HomeMy WebLinkAboutPermit Plumbing 1990-5-8
INSPEC1!ON LIN~
26-37~
Job Address /605 m/~IVI Sf-
Legal Descri pt I on I 7 O'?J 'b (g '=3 2.- -
~
CTY OF 5PlnNGFI~LD
COMBINATION APPLICATION/PERMIT
'I EilERGY SOURCES:
Heat
o (" <--I Dol \~ater H.ater
Range_
Valu€ of Hark:
.
INFDRlIATION lit'"
726-3753 '
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq, Ftg_ Other
flew Add Alter -Rep.
-Fence Demo Change/Use
Other- -
~
~
'-J
oJ
Owner' E,C[, :::feme"
Address q~J7t? RmJer liYl(2.. f2.-.d
Phone~j?_2J~7.
BuilriinQ Permit Info: Describe Work(;.e.. Build Single
Familv Pesidence With Attached Garaael
2- 5h~
I -b;le'+
Construction Lender
Address
DESIGN TEAi~
(name)
Phone
(address) (1 ics. no.) {exoiresl (ohone no. ,
'"",", A
~
'4
(address' (1 ics. no.) (exnires\ (ohonp no.'
'67417 J3J~s t?d Ve,iltv-l7;' 2l-/953 'if -2t?-Cj() 9. 3"7 -79-15
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
General
Plumbin<l
lICWln IAllf'S
Electrical
~1echani ca 1
PLUf.lBING
ELECTRICAL
MECHANICAL
NO, '
FEE CHARGE NO
EEE rH~ NO,
EEL LJJARliE.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
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
Snace heatFlr )'1nrl vpnt
Storm Sewer
Of
amps,
Appliance vent
5.eoarate
Stationary evap.
coolar
Vent fan with
sinala duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
rPOSlqr,ncp
multifamily, comm. or
Tnduo;.tr;al
Water service
'2 Sh(l7A1ey"S 7.. 7'1D ZZ.';'
I 1AJttl--tr do sQ.T-)
COMfl,/INO, FEEDERS
Install/alter/relocate
d;o;.trih. fppderc;.
Wood stove/heater
Of
amps.
ISSUANCf OF PFRIilT
TOTAL CHARGES 2 z. fi TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\W REQUIRES that the Electrical work be done by an,-Electrical Contractor, the electrical rortion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
I HAVE CAREFULLY EXM11N2D 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 OCCUPAUCY 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 subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGilATURE
FOR OFFICE USE OilL Y ~ \
Sq, Ftg, Mitrr'
Sq. Ftg. Access
Sq. Ftg. Other
~~~
DATE ~g - to
IW,iE (p 1 ease pri nt)
RJ ~e!~l
x
x
x
Value
Value
Value
TOTAL V ALUA TI Ot!
BUILDING PERmT
Charges and
Surcharges
Plan Ck, Comm/lnd
65%/BldQ Ppr Fee
------------ Plan Ck, R'es
30%/Bldo Per Fee
''22--170 Fence
------------
1,/3 D6mo
Systems Development
Charoe (J.5~)
PLUt~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERiHT
Charges and
Surcharges
'Sidewalk
A/C Payi ng
Total Comb. Permit
MECHANICAL PERMIT,
Charges and
Surcharges
Curb Cut
TOTAL
2'3,&'7
.
..nUI.., a
COMBINATION APPLICATION/PERMIT (CAP)
1_ Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
II oj 43
2, exam~le- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
I, example- heat/electrical ceilin~/or forced air aas
2. examyle- waterheater/electrlcal/or 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. 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. U 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 ANO
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 rees 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
PERMIT VALIDATION
9\~O
\\0
r :-n
s.-8-QU
Penni t
Cle~\\~ )
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date
. ..,
...2
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