HomeMy WebLinkAboutPermit Mechanical 1991-2-7
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Job Address ,,~l 0 l Qfl Lo \:)'(()J\C1. ~ \2rL -,~~~~GY SOURCES:
Legal Description \ ~()/~\()()D D\ \0\ Hater Heater
Ranqe
Val u( Of~O 1) . .
Builciinq Pel'111it Info: Describe l'Jork(Le., Build Single
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(lics. no.) (exoires) lohone no. )
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MECHANICAL
CHAR(.;F NO. FFF rHARGF
furnace/burner to
BTU's
Floor furnace
and vent
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I ~m[':y. (112 ~ I
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I ISSUANCE OF PFRr1IT
JTOTAL CHARGES c9n.OcJ
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
.1 INSPECTION LINE
726-3769
I Owner C-\f)\{Y\N\ T\\ ~,;~\) _
A""",-:>)\ O\()t5 ~{(\ \.~ ~ YR'
coo,t,,~~- . ' '1G,\i1- 'iS31']
Address
DES I GN TEAr~
, Phone
(address)
(1 ics. no.)
(name)
Pri ma ry
Structural
Electrical
11echani ca 1
CONTRACTORS
(name)
(address)
General
Plumbinq
Electrical
~1echanic'al (\(\ \\ \-. \l ~
V()'c)~ 4\n l~~,-n
ELECTRICAL
PLUI1B I NG
NO.
FEE CHARGE NO.
FFF
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
!l bath)
Duplex (1 bath) each
Additional bath
I ~Ia ter servi ce
I Sewer
Istorm Sewer
I
SERVICES
ITempOr~ry Construction
IChange in existing
residence
multifamily, comm. or
Industrial
amps.j
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Of
ICOMM./IND. FEEDERS
I Install/alter/relocate
distrib. feeders
10f amp~1
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TOTAL CHARGES TOTAL CHARGES
WHERE STATE U\H REQUIRES that the Electrical work be done by an
shall not be valid until the label.has been signed by an Electrical
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INFORf1ATION liNt .
726-3753
Sq. Ftg. f.la in
~q. Ftg. Access.
Sq. Ftg. Other
rJe\~ Add Al ter Rep.
--Fence Demo Change/Use
-Other -- --
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.y
(exoires)
(ohone no.)
I Recessed wall
Soace heilt.pr ilnd
I
vpnt I
I Appl iance, vent
seDa ra te
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
I Vent system apa rt from I
heating or A.C.
I Mechanical exhaust
hood and duct
I ~Jood stove/heater
I HAVE CAREFULLY EXAI1INED 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 oertaining to the work described herein, and that NO OCCUPArJCY will be made
Qf 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 th sis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 wil e sed on this project.
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NM1E(please pri'nt),~ /? O/")/IJ /12 i PP SIGNATURE DAT~-: 7-91
Zone
Fire Zone
Flood Plain
FO~ OFFICE US
TYDe/Const. Units So. f1ain
Bedrooms Occy Load Sq. Access
Stori es Occy Group Sq. Ftg. Other
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck. Comm/lrid
____________ 65%/Blda Per Fee
Plan Ck. Res
30%/Bldg Per Fee
___________-' Fence
I Demo
I Si dewal k
---------~--I A/C Paving
Qs O-J ' I Curb Cut
-----( .~rS-1
PLur~BING PERMIT
Charges and
Surcharges
ELECTR I CAL PERr~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
x
Value
Value
Value
x
TOTAL VALUATION
Systems Development
Charge (1.5';)
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i.
ITotal Comb. Permit
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
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 construc'tion lender
D. Energy Sources
'1. example- heat/electrical ceilinq/or 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 or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbre~iated Plumbing, Mechanical, & Elect~ical 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 pajd. All other fees and charges are due and
payable when the permit is issued.
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V. FOR OFFICE USE ONLY
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Permit
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
".,
PLANS REVIEWED BY:
name
signature
date