HomeMy WebLinkAboutPermit Mechanical 1983-1-10
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I IrlSPECTlOll lIflE.
726-3769
Job Address /6 9 tJ c60,-, TH
legal Oe"ription/'."3_~&'31
ttJ.6a:?C
cln Uf SPRlflGFIElD
CDrlBJ:IATlDfI APPlICATION/PERMIT
EiIERGY SOURCES:
Heat
Hater Heater
Range__
ValuE of l'/ark:
HIFORttATIQN llNt
726-3753
So. Ftg. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
~ew Add Alter Rep.
--Fence Demo Change/Use
Other -- --
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A t:?r.
,
Owner LJl1,tEP
Address
t/A .y
,
~/HT;Y
Address
UESIGN II:.Arl
(name)
Phone
(address)
BUll~lnQ Pe~lit Info: Describe Workl;.e.. Build Single
Family nesidence With Attached Garaoe)
/..y~7'''''L. '- '" :-"'~ER ~.Ar)lM'~~
tdL;~ rL71<E-.fl?~~ ~
.~c.e~$' .
(1 ics. no.)
(exnires)
(ohone no.
~.~".2 J
Construction Lender
Primary
Structural
Electrical
!1echan; ca 1
CONTRACTORS
(name)
(address)
(lies. no.l
(pxnirec;l
(ohnnp no. \
Genera 1
PlumbinQ
Electrical
PAYeA-.;N .
,?e;Wh 'f'c;....,.,rJ'P'7' /hEC.N.
~.
IA/SN :~N€~ Sr.~"'.7&_
C$ .:::a-3.J:;; .~
"lechan;cal
PlUflBIrlG
ELECTRICAL
MECHANICAL
Each single fixture
FFF I CHARGE ':tfl I I n:'~ J rl-l~ J!0 I
Residence of furnace/burner to
SQ. FT. . BTU's
I !:!:!: I r~11B.UL
/
NO.
I'Relocated building
(new fix. additional)
l's.F. Residence
(l bath)
IDuPlex (1 bath) each
IAdditional bath
~Jater service
New circuits alts.
or extensions
Floor fu rnace
and vent
Storm Sewer
Of
amps
I
I
I
I
I
I
Recessed wall
SOnCP hPntpr nnd vpnt
SERVICES
COI~1./IND. FEEDERS
Install/alter/relocate
di,,-trib. fperlerc;
Appliance vent
seoarate
Stationaryevap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and dud
Sewer
!TempOrary Construction
IChange in existing
ffl'; i rlJ>Jlcp
multifamily, COITm. or
Industrial
Wood stove/heater
Of
amps.
':2. ~~'E;te ~.-I<,"
......... ~i1'N.lE:.H.-6A~
I
I SSUANCf OF PFR!UT It?-
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES ~,-
WHEnE STATE LAN REQUlnES that tfle Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the 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 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 lW OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 \~be used on this project.
UAflE(please print) e4oL,1. Wt>t..1=("f7(. SIGflATURE ('::.. Y W~ DATE/~..L...~f
FO~ OfFICE USE OflLY-
Sq. Ftg. t1ain
Sq. FtSl. Access
Sq. Ftg. Other
Zone
Fire Zone
Type/Canst.
Bedrooms
Stories
Units
x
Value
Value
Value
Flood Plain
Occy load
Occ.y Group
x
x
TOTAL VALUATION
BUILDING PERI.IIT
Charges anc
Surcharges
Plan Ck. Comm/Ind
65%1Blda Ppr Fpp
------------"""Pfan Ck. Res
30%lBl do Per Fee
Fence
Systems .Development
Charae (1.5~)
PLUf1BING PERMIT
Charges and
Surcharges
Demo
ELECTRJC~.L PERf~1T
Cha rges and
Surcharges
HECHAN I CAL PERf11T
Charges and
Surcharges
Sidewalk
AIC Paving
<,<. -. Curb Cut
------------
Total Comb. rermit
.$8
TOTAL
-=<'<>.8.2:.
J
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COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, lane County ~lap Refen
1/ 03 43
2. examDle- lot 1. Block 3. 2nd Addition to
Sprlngtleld Estates
C. Name,'etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceiling/or forced
2. example- waterheater/electrical/or solar
E. Square footage or valuation. etc. -
1. ex amp 1 e- 1250 sq. foot house. 500 sq. foot ( i:l-
2. example- if new project. checkli"ew - if addi 1(1.
check add. etc.
F. Building pennit information:
1. example - construct single family house with
attached garll:ge . ,". <.:
2. example - remodel existing garage into famll
3. example - convert single family residence in
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of t (
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able .to contact appro'pria c:
persons regarding design information or job site
corrections. etc.
Abbreviated Plumbing, Mechanical, & Electrical Schedl
A. Except where blank spaces occur in the descriptil (
portion of the Mechanical and Electrical Schedull "
the applicant need fill-in only the No. Boxes ad~
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedu', (
are available at the Building Division
1. To conserve space on the permit form the schE
have been abbreviated
2. If the item(s) to be installed are not covere 0
the abbreviated schedules you should consult
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A~
CHARGES ON THE SCHEOULES
D. As noted on the CAP, "the label must be delivered
electrical contractor for signature by his electr
supervisor. The general contractor is,not author
to sign the electrical label. ---
Applicant to sign and date
Whenever possible, the initial application will be us__.._.
a worksheet only. Where possible, Building Division Staff
wi 11 prepa re a type wri t ten copy .and return it to. the
applicant at the time the':"actua( permit is issued 'for his
signature.
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.
II.
III.
IV.
V. FOR OFFICE USE ONLY
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CITY OF SPRINGFIELD
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CllyHan
Springfield, Oregon
Oepartmanl 0' PublIc Works (
OFFICIAL RECEIPT
No.B60238(
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Date ,lA-H. /t:!'~ 199"$
Co. Rec'd From -z;......... ;, C::;-4NT~ ~.
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Address /1,I.f"N ~~ 5'7;. ~ ri
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Received For.
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Amount Received
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BRIGGS ~R1NTE"SIL1THOGRA~HER.. ItUOlENE. ORJ:OON
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Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
?I
name
signature 4~ -
date /../t:>-8"2-
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