The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 1981-6-26 CITY OF SPRINGfiElD COMBINATICN APPLICATION/PERMIT ~") \ 0_ 00[\) _ \1)f\\.m 11J. 0 PlUMBINO jr --:~ / . _J \, I ~i:l ft I INSPECTION LINE 726-3769 - Co rltOJ? n ir& Job Addren \'l()! Legal DescrIption I _. !\ __I - lOw,", Y l U \), JlC ~ V A V ) I Add,... 17(01 _ (! a f1ToA lfitfil,[J : ~o?\~~j.,1 fLUQ - . I Addreu I DESIGN TEAM Phone (oddren) (name I Pflmary Structural Eleclncal Mechanical CONTRACTORS (namel (address) G..nl'!ral PlumhlnQ 1 Electrical r",hO'''OI I NO I I I I I FE:: CHARGE I NO I Residence o~ Eocn stnqle fixture R~locoled budding (new fill: add.tlonal) S F R~"dence (1 balh) - INFORMA TlON LINE 716-37 S3 I' ENERGY SOURCES Heat I Water Heater Ranqe - I Value of Work Sq ftg Main Sq fig Accen Sq ftg Olher _New _Add _Alter _Rep _ _Fence_Demo_Chonge/Use ? --c5t~-" ~/, - f j:J --- ~I BUIlding Perm.t Info Describe War... II e Fom.!" ResIdence Wllh Attached GaraClel Budd Single \.If' 0 f' eN (0 ~Jtl U ;") () (lIes no) (expIres) (phone no) (lICS no) (elCplfeS) (phone no) MECHANICAL FEE I CHAR'GElNO I I , FEE CHARGE furnace/burner to BTU's Appliance ...ent separate Sla'lonary evap cooler Vent fon wllh Single duct Vent system Clpart from heatIng or A C Mechanical elChaust hood and duct New ctrCUIIs alterations or extenSions SERVICES Temporary Construchon Duolell: (l both} each Aodlhonol hOlh Amps Water service Sewer Storm Sewer fEEDERS Amps r I TOTAL CHARGES I TOTAL CHARGES Wood slove/heater Heat Pump AIr handler to JO 000 CFM Atr handler over 10000 CFM ,::ceo 1 ,--) 1 fDcol \3 CO ] ISSUANCE OF,PERMIT TOTAL CHARGES WHERE STATE LAW REQUIRES thai the Eleclrlcal work be done by the E1ert1lcol Contracro~, tho electllcol porhall af thiS permit sholl nat b. valid until a lobel has been slgnod by on Electtlcol Conrractar and attached to the electru;ol ponol I HAVE CAREFUllY EXAMINED the completed application for permit ond do hereby cerhfy that all mformatlon hereon II true and correct and I further certify that ony and all work performed sholl be done In acwrdance With the Ordinances of the City of Sptlngfleld and the lows of the State of Oregon pertalnmg 10 the work descrl~d henn and that NO OCCUPANCY Will be made of any structure Without the permISSIon of the BUIldIng O....lslon I further certify thot my roglstrollon wltn the BUilder's Board II m full force and effect os requlrea by ORS 701055 that If exempt the bosl5 for exemption IS noted heron, and that only subcontractors and employees who are In wmpllonce With ORS 701 055 Will be used on thll prOlect SIGNATURE ~'/'~~.L~_ FOR OFfiCE USE ONLY P c:/ BaSil for BUIlder s Bo~x~m~n NAME (please prlnt)~~ ~4'i :,_hM }V Zon- Type! Canst llnlh Fire Zone Bedrooms ("Jccy load Flood PIClln <itone. Occy Group BUILDING PERMIT Plan Ck Comm/lnd Charges and 65..../ Bldq Per Fee Surcharges Plan CX Res 30"r./ Bldq Per Fee PlUMBING PERMIT Charges and Fence Surchorges Demo ElECTRICAL PERMIT Charges and SIdewalk Surcharges A/c Pavma MEeHAN ICAl PERMIT ._L~_CD_ Charges and Curb Cut Surchorges ,5,cJ DATE 6.::J;{ - fl/ Sq Fig Mom Sq Ftg Accen Sq ftg Olher "alue 'alue x Value TOTAL VALUATION Systems Development CharCle (1 5":" I Totol Comb P~rmlt I I I \().G~ TOTAL COMBINATION APPlICATlONfPEtIrt (CAP) I Applicant to furnish A Job Address S legal Descnptlon 1 example-tox lot 100, lone County Map Reference 1703 43 2 example-lot 1 Block 3, 2nd Addlhon to Springfield Estates C Name, efe of owner and construction lender o Energy Sources 1 examole-heat/electrlcal ceiling/or forced Olr gas 2 examole-waler heater, electrical/or solar E Square footage or valuation, efc 1 exomo[e.1250 sc! foot house. 