HomeMy WebLinkAboutPermit Mechanical 1983-1-6
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INFORt1ATION Lll'tt
726-3753
Sq. Ftq. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
Nel< Add Alter Rep.
-Fence Demo Change/Use
-Other- -
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I IrISPECTION LIIIE.
726-3769
Job Address ) (') 9/)
0LlAll~t
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CITY UF SPRINGFIELO
Cm1BIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
('later Heater
Ranqe
ValuE of Hark:
Legal De5cription
\/ ()~f?[() '3 \ () (r;<<i) ! .
Ol<ner [n YJ1T~h}() I~~ '~ (DJlJl J llJ-/1l /
Address J (. ... A C"\ '(". . Phone
"'\ -r (J ,,\ > '\. L- .1",- ~,......... I
. - . -'. . . /'1 rlJ/cx
Construction lender
Jl00hfin,
11 net )
(lidsino. \
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BuilGinQ Permit Info: Describe \~ork(Le.. Build Single
Familv Residence With Attached GaraQe'
.'(name)
Phone
(address)
J
Address
OESIGN IEAr1
(exoires)
(ohone no.
Primary
Structural
Electrical
f~echan;cal
CONTRACTORS
(name)
(address'
(1 ics. no.'
(HO; res'
(nhonf" no. \
Gpnp.ral
PllJmb;no
(!<<~~~) /, ~
J{)QI.\ ~.~~(JJ'\I~ro. J,.l:))D 11)' ~JY\L'7:t~-
PLUI1BIrIG . ELECTRICAL. I MECHANICAL.
Electrical
~1echan; ca 1
NO.
FFF r.HARr;E NO
~~~ rHARr,F NO_
FFF rH<RGF l
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
I
Recessed wa 11
Sn~ce h@ntpr nnr! vpnt
(,,00
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hoorl ~nd rlud.
Wood stove/heater
~Jater servi ce
Temporary Construction
Change in existing
rp,? i rtpnf'"p
multifamily. comm. or
lnr!ust.ri~l
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
rli<;;t.rih. fppdpr<;;
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
I
ISSUANCE OF PFRlHT I () 1 DO
TOTAL CHARGES TOTAL CHARGES It:, , A4
that the Electrical work be done by an. Electrical Contractor. the electrical portio.n of this permit
label has been signed by an Electr;cal Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1lNED 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 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 NO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ORS 701.055. that if exempt t e basis for exe ion is noted hereon. and that
only subcontractors and emP10Y~ in comoliance with ORS 7nl.055 wi b used on thi project.
NAllE{please PrlntrY.If!rt /4't://,//h.t7ff SIG;lATURE
FOr OFFIcE 11SE OW Y ,.
Zone
Fi re Zone
Flood Plain
Type/Cons t.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
fiain
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfHT
Charges anG
Surcharges
Plan Ck. Comm/lnd
65%/Rldo Per Fpp
------------ Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charqe (1.5%)
PLUl1BING PERMIT
Charges and
Surcharges
D~R1o
ELECTRICAL PERr:1T
Charges and
Surcharges
Sidewalk
A/C Paving
_--J.f.o~9_~-- Curb Cut
. .(~
Irotal Comb. Permit
11ECHAN I CAL PERM IT
Charges and
Surcharges
TOTAL
l Co .12 L-f
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,
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced ai( Qas
2. example- waterheaterjelectrical/or sotar
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 foom
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 TEAl.! AND CONTRACTDRS
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 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 paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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Permit Clerk ,~~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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