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Home My WebLink AboutPermit Mechanical 1984-2-1 t I INSPECTION LINE 726-3769 Job Address \\J>S<J 0.~r\\ol CITY OF SPRINGFIELD C0/1BINATION APPLICATION/PERMIT ENERGY SOURCES: Heat Hater Heater Range ValuE of \'Iork: Address Phone d:) ~ Builc;ino Permit Info: Descr,be Work(i.e., Build Single ...... \ Family Residence With Attached Garaoe) ~ lJ\~~ 1-'\.0 MllhOfJ- ~ INFORI1ATION UN!:. 726-3753 Sq. Ftg. r.1a in ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- Legal Description Owner' U}Cl.H.. UCLr=t Canstruction Lender Address DES I GN TEAt~ (name) Phone (address) (Tics. no.) (expires) (phane no.) Primary Structural Electrical r1echani ca 1 CONTRACTORS, (name) (address) nics. no.) (exoir~~) (ohj)n,= nn i Genera 1 " Plumbino NO. FEE CHARGE NO. FFF I rHARGF NO. FFF rHARGF Each single fixture Residence of SQ. FT. furnace/burner to 5D,DCQ BTlI' s lD.OO 12((1 Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent I SERVICES I . ~Jater servi ce I Temporary Construction I Change in existing I residence Imultifamily, comm. or I Industrial 10f amps.1 I I I Recessed wall Soace heater and I I Appl iance vent seoarate I Stationary evap. cooler I Vent fan with sinale duct I Vent system apart from I heating or A.C. I Mechanical exhaust hood and duct I ~Jood stove/heater I I I vpnt I I I I I I I I I .1 , COMM./IND. FEEDERS I HAVE CAREFULLY EXAtlINED the compl eted apfll i cati on for permit, and do hereby certify that a 11 infarmati 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 pertaining 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 exempt the basis for exemption is noted hereon, and that ,only subcontractors and employees \.ho are in compliance with ORS 701.055 ~Iill be used on this project. IrW1E(please print)~ Sf/en':/ Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms ' Stori es -.S' ltJ; Ide DlmJ. 2'-/~fcJ Units Sq. Ftg. f1ain x Value Occy Load Sq. Ftg. Access x Value Occy Group Sq: Ftg. Other x Va lue TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. 65%/Bldo Plan Ck. 30%/Bldq ____________1 Fence I D~Rlo I,Sidewal k ------------, A/C Paving __,-__lZ,-oQ-' Curb Cut tJg I . _ _ ....JL, "._ "L 'h Comm/Ind Per Fee Res Per Fee 'Systems Development I Charqe t1.5%) , ',', I , I I I Comb. Permit PLUr1BING PERMIT Charges and Surcharges , ELECTRICAL PERrHT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges ,ITotal I I TOTAL c J/t_.q~ '- ....... COMBINATION APPLICATION/PERMIT (CAP) 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. "I. example- 1~50 sq. foot hause, 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 a ttached garage 2. example - remodel existing garage into family room 3. example - convert single family residence into restaurant (chan~e of use) - ,G. Value of work as defined in Section 303 (a) of the Structura 1 Speci a lty 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 s,ite corrections, etc. II. Abbreviated Plumbing, "Mechanical, & Electrical Schedules A. Except where blank spaces accur in the description portion of the Mechanical and El~ctrical 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 an 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 schedules ' 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 supervisar. The general contractar is not authorized to sign the electrical label. - Applicant to sign and date , Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Divis",ion Staff will prepa rea type written copy and return it' to the applicant at the time the actual permit is issued for, his signature. 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. ,. HI. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: t,,-" PERMIT VALIDATION 0,;.) '1 S- L ~-I-- y~ . ~ 'Ii ~ ~ ; oi" I 1i ~ j ~ ~ J ~ n\, / / rJ/~ i '1 ~ ~ ~ ~ ~ j Ii ';I f . \ \. \ \ ~ I 11 4 ~ ~ J ,~ , . .. " . ~ Permit Clerk W~ j . '! i . Permit appli cant exempt from registrati on with the Buil der I s Board because: Additional Project Information: PLANS REVIEWED BY: name signature date, . . , . .~ i~ !~ 1 I 1 1 ~ ~ ~ ~ . , I ~ ~ ~