HomeMy WebLinkAboutPermit Mechanical 1986-1-23
\ I INSPECTION LINE
I 726.3769 .
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Job Address
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Description /17 03 5 b, '1 c:? 07f/'JfJ!
CITY Uf SPRINGFIE,O
COMBIIIATIDN APPLICATIONfPERMIT
E!IERGY SOURCES:
Heat
Nater Heater
Ranqe
lNFORr1ATION 1Il'it.
726-3753
Sq. Ftg. I"ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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cxv
6""
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Legal
Owner
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ValUE of Hark:
Addrcsy''''l !/J ,&)
Phone J,;;z;;;
SCJI&9'
Buil~inQ Permit Info: Oescribe Work(i.e.,
Family Residence I-lith Attached Garaoe)
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Build Single
Construction lender
Address
UI:.~:dGr~ HAl.'
{name}
Phone
(address)
(1 ics. no.)
(exo; res)
(ohone no. J
Primary
Structural
Electrical
Hechan;cal
CONTRACTORS
(name)
(addrpss)
(l ics. no.)
(pxnirpc; )
(ohane no.)
Genera 1
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1{:,,,c;.,1'! /"l1U,/1 ~ ? r
.; I/N"'i... ,4?G"c:.1$' ,- ;?tj
Plumbina
Electrical
;?k~ IA7I!;J4:I
P,U/IBING ;
ELECTRICAL
MECHANICAL
"'lechanical
NO, ' FEF
Each single fixture
CHARGE Nn
SQ. FT.
HI=' fHARr.i= NO. I
I furnace/burner to
BlU's
Floor furnace
and vent
",
fHARr.i=
Residence of
Relocated building
(new fix. additional)
S. F. Res i dence
11 bath)
Duplex (1 bath) each
New circuits alts.
or extensions
SERVICES
Recessed wall 1
So~~P hPntpr nod vpnt
Storm Sewer
Of
amps.
Appliance vent
seDa ra tp
Stationary evap.
cooler
Vent fan wi th
s;nole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and rluct.
Additional bath
Sewer
Temporary Construction
Change in existing
resJ d~nce
multifamily, camm. or
tnrlustrii'll
~Ia ter servi ce
CDMM.fIND. FEEDERS
I Install/alter/relocate
,dic;trih. fpprlprc;:
Wood stove/heater
IOf
I
amps.
~ '-1
(J .dh~I/..c; t?D
I d~ I fan
ISSUANCf OF PFR'HT
TOTAL CHARGES J TOTAL CHARGES , TOTAL CHARGES /5, hD
WHERE STATE L\H REQUIRES that tile Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be val;~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 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 rw OCCUPArlCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
1lAf.1E(please print)
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SIGII^TURE 'j) /1.-.-
FOP. OFF I CE USE OiIL Y
Sq. Ftg. riain
Sq. FtQ. Access
Sq, Ftg, Other
"'& c.l'u ,..
DATE /4 ,/~
; .
Zone
Fire Zone
Flood Plain
Tyoe/Const,
Bed rooms
Stories
Units
Occy load
Occy Group
x
Value
Value
Value
x
x
TOTAL V ALUA TI ON
BUILDING PERl'lIT
Charges an~
Surcharges
I Plan Ck. Corrm/Ind
65%/Bldo Ppr ~pp
------------""""P"fan Ck. Res
30%/Blda Per Fee
Fence
I Sys tems Deve 1 opment I
Charqe (1.5~)
PLU!~BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERI~IT
Charges and
Surcharges
.S1dewalk
MECHANICAL PERMIT
Charges and
Surcharges
AIC Paving
_____tS-".~_ Curb Cut
.(P(),
Total Comb. Permit
TOTAL
I Is toD
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examFle~ Tax Lot 100. Lane County Map Reference
17 03 43
2. examole- Lot 1. BlocK 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examr.le- heat/electric~l ceilin9/or forced air Q3S
2. examole- waterheater/electrlcaj/or.solar
E. Square footage or valuation, etc. -
1, example. 1250 sq, foot house, 50D sq. foot garage
2. examp'le- 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. example - remodel existing garage into family room
3. examoJe - 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.
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 Dlvision
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. BUILOING 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 hls electrical
supervi sor. The genera 1 contractor is .not authori zed
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 lssued 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.
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V. FOR OFFICE USE ONLY
I
Permit Cl erk
or;
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date