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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