bath
1~later service
I Sewer
Istorm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Soar.p hpatpr and vpnt
Of
amrs.1
Apoliance vent
<;eoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dur.t
!TempOrary Construction
IChange in existing
rp<; i d~n('p'
Imultifaml1y. comm. or
lnriu<;trial
COMM./INO. FEEDERS
Install/alter/relocate
rii<;trih. fppder<;
Wood stove/heater
Of
amps.1
~I
I SSUANCF OF PFR'1l T
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
TOTAL CHARGES I TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor, the electrical portion of this perfilit
label has been signed by an Electrical Supervisor and returned to the Building Oivision
I HAVE CAREFULLY EXMlINED the completed aprlication 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 Orel]on pertaining to the work described herein, and that 110 OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certi y that my registration with the Builder's
\ Board is in full force and effect as required by Or-S 701.055. that if exempt the s;s for exemp . n is noted hereon, and that
::I::(:~::::t::::::S :: :::es w;;:: ;mOl i ance with :~: :::R:55 \lill b used ~ p oje t. om I~~/XX
FOr, OrFrCE USE~LY I
Sq. Ftg.'r1ain
Sq. FtlJ. Access
Sq. Ftg. Other
Zone
Fi re Zone
}ype/Const.
Bedrooms
Un; ts
x ~J
Value
Flood Plain
Stories
Dccy Load
Occy Group
x
Value
Value'
x
~~~~~~~Ga~~RMlT /' JDO~~@L~~
Surcharges S ~().dD
ELECTR I CAL PERI~IT sh I Qi"J
Charges and ---I--1.!....~v....
Surcha rges
Fence
1/')
/
,- )11
~?f
TOTAL VALUATION
Q)'sys;ems Development
_ Chavqe (1.5%)
~ J
BUILDING PERfIlT
Charges an':
Surcharges
, Plan Ck. Conm/lnd
65%/Bldo Ppr Fpp
------------""""PTan Ck. Res
30%/Bldq Per Fee
Demo
~
,=
~
Sidewalk
AIC Paving
f+0ul;.CJ..
80.m
TOTAL
II
11 It? /r 5n
~t-~
I
J
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
.
..:
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examyle- heat/electrical ceiling/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. example- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example, - remodel existing garage into family room
3. examele - 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. BUILOING OIVISION 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.
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.
I 2-~f)'6
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V. FOR OFFICE USE ONLY
Permit Clerk
CG
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PROJECT CONDITIONS TO BE SATISFIED BEFORE DCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date