HomeMy WebLinkAboutPermit Plumbing 1981-9-29
Buildinq Permit Info: Describe Work(i.e., Build Single
'Family Residence With Attached GaraQe)
~ToEN1 SE.W&~.aON4/&r~~A('
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~i3~. Of amps"1
~' COMM./IND. FEEDERS
I I I Install/alter/relocate I
distrib. feeders
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I , I I I ISSUANCE OF PFRrl!T
;1 7ft ~~ TOTAL CHARGES I TOTAL CHARGES
that the Electrical work be done by an-:Electr;cal Contractor, the electrical portion of this
label has been signed by an Electrical Supervisor and returned to the Building Division
'tlP\llION LI"'- >
Job .Address 5".;2. 5/'1,' /1 Sri
Legal Description /7-o~ -~S' "'~s.
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
I' J.. '1~OO Hater Heater'
Range
ValUE of Hork:
Owne r St!.40t>( JJ /S T. .# Ie;
Address 5::JS A-1,'/1 sr.
S oRI ~-{!'r.ld, (f)Q.r.f;tJtJ
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Construction Lender
Phone
Address
DESIGN TEA/.l
Phone
(address)
(name)
(lics. no.)
Primary
: Structura 1
: Electri ca 1
! r1echanical
. CONTRACTORS (name)
General OV/NE:i?
: Pl umbi nQ
(address)
(1 ics. no.)
. Electrical
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PLurIB I NG
ELECTRICAL
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Each single fixture
'rFfE
CHARGE NO,
'-'-+-_._~-_.
FFF r.HARGF NO.
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits.alts.
or extensions
IS.F. Residence
(1 bath)
I Duplex (1 bath)
IAdditional bath
I~Jater service
Sewer
SERVICES.
each
'TempOrary Construction
IChange in existing
residence
Imultifamily, comm. or
Industrial
Storm SewerqZIJ t/:I
/
TOTAL CHARGES
, WHERE STATE L~H REQUIRES
shall not be valiJ until the
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INFOR/1ATION UN!:
726-3753
Sq. Ftg. r.1a i n
~q. Ftg. Access.
SQ. Ftg. Other
Ne\~ Add Alter P.ep.
--Fence Demo Change/Use'
--Other-- --
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6'
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(exoires)
(phone no.)
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(exoires)
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FFL CHAR(;f j
()hone no. )
-'--U~;;HA:;~~~' T----=L'-
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,furnace/burner to
BTU's
'Floor fu rnace
and vent .
I Recessed wall
.Space heater and
,
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I App 1 i ance vent
separate
Stationary evap.
cooler
Vent fan with
sinale duct
I Vent system apart froll) I
heating or A.C.
I Mechanical exhaust I
hood and duct
I Wood stove/heater I
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permit
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I HAVE CAREFULLY EXAr1INED 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 Spri ngfi el d and the Laws of the State of Oregon oertaini ng to the work descri bed herei n, and that NO OCCUPAfKY wi 11 be made
of any structure without the permission of the Building Division. I further certify that my registration ~Iith 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 70.1.055 will be used on this project.
HAr-1E (p 1 ease pri nt)
SIGNATURE
'FOP- OFFICE USE ONLY
So. Ftg. f'iain
Sq. Ftg. Access
Sq. Ftg . Other
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stori es
Units
Occy Load
OccyGroup
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck.
____________ 65%/BldQ
Pl an Ck.
30%/BldQ
-----.d1~.33 I Fence
, I D~mo
ISidewal k
, AlC Paving
I Curb Cut
------------,
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CommlInd
Per Fee
Res
Per Fee
PLUt1BING PERMIT
Charges arid
Surcha rges
ELECTR I CJl.L PERr~IT
.Charges and
Surcha rges
f1ECHANICAL PERMIT
Charges and
Surcharges
DATE
x
Value
Value
Value
x
x
TOTAL VALUATION
ISystems Development
Char(je ('1.5%)
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ITPtal Comb. rermit
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, TOTAL
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/ !J. 79. &s \\
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp 1 e- Tax 'Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of'owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. example- 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. ,.
E. Building permit information:
\ '''I.' 'example - construct single family house with an
attached garage ~
2.' example - remodel existing garage into family room
3. example - convert single family residence into
res taurant (change of use) . ',:
G. Value of work ~s defined in Section 303 (a) of the
Structural Specialty Code
H. DES I GN TEAt.1 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 instalied are not covered on
the abbreviated schedules you should consult the
full schedul es
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.
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PERMIT VAll DATION
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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:
,f1
name
signature
date9' :29-~(