HomeMy WebLinkAboutPermit Plumbing 1991-2-15 (2)
I "',PECTIO:. L1IlE
726-3769 .
Job Address 201
legal Oe~cript;on
,
CIH Vi- SPiHliGFIELD
CO'\BI IIA TI ON APPll CATlON/ PERMIT
E!IERGY SOURCES:
Heat
l~ater Heater
RanQe
ValuE of Hork:
$4500.00
rBuilc:ino Permit Info: Oescnbe Workll.e., Build Single
~ar.1i1v nesidence \lith (Ittached (laraae)
Installation of approximately(:L850jreet
of water. line and a double check valve.
,
INFOR/1ATJO:-l llltt. I:
726-3753
So. Ftq. I-lain
~q. H9. Access.
Sq. Ftg. Other
__~ew__Add__Alter ~ep.
__Fence__Oemo__Change/Use
_Other
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-
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Dorris St., Springfield 97477
18 Q3 02 802
Owner Wi 11 arna 1 ane P~rk ~n.9 RE.:crE.:~ti on
Address 151 North 4th St.
SorinQfield, OR 97477
District
Phone 726-43
'J
Construct inn lender
None
Address
tlt.~! r..:.~ :~':\"
(name)
Phone
(address)
(lies. no.l
(exnires)
"
(ohone no. I
,rim", Wi11amalane Park and Recreation District (same as above)
Structural
Electrical
11echan; ca 1
CONTRACTO~5 (na~e)
General Force Account
Caddre5C;)
(1'..... nn)
(p'I(T);rF", ,
(ohnop nn ,
Plumbino
Electrical
f.lechanical
PlUllBlIlG
El'tCTRICAl
MECHANICAL
"0.
rH rH/,R(;F tln
!:'!:'1=' i rl-1t..PG1=' fin
i HJ:" 'nu.:u:J:"
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
IRelocated building
(new fix. additional)
IS.F. Residence
f1 bath \
Ouolex (1 bath) each
Additional bath
INew circu~ts alts.
or extenSlons
Floor furnace
and vent
SERVICES
I Recessed wall I
~n~rp hp~~p~ ~nrl vpnt
~!ater service
[Temporary Construction
IChange in existing
rp~,i rtP.nrp
Imultifamily. COIl1!l. or
Induc:;tri~l
Storm S~wl!r
10f
ICOI~'1./lND. FEEDERS I
Install/alter/relocate I
rlic:;trih fpprlprc:;
.mp~1
I
I
amps,
Apoliance vent
c:;poariltp
Stationarv evao.
rnoler - ,
Vent fan with
..inole duct
Vent systeM apart from
heatino or A.C.
Mecnanlcal exhaust
hnod and durt
Sewer
Uood stove/heater
Of
I SSUAIICF OF PFP.'HT
TOTAL CMARGES I TOTAL CMARGES TOTAL CHARGES
WHEnE STATE l~W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this per~it
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Zone
Fire Zone
I HAVE CAREFUllY EXN1WED t~e completed apf'llication for I)ermit. and do hereby certify that all infonnation 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 Soringfield and the laws of the State of Orel)on oertaining to the work des ribed herein. and that rlC OCCllPAllCY will be made
of any structure without the permission of the Building Division. I furth c rtify that my r istration with the Builder's
Board is in full force and effect as reQuired by ons 701.055. that if exem. t the basis for emo ion is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.5 7~1.055 wi 1 be used on th s Droject.
IIAlIE(ole.se print) tJed I~abeta SIr.:IATURF. . ~d$ _ _ '
FO~ orFrc~ USE Dm."y----] 7:--.'-'-'" .,......~ '-''- ",
Sq. Ftg. ,tain x
Sq. Ft!:!. Access )'
Sq. Ftg. Other x
''-
om 2/15/91
Flood Plain
Tyoe/Const.
Bed rooms
Stories
Units
Value
Value
Value
Occy Load
Occ.v Group
'.
TOTAL VALUATlOIt
BUtLDIIIG PERI-lIT
Charges an~
SurCharges
Syste~s Development
Charce (1.5')
PlU'IBING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ 65'.t/Bldo P_pr Fpp
Plan Ck. Res
-.. . 30%/Bl do Per Fee
_cL~5~ Fence
, (4' .'l-J Demo
I Sidewalk
I A/C Paving
I Curb Cut
I
Total Co~b, rermit
I
I
I
I
I
J30q ~S I
ElECTR I Ct.L PERI:IT
Charges and
Surcharges
HECHAHICAL PERMIT
Ch.,) rges and
SurCharges
1-0 'L
I' T"
I
;
,
",
'.
COMBINATION APPLICATION/PERMIT (CAP)
PEm1IT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole6 Tax Lot -100. Lane County Map Reference
II 03 43
Z. examole. lot 1. Block 3. 2nd Addition to
~prlngtjeld [states
C. Name. etc. of owner and construction lender
~ Energy Sources
1. examoJe. heat/electrical ceilina/or forced air oas
2. examJle- waterheater/electrlcal/or solar
E. Souare tootaQe or valuation, etc. ------
1. examole. 1250 sq. foot house. 500 sq. foot garage
? e~:~~1e- if new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. exa~ole - remodel existing garage into family room
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. OESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact ~ppropriate
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 aooropriate item{s} to be installed
B. Full Plumbing. Mecnanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
Z. If the item(s) to be installed are not covered on
the abbreviated scnedules you should consult the
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
suoervisor. 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 worksneet 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.
V. FOR OFFICE USE ONLY
2/2Yil
it- /7J2(
Permit Clerk ~~~AP
,
I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEW~~
name
~~
signature ~
date cJ-![)O!CJ;1