HomeMy WebLinkAboutPermit Mechanical 1983-11-7
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'I HISPECTIOII LlIIE
726-3769
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"CITY OF SPRINGfIELD
COtlBINATION APPLICATION/PERMIT
EnERGY SOURCES:
Heat
\,Iater Heater
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INFORIIATION LINE
726-3753
Sq. Ftg. '.la;n
~q. Hg. Access.
Sq. Ft9. Other
r~ew Add Alter Rep.
-Fence Demo Change/Use
Other- -
51
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LD
Y
Job Address
legal De$cription
FL 1!insr.o t8.:-/rW,Nl.rrt
/C;()q -S ilJ l <;1-
~nJj (1) nf~
Construction L~ -
Ranqe
ValUE of I'lark:
Owner
Address
Phone
Builc;inq Permit Info: Describe Work( Le.. Build Single
Family nes;dence IHth ,lI,ttached Garaqe)
Oii \ln~f\ili.f'n'\ 'UI~
41LJll
Address
UDlliN It:.N1
(name)
Phone
(address)
(lies. no.)
{exoires}
(phone no. ')
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lics. nn.)
(exniresl
(nhone no.)
Genera 1
Plumbino
Electrical
"lechanical
PLUllBltlG
ELECTRICAL
MECHANICAL
NO.1
-----lEach single fixture
IRelocated building
(new fix. additional)
IS.F. Residence
Cl bath)
IOuplex (1 bath) each
IAdditional bath
Water service
FFF
rHARr.F
'W
"-EL J:liARG.E. NO .
"-EL J:liARG.E.
SQ. FT.
furnace/burner to
\ \.10 llD.f:L BTU' s
10.00
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
Sewer
ISERVICES
I
ITempOrary Construction
IChange in existing
rp~ i d~n('_p .
Imultifamily, comm. or
Tnrluc;tri;:1l
Recessed wall
~nace heater ~nd v@nt
Storm Sewer
Of
COMM./INO. FEEOERS
amps.
Appliance vent
~eoarate
Stationary evap.
cooler
Vent fan with
sinale duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood and duct
I ~lood stove/heater
I
I
I
ISSUANCf OF PFRmT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES 10 .0 ()
WHERE STATE U\l~ REQUIRES that the Electrical work be done by an..Electrical Contractor, the electrical portion .of this penilit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I Install/alter/relocate
.rli~trih. feeders
IOf amps. I
I
I
I
I HAVE CAREFUllY EXAMINED the completed aprlication for permit, and do hereby certify that all information here9n 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 UO OCCUPAI~CY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and emp.lo e who are i~~~C~~ OP.S 701.055 will be used on this project.
IIAtIE(please Printli_ ~/?,A~~j_ .SIr,11ATUREi DATEl..id'// ;1j)
. ~ / / ..;--FOP. OFFICE USE 0I1LY I
Zone Tvpe/Const- / Units Sq. Ftg. tiain x Value
Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILOING PERt-lIT
Charges an~
Surcharges
Plan Ck.
65%/Rldo
------------ Plan Ck.
30%/Bldq
I Fence
I Demo
I Sidewalk
I AIC Paving
I Curb Cut
I
Corrrn/lnd
Ppr Fpe
Res
Per Fee
Systems Development
Charoe (1. 5%) ..
PLU'1BING PERMIT
Charges and
Surcharges
t1ECHAN I CAL PERMIT
Charges and
Surcharges
_ _ __ JQ. ._Q ~L
. YO
I
ITotal Comb. rermit
I
I TOTAL
10. '-10
ELECTRIU,L PERr~1T
Cha rges and
Surcharges
,
\' ')
.'.
.
.-#
.
COMBINATION APPLlCATION/PERl1IT (CAP)
PERMIT VALIDATION
I
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
1I 63 43
2. examole- lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examEle- heat/electrical ceilinQ/or forced air Q3S
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, check-new - if addition.
check add. etc.
F. .Building permit information:
1. example - 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. OESIGN TEN1 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.
II. Abbreviated Pl~mbin9. 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
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
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.
Ult5l
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V. FOR OFFICE USE ONLY
Pennit Clerk
(lL
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
.
Pennit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date