HomeMy WebLinkAboutPermit Plumbing 1984-3-21
'" IrISPECTION LINE . CITY OF SPRINGFIElD
1726-3769 COMBINATION APPLICATION/PERMlT
Job Address C;Vl ~ If ~ 1 ~pn..R~L-=, 111~d- ~ ) ~~;~GY SOURCES:
legal Description \'1 {,5a8-\ \1J('Y)f:rl) Hater Heater
- - Range
ValuE of Hork:
--r.- ~ ~ f:i/~.;. vvtWL) IL
Owner ~ r \ s....,;-~-;rtLJll(r-rzs-.
Address c: J'~ r- L " nO (\. n j' II) i..J~~ne J
01,~l I\.- ~ bbL:l '\:77-
~}g7 1)./J1k-Y>1 D/.', --' , A'1A":.f fA
u I .
Construction Lender
I HAVE CAREFUllY EXM1INED 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 UO OCCUPArKY 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 OP.S 701.055 will be used on this project.
(JUJ(IU:
11Af.IE(please print) WI '""\
Address
Ot~ I ~N rtAI1
(namel
Primary
Structura 1
Electrical
Mechanical
'CONTRACTORS
(name)
Genera 1
Plumbina
Jt'l<:-
SrJf'naf
Electrical
~1echanical
PlUlIBIrlG
-1!Q..,1
\
Each single fixture
Relocated buildin9
(new fix. additional)
S.F. Residence
11 bath 1
Duplex (1 bath) each
Additional bath
~Ia ter servi ce
Sewer
Storm Sewer
TOTAl CHARGES
WHERE STATE l~H REQUIRES
shall not be valiJ until the
Zone
Fire Zon/?
Flood Plain
Tvpe/Const.
Bedrooms
Stories
BUIlOING PERfIlT
Charges an~
Surcharges
-;;~H~~'\rRM{T""""'"
Charges and
Surcharges
.
INFORlIATION UNt
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A 1ter p.ep.
Fence_Demo _ Cha ngelUse
Other
00
...c.
o
9J
o
-D
BUllolnQ Permlt Info: Oescr be Work(l~e., Build Single
Familv nesidence With Attached Garaael
)~~O
LlitL/( )
Phone
(address)
.1
(ohone no. )
(lies. no_)
(exoires)
(address1
l1i('~, no.1
(exoir~s1
(ohnnp M_ )
01101?_ {ll. ~vr1
/I-nOON
~ Ll <,--0'7(.0
'3 LrZStD~
ElECTRICAl
MECHANICAl
FEE
rHARr.F
5~
FFF
I rlJARliE.
rH-'lB.G.l NO,
_NO
FFF
Residence of
furnace/burner to
BTU1 s
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~nA(,p hPAtpr Anrl vpnt
Temporary Construction
Change in existing
r~~iQf':n('~
multifamily, comm. or
Tnrlllo;.triil.l
10f amps.1
ICOffi1./IND. FEEDERS I
l'Install/alter/relocate I
di~trih. fppdpro;.
I Of .mp~1
I
I
I
5,{10 TOTAl CHARGES
Appliance vent
spoaratp
Stationary evap.
cooler
Vent fan with
sinele duct.
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hond and rlUI"',t
Wood stove/heater
ISSUANCE OF PFR!lIT
TOTAl CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
n .....eCl ()Y'-l
SIG!I^TURE /JIJ1 1-- ~
FOP. OfFICE USE OillY V
.....
O^T~ ") -z../ - >N'
-J
(
Units
Occy load
Occy Group
Sq. Ftg. t1ain
Sq. Ftg. Access
Sq. Ftg. Other
x
Value
Value
Value
x
x
TOT ^l V AlUA Tl Ot!
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
Plan Ck. Res
3D%/Blda Per Fee
Fence
Systems Development
Charce tI.5~)
,- ~
___iQ._Q __
.L/(
Demo
I Sidewa 1 k
------------1
AIC Paving
I Curb C~t
I
ElECTRICAl PERli!T
Cha rges and
Surcharges
MECHANICAl PERMIT
Charges and
Surcharges
Total Comb. Permit
TOTAl
lI;oJ~o
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II 63 43
2. example- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceil in-,Q/or forced air Qas
2. example- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project. check new - if addition,
cneck add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family foam
3. examole - 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 TEM1 AND CONTRACTORS
To avoid design or construction de.1ays. 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. ---
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.
etW Sj',
w %
3-'~
,
- ~:
~
V. FOR OFFICE USE ONLY
Permit Clerk
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because':
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date