HomeMy WebLinkAboutPermit Plumbing 1990-9-28
I HISPECTION LINE
726-3769
,a
CITY UF SPRINGFIELD
COMB!IIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Ran~e
ValuE or\r1n )
BUlldlnQ pe~t Info: Describe Work(i.eo.
Familv nesidence With Attar.h~d G~r~Q~)
.,
I NFORl1ATION Ll Nt
726-375~
5q, Ftg, ',Ia in
~q. Ftg. Access.
Sq, Ftg, Other
flew Add A I ter pep,
-Fence Demo Change/Use
-Other - -
Buil d 5 i ng I e
,
iJ
-
J
-
IS
()
Job Address \ 1-i 4 ?>\:.) (\ q f\ f01, A ')
Legal Omription \ II ()~fJ 2l4- O~I rn. ~
ow~J\~). ;--\'\\0 reA qc\9,~7?J~'8
Add~~~~R~A ~~ G14i7
Construc~ion ILe)der ) \
(lies. no.)
t ,t~:':W
I
I
no_ )
Address
DtSIGN TEAI1
(name)
Phone
(address)
~IJR LA~,e
(ohone
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.l
(pxnirp"l
(ohnnp nn
Genera 1
Plumbina \('\
Electrical
(\C\) ){\11 \. VlxvJ:l
6
VI) ~ \l.V\} JI"l.
/}\~
(~!gj9J
~lechanical
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
FEE CHARGE Nn FFL.. J:IlAllGE. ...llil....
Residence of furnace/burner to
SQ, FT, BTU's
t'~ t' I J:IlAllGE.
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
~Iater servi ce
Temporary Construction
Change in existing
rps; d_pnl'P
multifamily, comm. or~i,)
Induc;.tria1
-'
AP!>l iance vent
~_~oaratp
Stationary evap.
cooler
Vent fan with .
sinole duct .:
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd and dul't.
Sewer
I Storm Sewer
I
Of
CO~1,/INO, FEEDERS
Install/alter/relocate
di~tr;b. fppdpr~
amps.
Wood stove/heater
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\\/ REQUIRES that tile Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
ISSUANCF OF PFRrHT
TOTAL CHARGE S
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, and that IW OCCUPAt~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 7nl.055 will be used on this project.
IIAHE(please p, :i~v'Rnbf' Ie I tt \ P I <: C\ rUSIGrlATURE (f? clJ.j) ntrn J1,/YJ
, ~. FO~ OFFICE USE miL Y
Sq, Ftg,
Sq, Ft9,
Sq, Ftg.
OATEq.7R~qO
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
t1ain
Access
Other
x
ValuE'
Value
Value
Fire Zone
Flood Plain
x
x
TOTAL VALUATION
BUILDING PERI,IIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
. 65%lllldo Ppr ~p""
------------ PlanCk, Res
30t/Bldo Per Fee
__\~OO__ Fence
. 'IS Demo
Systems Development
CharQe (1.5~)
PLur1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERIHT Sidewalk
Charges and ------------
Surcharges AIC Paving
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
- TOTAL
I
i\~l~
Curb Cut
.
'"
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100, lane County Map Reference
1/ oj 43
2, example- Lot \, Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
0, Energy Sources
1. examQle- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
\, example- \250 sq, foot house, 500 sq, foot garage
2. example- 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 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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
.
PERMIT VALIDATION
L
Permit Cl erk
,fJ,~ 199G
g3~O
'-
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
12-24-85
1243 Ra i nbow
.
.
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