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HomeMy WebLinkAboutPermit Mechanical 1984-11-29 I rr:SPECTIOIl L1IIE 726-3769 CITY Uf SPRINGFIELD COMBIIIATION APPLICATION/PERMIT . \ _ ' 'LJ " EilERGY SOURCES: ~ /7 Heat Legal Description \1 f) 3 ~ 5L\-~ O'tf1()l yater Heater I Ranqe I I I r~ Value of Hark: Owne"-L wW /~. Address! A..I..a.. t' Phone ~~.,.. BU11GlnQ Penllit Info: Descrlbe ~Iorkti~e., ,,,~ 4-sc" Familv fl.esidence lHth ft.ttached Garaae\ .s~":o.#1~ 1;., iff j#..-9' "7</ i 7 ~~ Construction LJJfler ~... ,_..I) - . INFORlIATION LINt 726-3753 Sq. Ftg. t.lain ~q. Ftg. Access. Sq. Ftg. Other r~ew Add Alter Rep. --Fence Demo Change/Use Other - - JOb Address I] .?I ;1.. Build Single n ~ ~ ~ CJ ::::r OQ ~ Address DESiGN TEAi1 (name) Phone (address) flies. no.) (exo;res) (ohone no. J j Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lics. no.' (exo; res 1 (ohnne no. ) Genera 1 Plumbina Electrical ~eChani~al~ "A/!e4~/q:/tJJ'" vJ.-'o~ . ~I PLUI1BIIIG ELECTRICAL MECHANICAL NO. FEE CHARGF t.JO ~~~ rHARr,~ NO ~H. n.jAQr,~ SQ. FT. furna~b~er to 74 IJ BTU's Floor furnace and vent Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each New circuits alts. or extensions SERVICES Recessed wall Soac~ h~i'lter i'lnd vent Sewer Temporary Construction Change in existing res i q~n('e . multifamily, comm. or IndlJ~trii'll Of amps.1 ICOMM./IND. FEEDERS I Install/alter/relocate d;c;;trib. fpederc; 10f amp~1 I I I App 1 i ance vent seO<lri'ltp Stationary evap. cooler Vent fan with sinole duct Vent sys tern apa rt from I heatinq or A.C. I Mechanical exhaust hood nnd duct l Wood stove/heater I I I Additional bath ~Iater service Storm Sewer TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\~ REQUIRES that the Electrical work be done by an' Electrical shall not be valiJ until the label has been signed by an Electrical Surervisor ISSUANCf OF PFRr1lT TOTAL CHARGES Contractor, the electrical portion of and returned tO'the Building Division /d.tJV ' this permit I HAVE CAREFUllY EXAMINED 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 OCCUPAftCY will be made of any structure without the permission of the Building Division. I further certify th my registration with the Builder1s Board is in full force and effect as required by ORS 701.055. that if exempt th . or ~emption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 . ~_~n /~ ~E II' ,1_~ ,1~ ~ NAHE(p1ease printt1f'. J fi C/C g /~SIGI1ATURE. v...... ~ .L-. .....,.".'" _ t.ZZ~ I' FO~ OFFICE USVOUltt' /j I / / c ?a. Ftg {/ / x Value I Sq. x Value Sq. Other x Value Zone Fire Zone Type/Canst. Bedrooms Stories Units Occy load Occy Group Flood Plain TOTAL VALUATION BUILDING PERI.IIT Charges anc Surcharges PI an Ck. 65%/Blda ------------ Plan Ck. 30%/B1 do I Fence I D~mo I S1dewa lk I A/C Paving /0 ~ ()7) I Curb Cut --------:</01 ConrnlI nd Ppr Fpp Res Per Fee Systems Development Charoe (1.5%) PLU'~BING PERMIT Charges and Surcharges ELECTRICP.L PERI~IT Cha rges and Surcharges Total Comb. Permit tlECHANICAL PERMIT Charges and Surcharges TOTAL /0. yo _. , . . COMBlNATlON APPLlCATlON/PE~~lT (CAP) II I. Appl icant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100. lane County Map Reference 17 03 43 Z. examole- Lot 1. Block 3. 2nd Addition to Springfield 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. example- Tflnew project. check-new - if addition. check add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examole - 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 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 carrections~ 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 fu 11 schedu 1 es C. BUILDING DIVISlON STAFF WILL FILL OUT ALL FEES ANO 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 general contractor is.not authorized to sign the electrical label. --- Ill. Applicant to sign and date Whenever possible, the initial application will b~ 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: e PERMIT VAll DATION ((J. Y ~.tf ~ '" !;J},/Jt! e~ \1 ; ~ Permit Cl erk oJ , Permit applicant exempt from ,registration with the Builder's Board becau5e: Additional Project Information: PLANS REVIEWED BY: name signature . , date / l i \ i { { , I ~ '1 , , ! " . 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