HomeMy WebLinkAboutPermit Mechanical 1986-7-22
,-'
o~~
-,A,
.
.~
I INSPECTION LINE
726-3769' '
CITY OF SPRINGFIELD
CmlBINATION APPLICATION/PERMIT
E[lERGY SOURCES:
Heat
, \~ater Heater
INFOR/1ATION UNI:.
726-3753
Sq. Ftq. r'lain
~q. F'tg. ACcess.
Sq. Ftq. Other
Ne\~ Add Alter rep.
--Fence Demo. Change/Use
--Other -- --
!bZO
Job Address
~
~
If)
Legal Descriptian
Range
ValuE af Hork:
W /1.11 OMUlA:t- _
Ih20~ ._~
Owner,
Address
Buildino Pernlit Info: Describe Work(i,e.,
FamilN Residence With Attached ~araae)
~bAlZdLd~ /;/'
1r(~/f1- rv~r
Build Single
Phone
Construction Lender
Address
DESIGN TEAr,
Phone
(address)
"
(ohone no. )
(name)
(lics. no.)
(exoires)
. Primary
Structural
Electrical
I
r1echanical
CONTRACTORS
(name)
(address)
(lics.no. )
lexoire5)
lohone no.)
General
Plumbino
"--.
Electrical \
rY1 Ii R~
IY1Q. 4
'-12 b '{ <;j .
c2C(cZ gf'gbL
~'echani ca 1
PLUflB I riG
ELECTRICAL
MECHANICAL
I FEE CHARGE NO.
, NO.
FFF rHAR~F NO,
FFF rHAR~F
Residence of
furnace/burner to
BTU's
Each single fixture
SQ. FT.
Relocated building
(new fix. 'additional)
New,circuits alts.
ar extensians
Floor fu rnace
and vent
IS.F. Residence
(l bath)
I Duplex (1 bath)
IAdditional bath
I ~Ia ter servi ce
I Sewer
I
/SERVICES
I
I
I
I
I
I
I
I
1
,
I
.','
I
Reces sed wa 11 II
Soace heater and vent
"
I
I
I
I
I
I
I
each
ITempOrary Canstructian
'Change in existing
residence
Imultifamily, comm. .or
Industrial
IOf amps.1
"ICOMM~/IND. FEEDERS ,
IInstall/alter/relacate I
distrih. feeders
IOf amp~1
I I
,
I I
TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L'\H REQUIRES that tile Electrical work be done by an
shall not be vali-j until the label has been signed by an Electrical
I App 1 i ance vent
seoarate ,.
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system'apart from I
heatino or A:C. '
'Mechanical exhaust
hood and ,duct .
I
I
1\'"
I
I
I
I
/.sJ 00
/t:O
Storm Sewer
I
I
.1
I
I
Wood-stove/heater
,klrAJ Q
Il-w tit 0,: "'f
I \ 410
I
I
I
I ISSUANCE OF PFRr1IT
I TOTAL CHARGES
Electrical Contractor, the electrical portion of
Supervisar and returned to the Building Division
/S&X)
th is permit
I HAVE CAREFULLY EXAr1INED the completed application for permit, and do hereby certify that all informa'tian hereon is true
and correct, and I further certify that any and all work oerfarmed shall be done in accordance with the O~dinances of the City
of Springfield and the Laws of the State of Oregan oertaining to the work described herein, and that NO OCCUPAr~CY will be made
af any structure without the permission of the Building Division. I further certify that'my reqistration ~ith the Builder's
Baard is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is no~ed hereon, and that
only subcontractors and emplayees who are in campliance with ORS 701.055 will be used on this project. I
SIGNATUR() .#12:":~:'}/..~:
FOr. OFFICE USE/.@fiLY /' J f/- I
,S'q( Ft9.}:1fu ,/ x ! Value
VSq. FtlJ. ~s x I Value
,
Sq. Ftg. Other x IValue
I
TOTAL VALUATION
I
I
Systems Developmentl
Charqe (1.5%) I
I
i
~.-(4LE
,.--,-.
J-e{'('U
I
DA.TE? ~~-J'~-
NAME(please print)
Zane
Fire Zane
Flood Plain
Tyoe/Const.
Bedroams
Units
Occy Load
Occy Group
Stari es
Plan Ck.
65%/Bldo
Plan Ck.
. 30%/Bl do
_ I' Fence
1------------, D~ma
BUILDING PER~lIT
Charges and
Surcharges
Comm/Ind
Per Fee
Res
Per Fee
PLUI1B ING PERMIT
Charges and
Surcharges,
I i
I.,
i
I I
I I I
I /Total Comb. Permit i I
I i TOTAL (5. c;/O
I
ELECTRICJ!.L PERr~IT Sidewalk
Charges and - --- -- --- -__
Surcharges A/C Paving
MECHANICAL PERMIT
Charges and
Surcharges
" L5 . CO I Curb Cut
----- --,-C:ol
r .
..
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
L examp 1 e- Tax Lat '100, Lane County Map Reference
17 03 43
2. example- Lat 1. Black 3, 2nd Additian to
Springfield Estates
C. Name, etc. af owner and canstruction lender
~. Energy Sources
1. example:-neat/electrical ceilinq/ar forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot hause, 500 sq. foat garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit infarmation:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into. family raom
3. example - convert single family residence into.
restaurant (change af use)
G. Value af 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 infarmation or job site,
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
'portion af the Mechanical and Electrical Schedules,
the applicant need fill-in anlythe 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. canserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to. be installed are nat covered on
the abbreviated schedules you should cansult the
full schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As nated on the CAP, the label must be delivered to the
electrical contractar for signature by his electrical
supervisor. The general cantractar is not authorized
to. sign the electrical label. -
III. Applicant to sign and date
Whenever passible, the initial application will be used as
a worksheet anly. 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 far 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.
,/
bp01QS
1/- 2- 2- -O/P
V_ FOR OFFICE USE ONLY
Permit Clerk Cc--
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'- ~
" P.ermit appl icaJ:!J 'exempt from registration with the Build'er' s Boar.d because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date