HomeMy WebLinkAboutPermit Mechanical 1988-2-1
I INSPECTION LINE
726-3769
INFORlIATION UNt
726-3753
Sq. Ftg. 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
ValuE of Hork: -Other- -
Owner R.J..r JA (J/ ~UL~w..o....J::: -
Address J ,\ 1 ~ r:t ... ~- f\ = - () Phone~ BuilriinQ Permit Info: Describe Work{Le., Build Single
NLvf'lAld I"';:llL.A..IJI"'U---c-- 0{'1'1 17C.fFamilv nesidence Hith Attached Garaael
U ,a-..-.. I &L v \)/ LCl 1- ~ '^ t~r\Vl
Construction C~der
.
CITY U~ SPRINGfIELD
COMBINATION APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
l~ater Heater
Ranqe
.
"
o(J
00.
8
09
Job Address
L5cS IY-.J It ~
17 0 3 :3S 3;;Z
03(",00
Legal Description
Address
UI:.S tliN II:.Ar~
(name)
Phone
(address)
flies. no.)
(exn; res)
(ohane no.)
Primary
Structural
0)1.1").. , 'C"""). f') d
. ~ . - ,-
Electrical
Mechanical
CONTRACTORS
Genera 1
(namel
U!(' v
I '\O:;:"..\-
(address)
( \6'<Lc"trttdlffiol
(1 ir:~_ no.)
(pxn; res)
(ohonp nn.)
3.05 ::iFl ~
477 D~C;Z) O<! 1'1]'(;.")(
"'2"-1.-/"
Plumbina
El ectr;ca 1
f..lechanical
PLUI,IBI NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE Nn
~~~ r~ARr,~ NO.
'~~~ r~ARr,~,
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Ouplex (I bath) each
New circuits alts.
or extensions
Floor fu rnace
and vent
Sewer
ISERVICES
I
ITempOrary Construction
IChange in existing
rpsjqp'nrp
Imultifamily, COIl1l1. or
TnnlJ<;trii'll
IOf amps.
ICOW~./INO. FEEDERS
"Install/alter/relocate
ni<;trih. fppnpr<;
IOf amp~
Recessed wall
SOi'lrp hp~tpr ~nrl vpnt
Storm Sewer
App 1 i ance vent
$poaratp
Stationarv evao.
cooler" ,
Vent fa'n with
sinole duct
I Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud
Additional bath
~Jater service
Wood stove/heater
111" d j: "i. te.WS.
15<.9-
~f)
ISSUANCE OF PFRIIIT
TOTAL CHARGES I TOTAL CHARGES . TOTAL CHARGES
WHERE STATE L'\t~ REQUIRES that the Electrical work be done by an,-Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Divis;on
I HAVE CAREFUllY EXMlINEQ the completed apnl;cation for permit, and do hereby certify that all infonnation 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 rlQ OCCUPArKY will be made
of any structure without the permission of the Building Div;sion. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 701.055, that if e(Lem t the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 7nl.05 w 11 be used on this project.
NAlIE(Pleaseprin~) F1hl/cn/i".... SIGNATURE IV'-7 OATr.//.J/Zg'
// / / FOr. OFFICE U,7,7AlIILY / / / /
Zone ! Tyoe/Const. Units sI/. FtgVllain x Value
Fire Zone ... Bedrooms Occy Load Sq. Ftl]. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERHIT
Charges anG
Surcharges
I Plan Ck. COIl1l1/Ind
65%/Bldo Ppr Fpp
------------P'fan Ck. Res
30%/Bl do Per Fee
Fence
lSysteJ:lS Development I
Cha rQe (1. 5~)
PLUIIBING PERMIT
Charges and
Surcha rges
Dljlno
ELECTRICP,L PERIHT Sidewa 1 k
Charges and ------------
Surcharges AIC Paving
Total Comb. rermit
~~;~~:;C:~/ERMI~ __J~~~h___
Surcharges ~
, ,
Curb Cut
I
I TOTAL
jlt, 5 '12
J
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II 03 43
2. example- lot 1. Block 3,. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~'e- heat/electrical ceiling/or forced air Gas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add. etc.
F. Building pennit 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. OESIGN 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 ~ivision
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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
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. A11 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
(~J:l
10"671
Permit Clerk d'^- J~J~
I.J~_J-~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date