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)
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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
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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~
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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
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.
.
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:
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PERMIT VAll DATION
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Permit Cl erk
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Permit applicant exempt from ,registration with the Builder's Board becau5e:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
. ,
date
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