HomeMy WebLinkAboutPermit Plumbing 1983-9-6
I I'ISPECTIO'/ LIr'E CITY OF SPRINGFIELD INFORrlATION LINt
'7~6-3769 r , COMBINATION APPLICATION/PERMIT' , 726-3753
I ~ErlERGY SOURCES: Sq. Ftg. r'lai n \),)
Job Address 2 12 'Q' -:j)"~'&'f!!!!r Heat :q. Ftg. Access:
Legal Description I?<!:)Y"'=<:~":< ~&:>./$~I Hater Heater Sqiie~tgAd~th~~ter P.ep. WN
. , Ranqe -Fence~mo Change/Use
, ValuE of I'lork: AOther , ' v/Nc:f. ~
Owner ~ y cb~ J3~tI?HfC;,~ ,,~. ~ 0 . . .. ......
Address"..., ~ .,/.' 'I __ ~_.--:::>>~ BU11clna Pernllt Info: Descnbe Work(l.e., BU11d Slng1e 111
..4/7< "WJIIC 'i:) 7RE'E,' '7Ijo~..:;7C:i'" Family P-esidence \1ith ft.ttached Garaae) "B
~jP~(.r ~Y/h4'" J?;;rH/N;IP&'-E
Construction Lender ",;,I:-~ f'A--~A./~ ~C~ :::;'SI~,1jI1
Address Phone
DESIGN TEAr-1 (name) (address) (lics. no.)
Primary .1Ji1?A~ ~)y~N~""'.IY~ . -::?/-<. C:s:? 1677'
, "/
(exnires)
(phone no:)
?~"-o:a'"
Structural
, Electrical
Mechanical
, CONTRACTORS
(name)
(address)
(lics. no.)
(expires)
(phone no.)
, Genera 1 '
Plumbinq
Electrical
~1echani cal
PLUf1BING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO'
I FFF rHARGF NO.
SQ. FT.
furnace/burner to
BTLI',s
FFF rHARGF:
/~/
Each single fixture
Residence of
Relocated building
(new fix.' additi~nal)
New circuits alts.
or extensions
Fl oor fu rnace
and vent'
IS. !:.Residence
(lbath) ..
[Duplex (1 bath) each
IAdditional bath,
IHater service
SERVICES
Recessedwa 11
Soace heater ahd vent
Of '
amps.1
Appliance vent
seoa ra te
Stationary. evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust I
hood and duct
Wood stove/heater I
I
I
I
i
Sewer
I
I
I
I
~
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
Of
COMM./IND. FEEDERS
Insta 11 /a 1 ter/relocate
distrib. feeders
amps.1
I
I
;~~ Storm Sewer
TOTAL CHARGES
WHERE STATE L~W REQUIRES
sha)l not be va1iJ ~ntil th~
ISSUANCE OF PFRMIT
-2-S:~ TOTAL CHARGES TOTAL CHARGES
thatlthe 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
I HAVE CAREFULLY EXNlINED thecomp 1 eted apflli cation for permit. and do hereby certify that all informati on hereon is true
and corr!"ct. and I further certify that any and all \10rk oerformedshall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein. and that NO OCCUPAlKY \1il1 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 emp,l oyeeswho are in como 1 i ance with ORS-701. 055,\1i II be used on thi s oroject. , .
''''IE(,J"" ,""tl.Jb,N-"1L' a /l4'A~// SI'"ATURE~~~--r>L "OA>E9-tt-6'3!'
FO~ OFFICE USE ONLY ,
Zone ;l<- ~' Tyoeli:onst.~'VI'~ Units' Sa. Ftq. rlain x. Va;lue
Fire Zone ' Bedrooms Occy Load Sq. Fta. Access x Value
Flood Plain Stories Occy Group Sq. Ft;. other~j;9~ Value_ 9 ",--
TOTAL VALUATION
BUILDING PER~lIT
Charges and
Surcharges
'1 Plan Ck.
65%/B1da
-'-----------, Plan Ck.
" l, . 30%/Bldq
::z s-: ~ I Fence
---~--/~-~o-I Dt;mo
I Sidewalk
I A/C Paving
, , I Curb Cut
- - - -,-- -,,,,,-, - --'-I
1 _
\1
. ' I
CommlInd
Per Fee
Res
Per Fee
I s: ~t> rc:t '
12"Z'.SZ ~ 60lS $'"
I I'
I
I
I
I
I
'Systems Development
Charqe (1.5%) ,
PLur~BING PERMIT
Charges and
.Surcha~ges
ELECTRICAL PERr~lT
Cha rges and
Surcha rges
:zy. --
Total Comb. Permit
S'"tf),4-
MECHANICAL PERMIT
Charges and
Surcharges
I TOTAL
S<f), d.o
.~, I. ~.
.
.
"':;'J
COMBINATION APPLICATION/PERMIT (CAP)
_:'M'
PERMIT VALIDATION
I. Applicant to furnish "
, A. Job Address
B. Legal Description
1. examo1e- Tax Lot lOa, Lane County Map Reference
17 03 '43
2. ' examp1e- Lot ,I. B10c~ 3r 2nd Addition to"
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examo1e- heat/electrical ceilinQ/orforced air gas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examo1e- 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 gar"ge
2. example - 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. DESIGN TEAI~ Arm 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 sChedul es
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 ~sed 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
signa ture.
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.
~B5
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, ". ,. .;.
V. FOR OFFICE USE ONLY
Permit Clerk
P ,
(;')VYJ--)
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PLANS REVIEWED BY:
name t.~c.: rl~~~
~,.~"~
signature ,;PI"::-r~'
" ;-
date 97..p'~