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Home My WebLink AboutPermit Mechanical 1981-9-28 (2) INSPECTION LINE 72~769 --.- NOTIFIED ~,.,'~ INfORMATION LINE 72~753 -,' CITY Of SPRINGfiELD COMBINATION APPLICATION/PERMIT " Sq. ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _New_Add_Alter_Rep. _Fence_Demo_Change/ Use _~er Job Add,... 1117 South "A" Street l.gol D.",ipHon 17-03-35, Tax Lot 100 ENERGY SOURCES: Heat "A C' Water Heoter Range Value of Work: Owner Nicolai Company 1117 South "A" St. Phone Building Permillnfo: Describe Work (i.e., Build Single Famil" Residence With Attached Garaoe) Install 2 "a", susnended ],e"t:ers Address C:r"t"';T'I3-F;~1r1. n~ 7?f;_1071 Cnnstrl)t;!ion Lender Addren Phone DESIGN TEAM (name) (address) Primary .~tructural Electrical Mechanical CONTRACTORS (name) (address) General PlumbinQ Electrical ()O i-' o 0'> .,. o (lies. no.) (phone no.) (eJtpires) (lies. no.) (Dhone no.) (exDires) 74'7 -7 445 PLUMBING ElECTRICAL 4131 "E" Street, Springfield, OR MECHANICAL Mechanical Marshall) s "'0 FEE CHARGE NO.' Residence of Each sinQle fixture Relocated building (new fix. additional) S,F. Residence (1 both) sq, ft. New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Construction Additional bath Amps. Water service Sewer Storm Sewer FEEDERS Amps, TOTAL CHARGES TOTAL CHARGES FEE CHARGE NO, FEE CHARGE furnace/burner to D.TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical eJthaust hood and duct Wood stove/heater Heat Pump Air handler to 10,000 CFM Air handler over 10,000 CFM 2 SllS Ht:r/Vpnr 11. 011 1 Gas oioill\1: 2.0(1 ISSUANCE OF PERMIT 10 O(\l TOTAL CHARGES 24,00 WHERE STATE lAW REQUIRES that the Electrical work b. done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has bun signed by an Electrical Contractor and attached to the el.ctrical panel. I HAVE CAREFULLY EXAMINED 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 lows of the State of Oregon pertoining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division. I further certlfy that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if eJtempt the basis for exemption is noted heron, and that only subcontractors and employees who a're in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption- NAME (pl.o.. p';nt) l"\a.", I,.~ l \ LJA.,\ "oil ()AI'III"14 ~L SIGNATURE fOR OFFICE USE ONLY Zone~-3 Fire Zone Flood Plain Type/Canst. Bedrooms "torie-" Ilnits "uy load jccy Group BUilDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Bld~ Per Fee Plan Ck. Res 30%1 Bldg Per Fee PLUMBING PERMIT Charges and Surcharges Fence Demo ElEORICAl PERMIT Chorges and Surcharges Sidewalk A / C Pavina MECHANICAL PERMIT Charges and Surcharges 24.00 -------- .96 Curb Cut ~W0l1 ~_ 1. DATE<1 - ~'f. -<;{l Sq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other Volue Value Value x x TOTAL VALUATION Systems Development Charco8 (1.5%) Total Comb. Permit TOTAL 24,96 COMBINATION 'j -;------.., "...,; ".''If..'.... ,.wr'''i.'.~. APPLICATION/PER.' (CAP) ',- I. Applicant to furnish A Job Address B. legal Description L example-tax lot 100, Lane County Map Reference 17 03 43 2, example-Lot L Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exomple~heot/electrical ceiling/or forced air gas 2. example-water heater/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'& Electrical"Schedu'les 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 abbrevi. ated schedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 typewritten 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. 'V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: AdditionQI Project Information: PLANS REVIEWED BY, naml'" ~ignaturp ,,' 'I' ... PERMIT VALIDATION ~-, Permit Cler~ ~at.,.