HomeMy WebLinkAboutPermit Plumbing 1988-4-20
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lINSPECTION LINE
726-3769 '
Job Address 533
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
Hater Heater
Range
Phone
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Buildinq Permit Info: Describe Work(Le., Build Single) LN
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INFORI1ATION UN!:.
726-3753
Sq. Ftg. r'1a i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Legal Description
Address
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ValuE of I-Jork:
Owner'
Construction Lender
Address
DESIGN TEAI'1
(name)
Phone
(address)
(lies. no.)
(exnires)
(ohone no:)
Primary
Structural
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Electrical
Mechanical
CONTRACTORS
(name)
(address)
(] ics. no.)
(exoires)
(ohone no, )
Plumbinq
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General
Electrical
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PLUr,1BING
ELECTRICAL
MECHANICAL
NO.
FEE I CHARGE NO
FFF rHARhF NO,
FFF rHARhF
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
Soace heater and v~nt
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,
Appliance vent
seoarate
Stationary evap.
cooler
I Vent fan with
sinole duct
,. Vent system apart from I'
heating or A.C,
I Mechanical exhaust
hood and duct
I \'Jood stove/heater
I
I
I
permit
Zone
Fire Zone
I HAVE CAREFULLY EXAI11NED 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 OCCUPAr~CY 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
"'y ,"b"'t",t", "d ,mpl,y", who '" i, "m,li"" with ORS 701.055 will be "',d " th!;lO"j,'t.
IIAI-1E(""" ,'i't) ~.Et>OI2-T\\ ("T SI'''ATURE~ &~ ~.-
FOR OFFICE USE ONLY
So. Ftg. 1lain
Sq. Ftc]. Access
Sq. Ftg. Other
/
DATE
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
Stori es
x
TOTAL VALUATION
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Plan Ck.
65%/Bldo
Plan Ck.
30%/Bldq
C20,OO I Fence
-------/~oDI D6mo
I-Sidewal k
I A/C Pavi ng
I Curb Cut
I
CommlInd
Per Fee
Res
Per Fee
ISystems, Development
Charge (1.5%) ,
I
I
I
I
ITotal Comb. Permit
i TOTAl
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BUILDING PWlIT
Charges and
Surcharges
PLU/1BING PERMIT
Charges and ~
Surcharges '0
ELECTRIC~.L PERfm
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
SurCharges
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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
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/electricalior 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.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - 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 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
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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V, FOR OFFICE USE ONLY
Permit Clerk
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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