HomeMy WebLinkAboutPermit Plumbing 1988-9-8
'I INSPECTION LINE
726-3769
Job Address ~~~
Legal Description
FEV~c( 7'
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
,ENERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of Hork:
~~/';:1t"'"J~ ~
Buildinq Permit Info: Describe Work(;.,e.,
Family Residence With Attached Garaqe)
INFORt1ATION L1N~
726-3753
Sq. Ftg. r.1a i n
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep. '
--Fence Demo Change/Use
--Other -- --
Address
Phone
Build Single
~
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~
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Owner',~~~ &.?6\oY"TH ~C:-AtL/r.
Construction Lender
457?~ ~~/-:? ~ _5c~/~
h ~~ ~7h".cn::7~..,..p- ~/Z" C=-/?
Address
DES I GN TEAr-l
(name)
Phone
(address)
(1 ics. no.)
(expires)
(phone no. )
Primary
Electrical
OlA/
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"TJ J
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yo
Structural
Mechanical
CONTRACTORS
(name)
(address)
(1 i cs. no.)
(exDires)
(ohone no. )
General
P1umbinq
1.04:) ~V~~~_
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.7?e>.2bx :</$>9. cz;..r-c;.-c=-~ ~ /'7&>2
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Electrical
~lechani ca 1
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF rHARr,F NO.
FFF rHARGF
Each single fixture
Residence of
SQ. FT.
furnace/burner 'to
BTlI's
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
SDace henter nnd vent
Storm Sewer
Temporary Construction I
(~.p.p Change in existing I
.) . res i dence
2-""'\. pe> I multifamily, comm. or I
~ Industrial
I 10f amps.1 I
I ICOMM./IND. FEEDERS I I
I I Install/alter/relocate I
distrib. feeders ,
I ' I 0 f amp s. I I
I I I I
I I I
I I I ISSUANCE OF PFmm
~-;r: &9 TOTAL CHARGES I TOTAL CHARGES
that the Electrical work be done by an, Electrical Contractor, the electrical rortion'of this permit
label has been signed by an Electrical Surervisor and returned to the Building Division
Appliance vent
seoarate
Stationarv evao.
cooler" ,
Vent fan with
sina1e duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood and duct
from
. '2$'1 \-later servi ce
?G>' Sewer
Wood stove/beater
TOTAL CHARGES
, WHERE STATE LAW REQUIRES
shall not be valid until the
I HAVE CAREFULLY EXAtlINED 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 NO OCCUPAfJCY 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 70.1.055 wi_~ e ed o~n this Qr.,oject.
, ~,d
"""'(p''''' pd,') ~ I M F. /J CJ S SI'''A,"' " ~ ~ DAT'?' ft~~
FOR OFFICE USE/or~L Y
Zone
Fire Zone
Flood Plain
TYDe/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
Sq. Ftg. 11ain
Sq. Ftg. Access
Sq. Ftg. Other
x
x
Value
Value
Value
x
TOTAL VALUATION
Plan Ck.
65%/B1da
Plan Ck.
,.' 30%/B1 dq
PL1Ir1BING PERMII.S" ,.. . d~ -- Fence
Charges and_....- -____J_d..:..___
Surcharges . ::(~ :< 51, D~mo
ELECTRICAL PERrmSidewal k
Charges and ---------___
Sur~~~rg~s, ,
BUILDING PER~1IT
Charges and
Surcharges
Comm/Ind
Per Fee
Res
Per Fee
Systems Development
Charge tl.5%) "
MECHANICAL PERMIT
Charges and
Surcharges
A/C Paving
I Curb Cut
I
I.
,!rotal Co.mb. Permit
I TOTAL ;
C/? 2.:>:J
-
" '
COMBINATION APPLICATION/PERMIT (CAP)' PERMIT VAll DATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. exam~le- 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 constructi'6~"lender
'D. Energy Sources
1. . 'example- heat/electricai ceil ingjor forced air qas
2. example- waterheater/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 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design oy:>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 schedul es
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. ' -
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. '
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.
", 7'0. ,- . .
"
. .
'.... .
I I I.
V. FOR OFFICE USE ONLY
~(l". ~~ it, 12-.278,
Permit Clerk d. (ji ~
q-15- ~'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from regis~ration with the Builder's Board oecause:
Additional Project Information:
-" ....
"
- .~.
PLANS REVIEWED BY:
namec't?i9u~ Rz~~?
signatured~;2~- date ;7~E-:g""l!!;..
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