HomeMy WebLinkAboutPermit Plumbing 1981-7-14
INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-375~
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Ow~er 12 /2.. ..5'#/9A/ER
Addr~ss~7q" ,- Asree c5'~
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ENERGY SOURCES:
Heat
Water Heater
Range
Value, of Work:
Sq. Ftg, Main
Sq. Ftg. Access.
Sq. Ftg. Other
_New_Add_Alter_Rep.
_F~nce~Demo_Change/ Use
_Other
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JobAddress 6'79'L?- 48T~/€ ',Sr
Legal Description {o.70&, 17 62 ~ <..I C/ ()
Construction Lender
'7"J/ /":Ir.,/ Building Permit Info: Describe Work i.e., Build Single
Phon~""(o-""'Q&;{e: Family Residence With Attached Garage} ,
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Address
DESIGN TEAM
Phone
(name)
(address)
(lies. no.)
(expires)
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(expires)
(phone no.)
General
Plumbing
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/
Electrical
Mechanical
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PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE 'CHARGE NO.'
FEE I CHARGE NO~'
FEE
'CHARGE I
Residence of
furnace/burner to
BTU's
Appliance, vent
separate
Stationary evap. ,
cooler
Vent fan with
single duct
Vent system apart from
heating 'or A.C.
Mechanical exhaust
hood and duct
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
sq. ft.
New circuits, alterations
or extensions
SERVICES
Duplex (1 bath) each
Temporary Construction
Additional bath
Amps.
Water service
Sewer
'-Wood stove/heater
:>-
Storm Sewer',
FEEDERS
Heat Pump
Air handler to
10,000 CFM
. Air handler a,ver
'10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOT AL CHARGES.AJ~ /-E e
~ TOTAL CHARGES
TOT AL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attach'd to the electrical panel.
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 perform,ed 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 herin, and that NO OCCUPAN,CY will be made of any structure without the permission of the Building ,oivision. I further
certify that my registration with the Builder's Board is in full force ,and eiffect a s required by ORS 701.055, that, if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Board exemption:
NAME (please print) J::,tv&CA-s. e ~A~
C;IGNATURE
!~MP~
u
]'-I'f!-n!-
DATE ,~
l
FOR OFFICE USE ONLY
'(
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charge (1.5%)
Total Comb. Permit
I TOTAL,
COMBINATION APPlICATION/P,
IT (CAP)
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 ceiling/or forced air gas
2. example-water heater/electrical/or 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 (0) 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 abbrevi-
ated sohedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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 typewritten 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:
AdditionClI Project Information:
PLANS REVIEWED BY:
namp
c;ignatun.
PERMIT VALIDATION
Permit Clerk
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