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HomeMy WebLinkAboutPermit Mechanical 1984-12-14 ---'" /'7'-(0 .~ "/9-. CITY UF SPRINGFIElD COMBINATION APPlICATION/PERMIT 'I EilERr,y SOURCES: Heat Hater Heater Range INFORt1ATlON L1l'it. 726-3753 Sq. Ftg. 1,Iain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use tilt H4t()~ ' Other-- Builriinq Permit Info: Descrlbe Work(i~e., Build Single T~~I;;A H~.\;;Raraoe' - ~f, Legal Description I I bJ ~ I INSPECTION lINE v~O Q- -, ., 726-3769 cr-/ (/7 0<- "'" Job Address ~, Owner.T~JI-~J , Address / q q () .-do . /9 Ph;fu.7/0.~..3 vi/) LeA fL..L- 9'7 "177 co~~~o;;-~;nd;r Address DESIGN ItAI1 (name) Phone (address) (1 ics. no.' (exoires) {ohone no. I Primary Structural Electrical Mechanical CONTRACTORS Genera~ I C/ Plumbino ~ (address 1. (lic" , nn.) (pxnirpc;) (phnnf> nn.) (dr~ ~ ch<-d. ~ ~_ J . ~ d. ~ ,aPA/7h,:ja . . ()U /! f.nu._.:;/ (name) I Electrical ~1echan;cal PlUI1BING ELECTRICAL MECHANICAL NO. FFF 'r.HARt;F Nn ~H. n-1~Rr,~ NO 1="1="1=" nl~IU~1=" SQ. FT. furnace/burner to BTU' 5 Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (J bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall SnnCP hPntpr nnrl vpnt Storm Sewer Of amps. Appliance vent seoarate Stationarv evao. cooler ~ . Vent fan wi th sinole duct Vent system apart from heatino or A.L Mechanical exhaust hood and duct Wood stove/heater ~Iater service Temporary Construction Change in existing rp$ i r1~nce multifamily. COl11T1. or lndllc;.trinl Sewer COffi~./IND. FEEDERS Install/alter/relocate r1ic:.trih fppfiprc:. Of amps. '-I o-z 0 I~-: _&0 ISSUANCE OF PFRllIT /S'.6; 0 TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be valid until the . TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical . TOTAL (HARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXM11NED 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 performed 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 OCCUPArKY 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 ORS 701.055 will be used on this project. Zone Fi re Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy Load Occy Group SIGNATURE FO~ OFFICE USE OIIL Y Sq. Ftg. f1ain Sq. Ft9. Access Sq, Ftg, Other AT x;?;.-" L DftTr/,;J- /..;--t' NAr"E(Pleas;pr;nt)a~'/{TV Ree..d ~ x x x Value Value Value TOTAL VALUATION BUILDING PERllIT Charges and Surcharges I Pl an Ck. CorrrnlInd 65%/Bldo Per Fpe ------------ Plan Ck. Res 30%/B1do Per Fee I Systems_ Development I Charqe (1.5%) PLU'~BJNG PERMIT Charges and Surcharges Fence ELECTRICAL PERI1IT Charges and Surcharges D~mo .S1dewal k A/C Pavi ng Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges ~_I&,-(i)p)__ Curb Cut (rf) TOTAL ~~60 I __ __ f40.~ III COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. ~xample- Tax Lot 100, Lane County Map Reference ]/ 03 43 2. examele- Lot 1. Block 3. 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical cellinq/or forced air gas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. ~ 1. exam~le- 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 attached garage 2. example - remodel existing garage into family room 3. example - 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 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. BUILDING 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 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 signature. IV. Fees and Charges Plan check fees are due and payable at the time of the ~pplication. 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 -:I'~ //lot I , 'Y J}1 f)y ) V L (? Permit Clerk ,L~ /r ~. j] Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date I