HomeMy WebLinkAboutPermit Mechanical 1985-9-24
I INSPECTION LINE
726-3769
Job Address /</9?{
Legal De;cription ) 7 03
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E!IERGY SOURCES:
Heat
t~ater Heater
Ranqe
Valu€ of Hark:
INFORr1ATION Uj~t.
726-37S3
Sq, Ftq, 1,1ain
~q. Ftg. Access.
Sq, Ftg, Other
lIew Add Alter P,ep,
--Fence Demo Change/Use
Other- -
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CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Owner
fAJtl.f' f (A IJ"rn hLL
Address rJ.'3 F W/1J.I);; //},-n.L.--- Phone /If/
~ '?%to
Construction le~der
Buildinq Permit Info: Describe Work(i.e.. Build Single
Familv nesidence With Attached Garaqe)
0$..4-- /i.A;Z/~
/ ,!/ 0
Address
Ut.:::dGN TtAfT
(name}
Phone
(address 1
(1 ics. no.l
(exn; res)
(ohone no.)
Primary
Structural
Electrical
Hechanical
CONTRACTORS
(n_J
(addrp~s I
(l ice;. no.'
(pxni rp<;)
(ohone no.)
Genera 1
PllJmbino
Electrical
~1echanical
dPc.ML../' uivddhrl
PlUllBInG 0
ELECTRICAL
MECHANICAL
...J!P
---ITL ..QjAR"' Nn
~~~ rl--!!1RGf..1l.Q
~~L..cJ:lAR.G..E.
SQ, FT.
furnace/burner to
8TU' 5
'~\
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bath\
Duplex (l bath) each
Additional bath
SERVICES
Recessed wall
Snacp heatpr and vpnt
Storm Sewer
Of
amps.
Apoliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood nnd duct
Sewer
Temporary Construction
Change in existing
res.idl;nce
multifamily. comm. or
Tndllc;trial
~Jater serv; ce
CDMM,/lND, FEEDERS
Install/alter/relocate
dic;trih. fppdprc;
Wood stove/heater
Of
amps.
iJJu - - 10 00
I /~
y/O '1'0
TOTAL CHARGES
WHERE STATE l,U~ REQUIRES
shall not be valij ~~til the
ISSUANCf OF PFRr1lT
I TOTAL CHARGES , TOTAL CHARGES /0_ ~O
that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pernit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUlLY EXAMINED the completed aPrlication 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 rw OCCUPAIKY will be made
of any structure -nthout the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full f~rce and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors' and ~loyees who are in compliance with ORS 701.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Tvoe/Cllnst,
8edroocs
Stories
Units
Occy Load
Occy Group
SIGlIATURE lli~QJ\:"\0..... '--
,
FOr. OFF I CE USE DilLY
So. Ftg. riain
Sq. Ftg. Access
Sq, Ftg, Other
DmC1 -1\.,LJ~
NAr,IE(please print) \0\a.."ka ~\ \,')12~n"~
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERMIT
Charges an~
Surcharges
I Plan Ck. CommlInd
65%/Blda Per Fpp
------------PTan Ck, Res
3D%lBl do Per Fee
Fence
ISystems Development I
Charqe (1.5%)
PLUMBING PERMIT
Charges and
Surcha rges
D~R10
ELECTRICAL PERr~IT
Cha rges and
Surcharges
'Sidewal k
Ale Pavi n9
Total Comb. Permit
/1ECHAN I CAL PERMIT
Charges and
Surcharges
10 ,0-0 Curb Cut
-71~_n-,~O-
TOTAL
~~c? ,
,
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax lot 100. Lane County Map Reference
11 UJ 43
2. examele- Lot 1. Block ~, 2nd Addition to
~pr'ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examDle- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 SQ. foot garage
2. exam21e- if new project. check new - if addition.
chee k add. etc.
F. Building pennit information:
1. examole - construct single family house with an
attached garage
2. examQle - remodel existing garage into family room
3. examDle - 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 TEM1 ANO 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 abbreviated schedules you should consult the
full schedules
C, BUILDING DIVISION 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
supervi sor. The genera 1 contractor is_not authori zed
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. All other fees and charges are due and
payable when the permit is issued.
~~\D :;, f("
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q/t
V, FOR OFFICE USE ONLY
Permit Clerk
(jV
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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
1
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~' .JORIS
~ PiZZA
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I fdVE BLUE~RA$
. SUN,DAY S}Q 8)0
.ItAP~.L__
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1498 SOUTH "A" STREET
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