HomeMy WebLinkAboutPermit Mechanical 1986-7-9
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INSPECTION LINE
726-3769
INFORllATION liNt
726-3753
Sq Ftq Ilaln
~q rtg Access
Sq Ftq Other
r~ew Add Alter oep
J7 Ranqe Fence_Demo_Change/Use
~ T - I Value: of \lark Other
Owner '1/YJ/Jfl//_ 'iMuiU/A1-rf.n--!.tJ - -
- JI J,.- ~ (/Vr: BUllClna Permlt Info Descnbe l~ork(l e , BUlld Slngle
Address :::J_-=<.C\NY OCl,..k-h11f>11 a...:hone TO, ~ - Fa",)i' nesldence Ih th ftttached r,araoe)
#-~J4 ';AJrLLkf) / (f t/f}/I ~AI~(J1;~.J.I~ H/
Construc"nn Lender f 0 l5yh/Jh/l /~At. J f
Address Phone (:;'
UI:.~l(jrl I tAr' (name) (address) (11CS no)
Lega 1 Deo:;crl pt 1 on
CITY OF SPRINGFIELO
COMBIrIATlON APPLlCATION/PERMIT
E'IERGY SOURCES
Heat
l~ater Heater
Job Address
/1)io
~Y' ,;:' ()
Pnmary
Structura 1
El ectn ca 1
f1echam ca 1
CONTRACTORS
(name)
(address)
(11CS no)
Genera 1
Pl umbl no
Electncal
"
1ft1~f/pd
tlechaOlcal
/J/t/./I~/
PLUllBI~#
ELECTRICAL
Of
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, ><L'J:lIARG.lj 110,
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I
FEEDERS amps -,-1-
I
I
I
I
NO I
-----!Each slngle flxture
IRelocated bUlldlng
(new flX addlt1onal)
Is F Pesldence
(1 bath\
IDuPlex (1 bath) each
IAddltlonal bath
~Ja ter serVl ce
FEF I CHARGE
..tI1l-1
I Res 1 dence of
SO FT
INew clrcu1ts alts
or extens10ns
I SERVICES
I
Sewer
lstorm Sewer
-----I
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I
I
-,
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amps.
ITempOrary Constructlon
IChange 1n eX1st1ng
rps,rlgnc:p
Imult,famlly. co~ or
InrllJ<:.tnal
C0I111 !lND
I
I
II
I I
I I
Install/alter/relocate
rllc;tr,h fppdprc;
Of
-----I
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TOTAL CHARGES J TOTAL CHARGES
WHERE STATE L \I~ REQUIRES that tile Electncal work be done by an
shall not be val1J unt,l the label has been slgned by an Electrlcal
~
I\~
:-N
')
(exnlres)
(aham'! no
(p){rllrpo;; ,
(ohone nn )
MECHANICAL
furnace/burner to
BTU's
, EELI J:HARG.E.
I Floor furnace
and vent
I Recessed wa 11
So~cP he~tpr ~nrl vpnt
I
I Apo 11 ance vent
<;eo~ ra te
I StatlOnary evao
cooler
I Vent fan W1 t~
slnole duct
Vent syste~ apart from
heat, no or A C
Mechanical exhaust
hood ~nd duct
15'0'
I
I
ItRo
I
~Jood stove/heater
//1
'110
ISSUANCf OF PFR'lIT
Electrlcal Contractor, the electrlcal portlon of th,s per~1t
Suoervlsor and returned to the BU1ldlng Dlv1s10n
TOTAL CHARGES
I:).. t,r)
I HAVE CAREFULLY EXArlINED t'le completed apnl1catlon for l1ermlt, and do herebv certlfy 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 Ord1nances of the Clty
of Sonngfleld and the Laws of the State of Oregon oertalmng to the work descnbed hereln, and that rm OCCl!PAIKY wlll be made
of any structure wlthout the permlSS10n of the BU11dlng Olv1S1on I further certlfy that my req1stratlon wlth the BUllder's
Board 1S 1n full force and effect as requlred by ORS 701 055, that lf exempt the baS1S for exemptlon 1S noted hereon, and that
only subcontractors and enployees who are 1n como11ance w1th OPS 701 055 \1111 be used on thlS proJect
SIr,lIATURF~ ~La..~<
FO" OfFICE USE ~r '
So Fto" f1a1n x /
Sq Ft~ Access x
Sq Ftg Other x
NAllE(please
prlnt)~
Zone
Fl re ZonE'
Flood Pla1n
Tyoe/Const
Bedrooms
Stones
Un1ts
Occy load
Occy Group
BUILOING PER/lIT
Charges an~
Surcharges
. Pl an Ck Comm!l nd
65%/Bldo Per Fee
------------ Plan Ck Res
30%/Bl do Per Fee
I Fence
------------
I D~o
I Sidewal k
------------
1 A/C Pavlng
~__nL~-!~_: Curb Cut
PLOP1BING PERMIT
Charges and
Surcharges
ELECTRICPL PERI'IT
Cha rges and
Surcharges
Dm 7-9' f I.
