HomeMy WebLinkAboutPermit Mechanical 1987-12-8
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11'NSPECTlON tINE
726- 37 69
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Job Address ~2C ~/e-/y,Iy/A~ ;;c. 'vD.
Legal Description 17"(J3~~-3'0~zc>c>
IfAML/Ar /-/J/PDL tF X~L
Owner ~PR/h~rr~P nB<./c;' )c~t:: 5
Address ::)=:z S-/'77 //J -5"r 7J.~~e?? 7-,-~
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Construction Lender
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EHERGY SOURCES:
Heat
\~ater Heater
Range
ValuE of I'lark:
INFORf1ATION LINt: I
726-3753
Sq. Ftg. r.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ne\~ Add Alter Rep.
--Fence Demo Change/Use
--Other-- --
%
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Buildinq Permit 'Info: Descr' be Wark(i.e., Build Single
Family nesidence With Attached Garaqe)
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4~J/.E / A:/~~ 7~"'/ 21.8"
Address
DESIGN TEAr'1
(name)
Phone
(address)
(lies. no.)
(exDires)
(Dhone no.)
Primary
Electrical
Mechanica17.1So!?/?'A'<~h;1~/~ 2~3 '5$ /5"?!:z~r
CONTRACTORS (name) / (address) (lics. no.)
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Structural
(exoires)
n~-9/"9""
(Dhone no.)
General
P1umbinq
C (181 If)
Electrical
~'echanic'a1 ?.M/?"# ~...r~ r~r~.c, Z~g' -5!f!. /:>$.5"7:
7:?~- 9/9'/
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PLur,1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO,
Each single fixture
Residence of
FFF rHARhF~ NO.
FFF rHARhF
SQ. FT ~
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts4
or extensions
Fl oor furnace
and vent
...~
.'~j~ ~
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Sqace heat~r and v~nt
'.~~.
'j,'
~
.1,':;)',
'~
f!J
Sewer
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
10f amps. '
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
10f amp~
a~7: ~/'-{,/'7'?/r d&
.~/;>.?~~~ h~ ,~?r
. ~5j/?,,~ ,2)/$ j,~ ,
/
Appliance vent
seDarate
Stationary evao.
cooler. ,
Vent, fan with
sino1e duct
Vent system, apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
'/.
Additional bath
~Iater servi ce
Storm Sewer
I SSUANCE OF PFRtlIT
TOTAL CHARGES 'TOTAL CHARGES
. '
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be va1i1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
M/H.
/_5:~
I HAVE CAREFULLY EXNlINED the completed app1 i cation; for permit, ar)d do hereby certify that all informati on 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 oertaining to the work described herein, and that NO OCCUPANCY 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 exemp ~he basis m tion is noted hereon, and that
only subcontractors and employees 0 are in compliance with ORS 7n.l.055 w 1 be used ' t
rW1E(please print)
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"LDATr/'Z -IB-BI
Zone
Fire Zone
Flood Plain
Type/Const;
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq., Ftg. t1ain
Sq. Ftg. Access
Sq. Ftg. Other
!(\)
Plan Ck. Comm!Ind c., '2 .,:::-
65%/Bl do Per Fee C.J_ 7........
Plan Ck. Res
30%/B1dq Per Fee
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcharges
Systems Development
Cha rge (1. 5%)
f
PLuP4BING PERMIT
Charges and
Surcha rges
Fence
ELECTRICfl.L PERrHT
Charges and
Surcharges
I tc1EhtHANICAL PERMIT
arges and
Surcharges lp
Dt;mo
_ ___ __ ___ __-' Sidewalk
I A/C Pavi ng
~ _ _ Lfi: _e:.~_ _I Curb Cut
~7~ ,
IT~tal Comb. Permit
1
I TOTAL
1S:7~
1/. S"CJ
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Gtr'........
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
17 03 43
2. example- lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 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 f~mily 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
fu 11 schedu 1 es
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
signa ture.
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
ItJ0r(~
12- f--81
U
Permit Clerk
PROJECT (ONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder',s Board because:
Additional Project Information:
PLANS REVIEWED BY: ~
nameY__nN&:" .>>~~Signature~__ .~ date /-Z-&" 27