HomeMy WebLinkAboutPermit Plumbing 1988-9-22
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"lINSPECTION LINE
726-3769
Job Address
Legal Oescription
Owner
~
(I) Rei
Address
Construction Lender
Address
Ul>l GN llAI1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~1echanical
NO.
Each single fixture
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CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l-later Heater
Range
ValuE of Hark:
INFORlIATION LINl
726-3753
Sq. Ftq. "lain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Pep.
-Fence Demo Change/Use
Other - -
)
-.:J-dA~ I
Pb4iJ lj)ev..,Phone
rJ
Builtiina Permit Info: Describe Work(i.e.,
Familv Residence Hith Attached Garaael
) o:n./t. ~
Build Single
II
v'--'
(name)
Phone
(address)
lohoneno.l
(lies. no.)
fexniresl
V)~I A
, 'l
')),J'J
(name)
(address)
(1 ;eo;.. no. \
(p:m; rpc;; I
(ohnn':' nn \
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PLUI1BING
ELECTRICAL
MECHANICAL
FEE r:HARGE NO
... rlJABliE.Jj(l
H~ r~ARG..E.
Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex (1 bath)
Additional bath
~Iater service
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~rp hp~t~~ ~nrl ~~nt
each I
I
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I
I
I
I
MI
. It '1
I
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Temporary Construction
Change in existing
r~c;.jdJ'J1r:p
Imultifamily, comm. or
Tndllc:.t~;~l
10f amps.1
ICOMH./lNO. FEEDERS I
IInstall/alter/relocate I
rlic:.t~;h f~prlp,.<:,
IOf amps.
I
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sin!;)le duct
Vent system apart from
heatinq or A.C.
I Mechanical exhaust
hood and duct
I Hood s tove/hea ter
I
I
I
ISSUANC, OF PFRrHT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LA1~ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
TOTAL CHARGES
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 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 110 OCCUPAIl(Y 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
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IIM1E(please print)-\~, ~I~ c,-e,......\"..,..... SIGrIATURE~'''''':-Jf'' ~ OATE 9-l' '- -r!J"
FOR OFFICE USE OIlLY
Zone Tvpe/Const. Units Sq. Ftg. f1ain x Value
Fi re Zone Bedrooms Occy Load Sq. Ft!J. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
BUILOING PERl11T
Charges and
Surcharges
PLUMBING PERMITC;'
Charges and./ .
Surcharges
~
"ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
SurCharges
TOTAL VALUATION
Plan Ck. Comm/lnd
____________~/Bldo p.pr Fpe
Plan Ck. Res
./ 30~/Bl do Per Fee
. I.'c- 0,0 Fence
-------~~-_.
.75 "Oemo
Systems. Development
Charae tl. 5~) "
'S1dewalk
A/C Pavi ng
____________, Curb Cut
I
Total Comb. Permit
I
I TOTAL
)5.75---
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. examele- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. ~- if new project. check-new - if addition,
ched add, etc.
F. Building pennit information:
1. exam~le - 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 b~ 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 ;s issued.
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V. FOR OFFICE USE ONLY
Permit Clerk
QG
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permi t appl i cant exempt from regi strati on with the Bun der' s Board because:
Additional Project Information:
'.
PLANS REVIEWED BY:
. name
signature
date