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Home My WebLink AboutPermit Mechanical 1985-10-24 INFORllATlON UNE 726-3753 Sq Ftq Ilaln ~q t'tg Access Sq Ftg Other New Add Alter oep --Fence Demo Change/Use Other -- -- BUllGlna Permlt Info Descrlbe Work(, e . BUlld Slngle Fal1l1v nesldence Ihth Attached Garaoe) r2IJ ).od' ~ 01/t/J ~ .A /l~ /J1 'L ~..) / I HAVE CAREFULLY EXNlINEO t'1e completed apollcatlon for lJermlt. and do hereby cert,fy that all lnformatlOn hereon 1S true and correct. and I further certlfy that any and all work oerformed shall be done 1n accordance wlth the Ord,nances of the C1ty of Spnngfleld and the Laws of the State of Oregon oertawlng to the work descnbed here,", and that r10 OCCUPArtCY wlll be made of any structure wlthout the permlsslon of the BU11dlng D,vls1on I further cert,fy that my reqlstratlon wlth the BUllder's Board lS 1n full force and effect as requlred by ons 701 055, that lf exempt the basls or e ptlon ls_n~hereon, and that only subcontractors and e~ployees who are In compllance wlth OPS tnl 055 wlll be U 0 ~ro ~ /~ ~t!:.~ ~,,(8'6~rc::; b' ~/r";!?/6,utl4- '- ~?:~ ,r - ilAl1E(please pnnt) SlrNATU ______ DATE FO" OFFICE USE O,IL Y So Ftg Sq Ftg Access Sq Ftg Other --,/,~ ) IrISPECT IOil L WE 726-3769 CITY OF SPRINGFIELD COMBlilATION APPlICATION/PERMlT E'IERCY SOORCES Heat l~ater Heater Job Address /Il't {J. UJ.M~~ legal De~crlptlon Owner /ll/r/YL<A ~~ sct () CZ,l!.hlA--,,;:/' it )tJ~ Phone 1Z/:' ;f b,;2.9'cJ o Ranqe Valu€ of \lark Address Constructlon lender Address DES I GN TEAll Phone (address) (name) lllCS no l (eXOl res) Pnmary Structural Electncal Mechanl ca 1 CONTRACTORS (name 1 (address) f1 lrs no) (l'l){lJlres) Genera 1 Plumblna Electrlcal ~lechan1 ca 1 }):~::: ~~o MECHANICAL h, ?, =) I() '3 - / () - fro ELECTRICAL NO I -I Each I Relocated bUlldlng (new flX addltlonal) Is F Pesldence Il hathl IDuPlex (1 bath) each IAdd1tlonal bath FEE JlO..-I I Res 1 dence of SQ FT INew ClrCUlts alts or extenslons !SERVICES I CHARGF t ffL'...cl:lAB.G..E Nn slngle flxture furnace/burner to BTU's Floor furnace and vent Recessed wall C:;n~,.f' h",;:>..".. .......,f I'..n" l;:oW~~~ Apol lance -venf ~ seoarate Statlonary evap cooler Vent fan wlth slnole duct Vent syste~ apart from I hpilt.lno or ~ r Mechanlcal exhaust hood and dllrt Temporary Constructlon Change 1n eXlstlng rf'o;.ldf'nrp Imultlfamlly, COmM or Tnrluo;tnal ~Iater serVlce I I I IOf amps I I I COMll IIND FEEDERS I I Install/alter/relocate I r1l<:;t.rlh fp"r1pr<:; I Of amp~ I I I I I I I I TOTAL CHARGES J TOTAL CHARGES I TOTAL CHARGES WHERE STATE L \H REQUIRES that the Electncal work be done by an Electncal Contractor, the electncal portlon of shall not be vallj untll the label has been s1gned by an Electrlcal $upervlsor and returned to the BUlldlng Dlvls10n Sewer Storm Sewer \lood stove/heater ~7o ISSUANCE OF PFR'HT Zone Fl re Zone x Value Value Value Tyoe/Const Bedrooms Stones Unl ts Occy Load OCCy Group x Flood Plaln x TOTAL VALUATION BUILOING PERIIIT Plan Ck CommlI nd Charges and ------------ 65%/Bldo Per Ff'e Surcharges Plan Ck Res 30%/Bldo Per Fee PLU'1BING PERMIT Fence Charges and ------------ Surcha rges Demo ELECTRIC~L PERI'IT Sidewalk Charges and ------------ Surcharges AIC PavIng MECHANICAL PERMIT /0 0'0 Curb Cut Charges and --------~o-I Surcharges Isystems Development Charoe (J 5r) Total Comb rermlt i TOTAL rI\) Vi ---., (ohone no IS: ~ I I ) {ohonf' no , 1.H.L'J:IJAIllif. I I I 10 ('f) ,- I 1/3 I I In </D thlS perr.nt I ttJ, L( 0 r COMBINATION APPLICATION/PERMIT (CAP) Appl1cant to furnlsh A Job Adaress B legal OeSCflptlon 1 example- Tax lot lOa, Lane County Map Reference 17 03 43 2 examole- lot 1 BlocK 3. 2nd Addltlon to ~pr'ngtleJd Estates C Name. etc of owner and constructlon lender o Energy Sources 1 example- heat/electrlcal cel11nq/or forced dlr qas 2 examole- waterneater/electrlcal/or solar E Square footage or valuatlon, etc ------ 1 examole- 1250 sq foot house. 500 sq foot garage 2 examole- If new proJect. check new - If add,tlon. check add. etc F BU11dlng permlt lnformatlon 1 example - construct slngle faml1y house wlth an attached garage 2 example - remodel eXlstlng garage lnto famlly foom 3 examjle - convert 51ngle famlly reSldence lnto restaurant (change of use) G Value of work as deflned ln Sectlon 303 (a) of the Structural Speclalty Code H DES I GN TEAI1 AND CONTRACTORS To aV01d des1gn or constructlon delays, BU11dlng 01vls10n Staff must be able to contact approprlate persons regardlng des1gn lnformat10n or Job Slte correctlons, etc II Abbrev1ated Plumblng, Mechanlcal, & Electrlcal Schedules A Except where blank spaces occur 1n the descr1ptlon portlon of the Mechan1cal and Electr1cal Schedules, the appllcant need f1ll-ln only the No Boxes adJacent to the approprlate ltem(s) to be lnstalled B Full Plumb1ng, Mechan1cal, and Electr1cal Schedules are avallable at the BUlldlng 01v1s10n 1 To conserve space on the permlt form the schedules have been abbrev1ated 2 If the ltem(s) to be 1nstalled are not covered on the abbrev1ated schedules you should consult the full schedules C BOILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D As noted on the CAP, the label must be dellvered to the electrlcal contractor for slgnature by h1S electrlcal superv1sor The general contractor 1S not authorlzed to s1gn the electrlcal label - III Appllcant to slgn and date Whenever posslble, the 1nlt1al appllcatlon w1ll be used as a worksheet only Where posslble, BUlld1ng 01vlslon Staff w1ll prepare a type wr1tten copy and return 1t to the appl1cant at the t1me the actual permlt 1S 1ssued for hlS slgnature IV Fees and Charges Plan check fees are due and payable at the tlme of the appl1cat1on, and no plans wlll be processed untll these fees are pald All other fees and charges are due and payable when the permlt 1S lssued V FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY' Penm t Cl erk ~ PERMIT VALIDATION -s5~ ~~ ' ~ul (/ C( Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because. Addltlonal Project InformatlOn PLANS REVIEWED BY. name slgnature . , . " date ~ I