HomeMy WebLinkAboutPermit Mechanical 1982-3-5
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INSPECTION LINE
726-3769
CITY OF SPRINGFIEW
COMBINATION APPLICATION I PERMIT
INFORMATION LINE
726-3753
Job Address 1290 Centenni a 1
ENERGY SOURCES:
Heat
Water Heater
Range
Volue of Work:
Sq. Ftg. Main
Sq. Ftg. Access.
Sq. Ftg. Other
_New_Add_Alter_Rep.
__Fence_Demo_Changel Use
J<..Other
00
N
o
o
W
-....J
Legal Descriptian
Owner
Mi 11 er. Susana
Address
Phone
Building Permit Info: Describe Work (i.e., Build Single
Fom;n;:X"02)~
Construction Lender
Address
Phone
DESIGN TEAM
(oddress)
(expires)
(lies. no.)
(nome)
Primary Wi 1 "nn- '\Yrrl nt- r" mrlprc:nn- ~p; ripV'
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(expires)
(Iics. nc.)
General
Plumbing
Electrical
Mechanical Comfort Flow Htg.
855 W 2nd st, Eugene, OR 460
6-30-82
PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE
CHARGE NO.
FEE CHARGE NO.
Residence of
furnaceLburner to
2 lo.~o.OO_BTU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart fram
heati"g ar A.C.
I Mechanical exhaust
hood and duct
I Wood stovel heater
1 Heat Pump
I Air handler to
10,000 CFM
I Air handler aver
10,000 CFM
I COmDreSSOr -
I
I
Each single fixture
Relacated building
(new fix. additional)
S.F. Residence
(1 bath)
". ft.
New circuits, alterations
or extensions
SERVICES
Duplex (1 bath) each
2
Temporary Construction
Additional bath
Amps.
Water service
Sewer
Storm Sewer
FEEDERS
Amps.
ISSUANCE OF PERMIT
TOT AL CHARGES
TOT AL CHARGES
TOT AL CHARGES
(phone na.)
(phone no,)
342-8101
FEE
CHARGE
6.00 12.00
I
3.00
6.00
4.50
10_00
32.50
WHERE STATE LAW REQUIRES that the Electrical work be done by the Elp.ctrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 informatian hereon is true and carrect, and I further
certify that any and all work performed shall be done in accordance with the Ordinances af the City of Springfield and the Laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure withaut the permissian af the Building ,Division. I further
certify that my registration with the Builder's Baard is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is nated
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used an this project.
Basis far Builder's Board exemption:
NAME (please print) fJ ;r 1/ I ') N ~ / / Hil r u/ /, (' r)
SIGNATURE a~%?a~J
FOR OFFICE us( ONLY
Zone R=.P
Fire Zone
Flood Plain
V_=N
1
Typel Const.
Bedraoms
<:'tories
Units
('lecy Laad
Occy Graup-B?
Sq. Ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
'(
x
Value
Value
. Value
?
'(
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%1 Bldg Per Fee
Plan Ck. Res
30%1 Bldg Per Fee
Systems Development
Charae (1.5%)
PLUMBING PERMIT
Charges and
Surcharges
Fence
I Total Comb. Permit
Demo
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
AI C Pavina
MECHANICAL PERMIT
Charges and
Surcharges
_ _ _ _ _ .3..2...511
1 , ":In
Curb Cut
TOTAL
DATE -z -r;- - e '2-
$33.80
.,.~ .
, .
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III. Applicant to sign and date ,
Whenever possible, the initial application will be used as <-
worksheet only. Where possible, Building Division Staff "'+-
prepare a typewritten 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.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference
2. example-Lot 1. Block 3, 2nd Addition to Springfield
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/ electrj~al ,c~li?g/ or:,torced-~\r ~,aJ
2. example-water h1eo.ter,.1etectncal/91'1'SOIO'r. \ \ '\
E. Square footage or va~tion, etc. .
1. example-1250 sq. foot house, 500 sq. foot garage
2. example-if new project, check new-if addition, chec
add, etc.
F. Building permit information:
1. example-construct single family house with an atta.
garage
2. example-remodel existing garage into family 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 Divisi.
Staff must be able to contact appropriate persons regc
design information or job site corrections, etc.
II:: 'Abbreviated Plumbing, Mechanical & EleCtrical Schedules
A. Except where blank spaces occur in the description pOI
of the Mechanical and Electrical Schedules, the applicc
need fill-in only the No. Boxes adjacent to the appropl
item(s) to be installed
'.r B.' Eull Plumbing, MechariiCal, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedule!
have been abbreviated
2. If the item(s) to be installed are not covered on the
",' _~.. ated schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI'
CHARGES ON THE SCHEDULES
IV.
V. FOR OFFICE USE ONLY
l'ROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
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PLANS REVIEWED BY:
Dan Smith
signatur'"
name
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CITY
(.
DCDMIT'-VAllnATlnN
OF SPRINGFIELD
(~~
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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Rec'd .'om ~i lOQ) q
Address ~ SS l ~ I~ fj D.
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Received For:
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SHELTON-TURNBULL PRINTERS' EUGENE. OR 97"01
BY
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Permit Clerk
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--late
3-3-82