500 sq foot garage 2 exompie-lf new prolect. check new-If addition, check odd, efe F Budding permit Information 1 examole.construct single family house with an attoched garage 2 example-remodel eXisting garagE:.. Into family room 3 eXO'Tlple convert Single family reSidence Into restaurant (change of use) G Volue of work os defined In Section 303 (0) of the Structural SpeCialty Code H DESIGN TEAM AND CONTRACTORS To aVOId deSIgn or constructIon delays, Budding DIVISion Stoff must be able to contact appropriate persons regarding deSIgn Informetlon or lob site corrections, ere II Abbreviated Plumbing, Mechonlcal & Electrical Schedules A Except where blank spaces occur In the deSCription portion of the Mechanlcol and Electrical Schedules, the applicant need fill In only the No Boxes adjocent to the appropnate Item(s) to be Installed B Full Plumoln9, MechanIcal, and Electrical Schedules are available at the Budding DIVISion 1 To conserve space on the permit form the schedules have been abbrevloted 2 If the ttemls) to be Installed ore not covered on the abbrevl~ oted schedules you should consult the full schedules C BUILDING DIVISION STAFF Will Fill OUT All FEES AND CHARGES ON THE SCHEDULES III Applicant to sign and date Whenever possIble the Inulol appltcahon wall be used as a worksheet only Where possible, BUlldmg DIVISIon Staff will prepare a typewritten copy and return If to the applicant at the time the actual permit IS Issued for 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 V FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY o Additional Project Information PLANS REVIEWED BY nam"" ",Ignalur~ - PERMIT VALIDATION , Perm.t Cler~ r .J..,te i Job Addreu I I INSPECTION 72~J769 I NO I I I I I I I I I I I LINE - a INFOllMA nON LINE 726-J7SJ CITY OF SPRINGfiELD COMBINATlCN APPL1CAIION/PERMIT Ill() \ , ) o 0ntoli 11 1 (Jl Heal Woler Heeler Ronqe - Value of Work ENERGY SOURCES ISq fig Main ISq FIg Accen Sq Fig Other I _New _Add _Alter _Rep 1_ _F~ence=E:mo_Changel Use ~Olher '----" f De$cnbo Work \1 e Budd Single Attached Garaqe) j:J ~ ~' I 1 I ,I ~' legal OI!1Crlptlon Own" f l tl\J,Jlri j(~ll ) Add,...!/)()/ (I 0 J1To~() /7 (j,),{J ~o~~ ~j.,1 tiL<2 Budding Perm,t Info FomJ/y ResIdencE! With \ nl () ['eN (O.V\ .~ jf Addrell Phone DESIGN TEAM (addrenl (l,CS no i (phone na } (eXpires} (namel Primary Structural Electncal Mechanical CONTRACTORS (nome) (address) {lres no I (phone no) (eXplre51 General plumbll,q " Electrical ~ ') \ U_ C:ln [\1..._ \1)\\\.f:X't.JltrJ PLUMBING I \ ElECTRIC F:;r:: CHARGE. NO 1 ReSidence o. furnace/burner '0 ll.TU s Ap.,lrance vent separate StatIonary evop cooler Vent fan With slnq)e duct Vent $ystem epart from heehnq or A C Mechanical ei(hau5t head and duct , / " Mechonrcal MECHANICAL -l ICHARGE CHAl;1GE NO FEE FEE Eaen 11nqle fllO:ture R<!locared buddIng ("'8"" fr;o; additional} S F R"'s.dence (1 beth) $q ft New crrcults olteralrens or eXlen$10nS SEQ.VICES Duplel( (1 bel"l each Temporary Construction Aedtll0nol balh Amps Waler ser...,ce Sewer Wood stove/healer Slorm Sewer FEEDERS Heet Pump Air hendler to 10000 CF'!1. Arr handler over 10000 CFM Amps ':;;'cO r I TOTAL CHARGES I TOTAL CHARGES ISSUANCE OJl,.PERMIT I TOTAL CHARGES iOCOI \3 CO I I WHERE STATE LAW REOUIRES that the Ii:Ject'lcal work Qe done by the Elertrlcal Cantlauo.... tho electr,cal portion of Ih,s pe,mll sheall not b. valid until 0 JQbel hOJ been SIgned by on Electrlc-ol Conlractor and attached to the electrical panel I HAVE CAREFUllY EXAMINED the compleTed apphc.ahon for permit and do hereby certIfy that all lflfarmahon hereon IS frue and correct and I further certify thai ony and 011 work performed ,hall be done In accordance