HomeMy WebLinkAboutPermit Plumbing 1988-1-22
CITY Uf SPRiNGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Range_._=_______ =~
ValuE of Hark:
-=< .5' 6 ~ e>C>
Builrlino Permit Info: Descr,be Work(i.e., Build Single
Farnill nes;dence With Attached Gara~el
C:~Y~/"$7 ~"""Ao?E?'\' r:;;...?'~
7,; UV/~ /' Av// h c: f 5
I m,;:!>rcc , ,-
flies. no.)
liNSPEC1'ION Ll~E
726-3769
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Job Address /'i'L/g iv.:?#/N
- .,
9r
,
Legal De~cription
, Owner. -a.,V L: 7 Afi" rL>/Y
Address / '7 ij,/ /'-/7# //Y
<:);PF.c..Z" . ~l? .
Construction Lender" . ~~
Phone
67.
7L.,1L~"
745-///~
Address
Ul:.~lliN HN1
(name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
{namel
(address \
General /?r-NE~
P1umbino ,1A.-50;A/ .4~<c.:z-^, (/c/7,O~__7) C~ 7.)
Electrical - ~P~;''rs-S/vE -<:=C:~C7 ,(///'~;~~,'.: 7-?H<:s~ ')
. //' \ ,/
~1echanical
PLUf1BING
ELECTRICAL
NO. .
. Each single fixture
FEF . nrARf;1=" ~n
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INFORl1ATlON UN. ,I
726-3753
Sq. Ftg, Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
-Fence Demo Change/Use
-Other- -
0))
~J
g
C)
-
(exnires1
(ohone no .~\
~k.
~
<;( J J I }S/t)
f1 i~c;,. nn.)
(pxnirpc;,)
(ohnnp nn
,,.;,~
MECHANICAL
SQ. FT.
~~~ fl-lM.Gf. .....llil......
furnace/burner to
BTU's
I="J:'J:' r~~
I
I
I
I
I
I
I
I I
TOTAL CHARGES -:?~ - TOTAL CHARGES 4'::?---J5C::> TOTAL CHARGES '9: -Do
WHERE STATE L'li REQUIRES that the Electrical work be done by an,.E1ectrical Contractor, the electrical portion of -this permit
shall not be vali:J..until the label has been signed by a~ Electrical Supervisor and returned to the Build~n9 Division
Res idence..of
?-s~w..-
Relocated building
(new fix. additional)
~ New circu~ts alts.
. or-:1xt~~s~~~
SERVICES
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rp-s-jrjp'nrp
multifamily, camm. or
Tnrluc:.trial
Water service
Sewer
Storm Sewer
Of
amps.
COffi1./INO. FEEOERS
Install/alter/relocate I
rlic:.tr;h fpprlprc:.
amps.1
I
I
Of
.4,/.0& .
Floor furnace
and vent
I
Recessed wall
~n~rp hp~tpr ~nrl ~pnt
h-
I
Appliance vent
5eoaratp
Stationaryevap.
cooler
Vent fan with
sinole dur:t
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnod and duct.
~.....-
Wood stove/heater
ISSUANCE OF PFRlIIT
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 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 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further cert. ~;...~ ~ registration with the Builderls
Board is in full force and effect as required by ORS 701.055. that if exempt bas.u. for e~emption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 . be used on this project.
~ ----
SIGrlATURE _ _ _;..~~ ~ ~OATE /-Zz....fX?
FOP. OFFICE USEf~ik'r- /:. /~
20ne c:::::. L::. TVDe/Const. ~") ~# Units Sq. Ftg. 11.rrn x Value
Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value
Flood Plain Stories I Occy Group}\"-r Sq. Ftg. Other //r-7- 1~t;;;;,......~Va1ue ':4-':> ~~
/lesTc' EcS:S ZP=itf.C.co-O ~ y-vz.,./:;.y-1' ~)9'T':::=P W/,;;;J~TOTAL VALUATION
Tq'~66,RF"D ;1?.5?'IP/:r<>.
BUILOING PERflIT ...-,""7 crciS. Plan Ck. Contll/lnd
Charges and ~ ___.:!!"_~,:_____~/Blda Pj'r F'pp
Surcharges do. -:;:;( C>~ Plan Ck. Res
~~ GJ 30%/Bldo Per Fee
1lAf.IE(please print) D'AUt:...
TfClNI1)1\.J
PLU'~BING PERMIT ./...... c:;:..-6
Charges and S ---~._----
Surcharges -::::;.. c::st:5>
ELECTRICAL PERrm
Cha rges and
Surcharges
~.e?S-
(\)
I-
I
I
I
I
I
Fence
Demo
\oj
_ ___ Ys'_::",_sldewa1k
7- -;;>f) . A/C Paving
__.L~_::."_J Curb C~t
. "70 I
MECHANICAL PERMIT
Charges and
Surcharges
(0
Systems Development
Charpe t1.5%) .
&4.
Total Comb. Permit
"2 / ~ <7f>
'26&1 t:JS
TOTAL
..
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
\I oj 43
2. examole- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. 'Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air aas
2. exa~le- waterneater/electrlcal/or solar
E. Square footage or valuation, etc. ------ .
I. example- 1250 sq. foot house, SOD sq. foot garage
2. examJPle- if new project. check new - if addition,
cneck add, etc.
f. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. exam21e - 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 jab 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.
I D&3?
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V. FOR OFFICE OSE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISF~ED BEFORE OCCUPANCY:
V"!7/T 7tf;!f~ $-/;?-~~"Z' ;;0 {/~/,/
/O~~./~ ~ :5C~/~,;,,-,,- p~
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OA?CS>.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
"
PLANS REVIEWED BY:
nam~_Le>8#G ;zl~~Gff
v
signature
4/n/~
'/ /
date /-7~
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