HomeMy WebLinkAboutPermit Mechanical 1990-8-14
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I INSPECTION LINE
726-3769
J.;!, Address Pf)J Q-\.~ \\ ~ m0(1:1,1
Legal Description \fln~~S4Q ()8.w(l.'
(
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Owner \ \\ "''(. 9 . 1=\ i- (' \rL
Address<p{'){ n- ~ \1"\ < A
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construc~on ~en'de~ l - ,
TY SPR NIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE of ~Jork:
NFORllAT ON
726-3753
Sq, Ftg, ',lain
~q. FtlJ. Access.
Sq, Ftg, Other
New Add Alter Pep,
--Fence Demo Change/Use
-Other- -
.-1)
D
-
~
Phone
BuildinQ Pe~lit Info: Describe Work(i.e.. Build Single
Family nesidence With Attached Gara~e)
Address
UI:.SlliN II:.Af1
lnamel
r F4VJ~3~&1 V \. '\
JlQJ) ~ l ~c \Q fUll A1Yl 11 )
I \ \ r
(ohane 00.\
Phone
(address 1
(lies. no.)
(exoires1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(address)
(1 ice:;, no_
lexoirf'<;'\
(nhonp no. \
Genera 1
Plumbina
~lechanical
~C9Jl\).~ Q 9 C\- 6nY\
~
PLUI,IBING
':)~?:,L. /J ,1{)Ulqz-
4\.0<61', \f(]'Q..j\ #C.~\C1 OCJ' 'l~lw'Ilr1)' J
ELECTRICAL \ I MECHANICAL
E1 ectr1ca 1
NO,
HE CHARGE ~tn
FFF r~ARr,F NO
Fn~ rH~
,SQ, FT,
furnace/burner to
BTlI's
Each single fixture
Resldence of
Relocated building
(new fix, additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Scarp heater and vent
Storm Sewer
I
Of
amps.
Appliance vent
c;eoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnrl and dud
Sewer
Temporary Construction
Change in existing
res.; rt~ncr.
multffamily, camm. or
Industrial
Additional bath
Water service
CO~1,/IND, FEEDERS
Install/alter/relocate
ni<;.trib_ fpprlers
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
ISSUANCE OF PFRt1lT
\ TOTAL CHARGES " TOTAL CHARGES
that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this
label has been signed by an Electrical Supervisor and returned to the Building Division
penilit
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 Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n. and that NO OCCUPAIKY will be made
of any structure without the permiSSion of the ~uilding Division. I further.certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that iEt th basis for exemption is noted hereon, and that
only subcontractors and employees who are in compllance with DP.S 7nl 55 w 11 used on this project.
/,
IWIE(please print) I!l?rl/.Gy ,z:/I?,v.o SIGtl^TURE DATEOBJ/~/ 7'CJ
FOP. OfFICE USE O~LY ~ '
$q, Ftg, tiain
Sq. Ft!). Access
Sq, Ftg, Other
Fi re Zone
Type/Const,
Bedrooms
Units
Occy Load
Dccy Group
x
Value
Zo~e
x
Value
Flood Plain
Stories
x
Value
TOT^L VALUATlOtl
!
BUILDING PERflIT
Charges and
Surcharges
, Pl an Ck, COIlll1/lnd
____________~/Rldo P.er Fee
Plan Ck, Res
3D%/Bldo Per Fee
Fence
'Systems. Development I
Charqe tl,5~) "
,
PLUI~BING PERMIT
Charges and
Surcha rges
D~mo
'Sidewalk
ELECTRICAL PERI1IT
Cha rges and
Surcharges
A/C Paving
__J~~-_ Curb Cut
,'l~
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
j (~,~,
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. examp.le- Tax Lot 100, Lane County Map Reference
1/ 03 43
2, example- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/etectrical/or solar
E. Square. f~otage or valuation, etc.
1. examole- 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
a ttached garage
2. examele - remodel existing garage into family room
3. exa~le - 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.
I II. "Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant n~ed 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
fu 11 schedu 1 es
C, BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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
signa ture.
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:
.
PERMIT VALIDATION
~~,\41\qqO
;jf \ ~05~
Permit' Cl erk
!:d1DQ)
Permit applicant exempt' from registration with the Builder's Board becaus,e:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date