With the OrdlnOnCe$ ef the City of Spnngfleld and the lows of the State ef Oregon pertaining '0 rhe work deicnoed henn and thot NO OCCUPANCY Will be made of any s.ructure Without the permU510n of the BUildIng D,VISIon I further eertdy that my re-gutTohon WIth the Budder's Board IS In full force Clnd effect os reqlJlrt~O by ORS 701055, that d exempt the baSI' for ei(emptlan IS noted ::'>:,~::':::~:~Si;;;~:;,,~~;O~'::~ 0" on ~mp' ~~:N~~~:~R;Z'~:/~L ~ _ '/ DATE 6 -J~ _ fJ fOR OFfiCE USE ONLY v.'; / Zon- Type/Const 11mb Sq Ftg Mam Fire Zone s.edrooms n..cy load <q Ftg Accen Flood PlaIn <::IOtl8' I""'lccy Group Sq Ft9 Olher BUILDING P~RMIT Plan Ck Cemm/lnd Charges and 65~,,1 Bider Per fee Surcharges Plan Ck R.. 30":./Bldq Per Fee PLUMBING PERMIT Chorges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and SIdewalk Surcharges Alc Pevlncl MECHAN ICAl PERMIT l~CD I Charges and Curb Cut Surcharges -- ------ ~,CJ J x Value Value x -.'alue TOTAL VALUATION Systems Development Charqe (f 50S! I I I I I ] 'I (Q SQ-< Total Comb Permit I TOTAL COMBINATION APPLICATION, P.T (CAP) ApplICant to furnish A Job Address B legal Description 1 examole-tax lot 100, lane County Mop Rei 2 exomole lot 1 Block 3, 2nd Addlllon to Spr he C Name, efe of owner and construction lender o Energy Sources 1 exomole-heot/electrlcal ceding/or forced all as 2 exam ole-water heater, electrical/or ~ E Square footage or valuation, efe 1 exomole-1250 sq foot house 500 sq foot gc dt:> 2 exomoie-.f new prOlec', check -;;e;.,-lf addlhol L.~ odd. efe F BUilding permit lOformatlon 1. exornole-construct single famaly house with 01 lto garage 2 example-remodel eXisting garagE:- Into family 3 exo'l1pie convert single family reSidence anto restaurant (change of use) G Volue 01 work as defined In Section 303 (a) of the Structural Specialty Code H DESIGN TEAM AND CONTRACTORS To aVOId design or constructIon delays, Buddmg 0 Stoff must be oole to contact appropriate persons design IOformc;flon or lob sire corrections, etc ( II AbbreViated Plumbing, Mechanical & Electrical Schedu A Exccot where blcnk spaces occur In the description of the Mechanical and Electrical Schedules, the app 'n+ need f"I~1O only the No Boxes adJacent to the oppr Item(s) to be Instolled B Full Plumolng. Mechonlcal and Electrical Schedules are avollable at the Budding DIVISion 1 To conser.....e space on the permit form the schedul ha.....e been abbreViated 2 If the Itemu) to be Installed are not covered on th b~ oted schedules you should consult the full schedul C BUILDING DIVISION STAFF WilL FILL OUT All FEES A CHARGES ON THE SCHEDULES III. Applicant to Sign and dote Whenever pOSSIble the initial application will be used as worksheet only Where pOSSible, Budding DIVISion Staff "" prepare a typewritten copy and return It to the applicant the time the actual permIt 15 Issued for hiS slgnatun: IV Fees and Charges Plan check fees ore due and payable at the time of the apt-- and no pions Will be processed untlt these fees are paId All other fees and charges are due Qnd payable when the permit is Issued V FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Additional Prolect InformatIon PlANS REVIEWED BY nam- ",lgnaturo. , PERMIT VALIDATION. . CITY OF SPRINGFIELD ( CIty Hall Springfield, Oregan Department 01 Pubhc Works OFFICIAL RECEIPT ,... 71 No. B 5 0 5 , mfu \ ~ l~J Date \ \ '\.)., \\. ~::>, ~~q-- Rec'd From Y - - _.- Y\ I /II' \ ~ , -( Address ~ Received For ( \ X\\]~\-\'. . . 470 ~--:S r, - U ,~ , \ ( C":J'L ( ~'!'9.,:,nt '~-' Received ~::) _ -- --- ~J~ ..,U"'f\-IORl'l.E'O SIG,NIc1"URE ~ee" & EUGENE 01\ ~7.0\ ,.NE\.70N TURNBU~~ PRINTERS ( I ( ( ~I ( - , Permit CIerJ.. " ~ I f I I .J~te