HomeMy WebLinkAboutPermit Mechanical 1983-10-17
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II:1SPECTIOr/ LlIIE
726-3769
CITY Of S?RlijGFIEliJ
COIIBI;IATlON APPLlCATIOr//PERMIT
ElIERGY SOURCES:
Heat
!'/ater Heater
Ranqe
Job Address
jyoq
s.
Sf.
'A'
Legal Description
Owner
1!in<",e'o H:J(,fnu.Yturt
ilJ ~t-
l)L
ValuE: of I-lark:
r::.L
;q()q ~
~DIJ ()
Construction ~~
lIIfORllATlON U:'t
726-3753
Sq. Ftg. Hal"
~q. Ftg. Access.
Sq. Ftg. Other
r~e\<i Add Alter Rep.
--Fence Demo Change/Use
Other- -
I'
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8J
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I,J,'
VJ7lnr,
BU1!c;ina Permit Info: Oeser be ~Jorl<li,.e" Build Single
Familv l1es;dence lHth .A.ttached Garaqe)
(u;\ l t-,w\lhrn,\'UiQ
\ \ ni +- U
ITempOrary Construction
IChange in existing
fl?s.i ~e-nre '
Imultifamily, camm. or
lnrlustrial
IOf amps.l
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
rli,tr;n. fppdpr,
10f amps.1
I
I
I ISSUANCE OF PFRrllT
I TOTAL CHARGES I TOTAL CHARGES 10.00
that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this pe~it
label has been signed by an Electrical Supervisor and returned to the Building Division
Address
Phone
Address
DI:.:::dlir{ TEAl'
Phone
(address)
(lies. no.)
(name)
Primary
Structural
Electrical
Mechani ca 1
CONTRACTORS
(name)
(addn's" 1
11 in,. no.l
General
Plumbino
Electrical
"'echanical
PLUI1B 1IIG
ELECTRICAL
110.
FFF [HARGF Nn
~F~ rHARGF NO.
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
10uplex (1 bath) each
IAdditional bath
IHater service
I Sewer
INew circuits alts.
or extensions .
I SERVICES
I
Storm Sewer
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
{exoires}
(chone no.
(pxni rpc;,)
(ohanp nn.)
MECHANICAL
FH rHARGr:
furnace/burner to
'lIH niliL BTU' s
1000
Floor furnace
and vent
I
l
I
I
I
I
I
I
I
I
Recessed wall
Snarp hpatpr anrl vpnt
I App 1 i ance vent
c;,eoarate
I Stationary evap.
cooler
I' Vent fan with
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust '
hoorl and duct
j ~1ood stove/heater
I
I
I
I HAVE CAREFUllY EXA!1WED the completed aprlication for permit, and do hereby certify that all infonnation hereqn 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 Spri ng fi e ld and the la\-/s of the Sta te of Oregon perta i n i ng to the work descri bed herei n, and that UC 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 s required by ORS 701.055, that if. exempt the basis for exemption is noted hereon, and that
only subcontractors,and emplo e who are i~~~C~~ OP.S 7Q1.D55, will be used on this project.
1IA11E(please print) ,y _~5A~Aj_ SIG,IATURE.t DATE X /&// ~ f3
, ;7" ......-FO~ OfFICE USE o;lLY
Zone Type/canst- / Units Sq. Ftg. Hain x Value
Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILOlNG PERI-llT Plan Ck. COIlm/! nd
Charges an~ ------------ 65VR 1 do Ppr Fpp
Surcharges Plan Ck. Res
30%/Bl do Per Fee
PLU'~BING PERMIT I Fence
Cha rges and ------------
Surcharges Demo
ELECTRIUL PERr~IT Sidewalk
Cha rges and ------------
Surcharges AIC Paving
rlECHANICAL PERMIT __u_tQ.._QS;L I Curb Cut
Charges and
Surcharges C-JO I
Systems Development
Charoe (1.51) ,
Total Comb, rermit
I
I TOTAL
10.10 .I
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COMBINATION APPLICATION/PE~1IT (CAP)
a
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100. Lane County Map Reference
11 03 43
2. examole- lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage.or valuation. etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. checklnew - if addition,
cneck add. etc.
F. .Building permit information:
1. examole - construct Single family house with an
attached gar~ge
2. example - remodel existing garage into family rOom
3. examole - 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 TEM4 ANO 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.
11. 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. BUILDIlIG OIVISION STAFF WILL FILL OUT ALL FEES AND
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 genera1 contractor is.not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possibJe, the initial application will be used as
a worksheet only. Where possible, Bui1ding 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
-~.
~DY
Permit Clerk
It
UltS'l
/
(! 1-..-
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:.
PLANS REVIEWED BY:
name
signature
1
date
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