Value
Val ue
Value
TOTAL VALUATION
Systens Development
Charoe (l 5~)
,
11ECHAN I CAL PERMIT
Charges and
Surcharges
jTotal Co~b rerm1t
i TOTAL
\
L.::;: bO
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,
Appl1cant to furnlsh
A Job Address
B legal Descrlptlon
1 examDle- Tax Lot 100, lane County Map Reference
17 03 43
2 example- Lot 1 Block 3, 2nd Addltlon to
5prlngfleld Estates ,
C Name. ete of owner and constructlon lender
~ Energy Sources
1 example- heat/electrlcal celllnq/or forced alr qas
2 examole- waterheater/electrlcal/or solar
E Square footage or valuatlon, ete ------
1 examole- 1250 sq foot house, 500 SQ foot garage
2 example- If:new proJect. check-new - If addltlon,
check add. ete
F BU11dlng permlt lnformatlon
1 example - construct slngle famlly house wlth an
attached garage
2 example - remodel eXlstlng garage lnto famlly foom
3 examole - convert slngle famlly resldence lnto
restaurant (change of use)
G Value of work as def1ned 1n Sectlon 303 (a) of the
Structural Spec1alty Code
H DESIGN TEAll AND CONTRACTORS
To avold des1gn or construct10n delays. BUlld1ng
Dlv1slon Staff must be able to contact appropr1ate
persons regardlng des1gn lnformat1on or Job slte
correct1ons, etc
II Abbrev1ated Plumblng, Mechanlcal. & Electr1cal Schedules
A Except where blank spaces occur 1n the descr1ptlon
port1on of the Mechan1cal and Electr1cal Schedules.
the appl1cant need f1ll-1n only the No Boxes adjacent
to the appropr1ate ltem(s) to be 1nstalled
B Full Plumblng, Mechan1cal. and Electrlcal Schedules
are ava11able at the BU11dlng Dlv1s1on
1 To conserve space on the permlt form the schedules
have been abbrev1ated
2 If the 1tem(s) to be lnstalled are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be dellvered to the
electr1cal contractor for slgnature by hlS electrlcal
supervlsor The general contractor lS not authorlzed
to slgn the electrlcal label
III Appllcant to slgn and date
Whenever posslble, the ln1t1al appllcatlon w1ll be used as
a worksheet only Where posslble. BUlldlng Dlv1s1on Staff
w11l prepare a type wrltten copy and return lt to the
appl1cant at the tlme the actual perm1t 1S lssued for hlS
slgnature
IV Fees and Charges
Plan check fees are due and payable at the t1me of the
appllcat1an. and no plans wll1 be processed untll these
fees are pa1d All other fees and charges are due and
payable when the permlt 15 155ued
,
;J?t1tJ~
1~ C;J{~
V FOR OFFICE USE ONLY
Permlt Clerk
o~
'.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because
Addltlonal Project Informatlon
PLANS REVIEWED BY
name
slgnature
date
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