HomeMy WebLinkAboutPermit Mechanical 1989-2-17
Job Address
1510~ 5tuztA
~
.. LilY UF SI'RIIMIELU
I COIIBlllhTlON APPLICATION/PERMIT
E!IERr,y SOURCES:
Ueat
Hater Heater
Ranoe_
..
INfORIIAT:.:1 LI,'=' Ii.
726.3753 I
So. Ftq. f.jain
~CJ. rta. Access.
Sq. Ftq. Other~.
-'le\"~Add_/1.l ter _:',eD. '""\---'1
_Fence_Demo_Change/Use '
_Other ~ R~
Uescr be 1.lork! i ,e.. Bui Id Single "
Il.ttached r.araQe)
/~ /L~ 1\) Ii
IPI
~ UI~IJECrlOll Ll;l~
1726-3709 .
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J.eqal De~cription
Owner C J. L Y~do
,\lJdrcss ~
(CrfE- I'~~
I
ValUf of Hork:
Phone
UUII(dno PenUlt InfO:
F~~ily nesidence 11ith
G-q.~
~nstruction Lender
AJJress
OESIGrl flAt'
(name'
Phone
(address)
(11cs. no.)
(exnires)
(phone no. )
Primary
Structural
...."
VI..... "
C',-IVJ
.J ;;...-
El~ctrlc<ll
!'echanica 1
CONTRACTORS
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(lcctrical
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General
Plufllbino
/lechanical
PLUrmlllG
ELECTRICAL
MECHANICAL
~l
r::H nUlR(i[ rJfL
Ul........IOH'IRr,r
Each single fixture
Residence of
SQ. FT,
furnace/burner to
aTU' ,
Relocated bui lding
(new fix. addition~l)
INew circu!ts alts,
or extenslons
!SERVICES
Storm Sel./er
Of
amps.1
I Floor furnace
and vent
I Recessed wa 11
~n~cp hp~tpr ~nrl vpnt
I
I Apol iance vent
<;.po.al.atp
Stat ionarv evao.
cooler ~ '
Vent fan \'lith
sinole duct
I Vent syste~ apart
heatino or A.C.
I i'lechanica I exhaust
hond iI nd tlllC t
_I \'load stove/heater
I
from
S.F. P.esidence
(1 hath)
Duplex (l bath) each
Additional bath
~!a ter serv i ce
Temporary Constructi~
IChan~e in existing
rp} i d~n('P.
Imultifamily, conrn. or
fnnll<;.triill
Sewer
_I
COf1f1. /IND. FEEDERS 1
lnstall/alt.e,'/relocate I'
_ .futd.b.Je.~.de.r~
OF
amps.1
Y'l
I
I.,
10'
ISSUANCF OF PFmllT
TOTAL CHARGFS TOTAL CHARGES TOTAL CHARGES
HI/Ef!.E STATE l'11 REQUIR(S that the Electrical h'ork be done by an Electrical Contractor, the electrical portion of this perr.lit
shall not be vali"J until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFUllY EXNlItleO U1C completed apfllicallonJor rJerrnit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all ,.,ork oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Ore,:!on pertainin9 to the work described herein, and that flO OCCUPAIlCY ,.,ill be made
of any structure without the nermission of the l3uildina Division, I further certify that my reflistration ~lith the Ouilder's
Ooard is ;n full force and effect as required by Or,S 701,055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees \.,ho are in comnliance with or~s 7nl.055 \'Iil1 be lJsed on this nro,jcct.
W\:.\({please print)
,-la nirp fJ.. fdlol1a"mS Slr.lrhTURE ~vwr.L n ,9r)lt~
FO~ OfflC, lISE 0!lJ YI
om Ol- 17 - 'ifI,
Zone
Fire 70ne
rlood Plain
Tyne/Const.
O~drooms
Stories
Units
Occy Load
Occy Group
s~. H!1. r'ain
SQ, Ftg. Access
S~. Ftg. Other
x
x
Value
Value
Value
x
TOTAL VALUATION'
BUILDlrrG PERf.lIT
Cl1ar'lPS an:::
Surcharqes
Plan Ck. Comm/lnd
65!/Bldo Ppr Fp~
Plan Ck. Res
JO%/Bldo Per Fee
Fence
Syster.Js Development
CharQe (1.5"-)
PLUr-mIrlG PERMIT
C~i1 rges and
Surcharqes
Dr,:mo
CLCCTRfUL r(nr"T
Char9cs and
Surcharges
Sidewalk
r1ECHMrlCAL PERf1rT
Charges and
Surcharges \J>
Me PavirrQ
.)5 (YO Curb Cut
---- --~7~1
Tota) (omb. Permit
I TOT/\l
(5,75
,
..
..
COMBINATION APPLICATION/PERMIT (CAP}
l.
Applicant to furnish
A. Job Address
B. legal Description
1. examF'e~ Tax lot 100. lane County Map Reference
1/ UJ 43
2. example. lot 1. Block 3. 2nd Addition to
Springtield (states
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air Qas
. 2. e~amDle- waterheater/electrlcal{o~ solar
E. Square tootage or valuation. etc. -
1. examoJe+ ]250 sq. foot house, 500 sq. foot garage
2. example. ~ew project, check-new - if addition,
check: add. etc.
F. Building permit information-:
). examDle - construct sinyle family house with an
attached garage
2. examole - remodel existing garage into family room
3. eXdmole. 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 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.
Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except ,...here 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
Z. If the itemes) 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 AlID
CHARGES ON THE SCHEUULES
O. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor 15 not authorized
to sign the electrical label. -
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.
Fees and Charges
Plan check fees are due and payable at the time of the
appl1cation~ and no plans Nill be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
.,.
11.
III.
IV.
V.
FOR OFFICE USE ONLY
.
II
II
:
I
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
PERMIT VALIDATION
I~Z~~
d-~!1)-<69
.
Permit Clerk
LC-----
J
"
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signa ture
.
date
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