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Home My WebLink AboutPermit Mechanical 1981-9-28 :~in5<~ .. \. '1t\QrDtee 0 \" . ~ -- INFORllATION LINE 726-3753 Sg Ftq IIa1n ~C] Ftg Acces 5 Sg Ftg Other -.rlew_Add__Al ter Qep ,~~~Oemo_Change/Use <;Other ~ ",..) ~ G JC I I INSPECTION LINE 726-3769 Job Address LilY Uf oPKINGFIELO COIIBIdATlON APPLICATION/PERMIT E'IERrv SOURCES Heat 'Jater Heater Legal De<;cnptlon Ranq:? Addre~s UtS ll.iN r tAr1 (name) Phone (address) Value of \lark kr) BUlltllnq Pernnf InfO Descnbe Hork{l e . BU11d Slngle Farnlv Resldence ~hth ,lIttached Garaqe) ~ -l::\\:\ Q A. - ~ t\) f\ k~ \..lnDOrrJ lJ L \ ~5<.:..l ( 11C5 no I (eXOJres) (ohane no J owner~n\\\'()f\ \. C')\\)p\" Address :31.09) <;< C'n~ff) ~\('~O~~. (' Phone const~~~Qrl ne.- ,lIl-lo'DqC\ Pnmary Mechanlcal CONTRACTORS I name I General ~__,~~ Plumb,na (address) (hes no) (~XOlrps) (ohanp no i I l I , , ~ ! Structural El ectn ca 1 Electncal PLUIIBIrIG ELECTRICAL MECHANICAL ~\ ~ , ~1e~ha ~~J=~..L.__ -"------0._ '__-=-__- NO ~~~=----= FEF CHARGE Nn ="""'"""" ~-=-==--",-..........,.--=-=- ~~~ rHAQr,~ NO H.~ rl-!.llRf!=' SQ FT furnace/burner to BTU's Each slngle flxture Res1dence of IRelocated bU1ld1ng (new f1X add1t1onal) Is F Pes1dence (1 bath) IOuPlex (1 bath) each jAdd1t1onal bath I ~Ja ter serv 1 ce I Sewer New C1rcU1ts alts or extens10ns I Floor furnace and vent I Recessed wall Sn~r.p hPntpr nnrl vpnt I SERVICES TOTAL CHARGES WHERE STATE L\W REQUIRES shall not be val1j unt1l the I Of I I I I I TOTAL CHARGES tha t the El ectn ca 1 work be done by an label has been s1gned by an Electr1cal amps I Apo 1 1 ance vent seea ra te StatlOnary eV30 cooler Vent fan wlth slnale duct. Vent systeM apart from heat1na or A C I Mecham ca 1 exhaust hood and duct. I flood stove/heater -5 (.)0 I Storm Sewer Temporary Constructlon Change 1n eX1st1ng rpc;ldpnrp Imultlfaml1y, comm or TnrllJc;tr1al IOf amps C0I111 II NO FEEDERS Install/alter/relocate rl,,,tr,h fppdprc; Electncal SUIJerV1 sor ISSUANC, OF PFR'lIT 10 cD : . TOTAL CHARGES 1.:5 CO Contractor, the electrlcal portlon of thlS per~lt and returned to the BUlld1ng D1v1s1on I HAVE CAREFULLY EX^~lINED t1e completed apol1cat1on for Qermlt. and do hereby cert1fy that all lnformat1on hereon 1S true and correct. and I further cert1fy that any and all work oerformed shall be done 1n accordance w1th the Ordlnances of the C1ty of Spnngf1eld and the Laws of the State of Oregon oerta1mng to the work descnbed here1n. and that rw OCCUPAlKY w1ll be made of any structure w1thout the perm1SS1on of the BU1ld1ng Dlv1s1on I further cert1fy that my req1strat1on w1th the BU1lder's Board lS 1n full force and effect as requ1red by ons 701 055. that lf exempt the basls for ex~mptlon lS noted hereon. and that only subcontractors and eMployees who are 1n comol1ance w1th OPS 7nl 055 w1ll be used on th1S nroJect NAtlE(please pnnt) c:, V,O.1n V\rA/'l I< {f'),OeR SIr,II^TURF_&~on-;l( /"/' u Dm.!4I;y__~/n~ ---u-F'or-orFIcCOSE O,ILY Umts So Ftg 11a1n~_ x Value Occy Load Sq Ft~ Access x Value Occy Group Sq Ftg Other x Va 1 ue TOTAL VALUATION Zone F1 re Zone Flood Pla1n Tyoe/Const Bedrooms Stones BUILDING PER~IIT Charges an~ Surcharges Plan Ck Comm/Ind 65%/Blrla Ppr Fpp ------------Pidn Ck Res 30%/Bldq Per Fee Fence ISysteMs Development Cha rge (J 5') PLU'1BING PERMIT Charges and Surcharges D,;:mo ELECTRIClL PERI'IT Cha rges and Surcharges Sldewalk /IECHAN I CAL PEPMIT Charges and Surcharges Ale Pav1 ng _J~_~__J Curb Cut (.o() I Total Co~b rerm1t I TOTAL j 10. (jJO \,- , - . . COMBINATION APPLICATION/PERMIT (CAP) Appllcant to furnlsh A Job Add res 5 B Legal Descrlptlon 1 example- Tax lot 100, lane County Map Reference II 03 43 2 example- Lot 1 Block 3. 2nd Addltlon to Sprlngtleld Estates C Name, etc~ of owner and constructlon lender o Energy Sources 1 example- heat/electrlcal cel'lnq/or forced alr qas 2 example- waterheater/electrlcal/or solar E Square footage or valuatlon, etc ------ 1 example- 1250 sq foot house, 500 sq foot garage 2 example- ~ew proJect. check-new - ,f add,tlon, check add, etc F BUlldlng permlt lnformatlon J exaffille - construct 51ngle faml1y house wlth an attached garage 2 examole - remodel eXlstlng garage lnto faml1y room 3 examole - convert 51ngle famlly res,dence lnto restaurant (Change of use) G Value of work as def1ned 1n Sect10n 303 (a) of the Structural Spec1alty Code H DES I GN TEArl AND CONTRACTORS To av01d deslgn or construct1on delays, BUlld1ng Olvls1on Staff must be able to contact approprlate persons regardlng des1gn 1nformatlon or Job slte correct1ons. etc II Abbrev1ated Plumb1ng. Mechan1cal, & Electr1cal Schedules A Except where blank spaces occur 1n the descrlpt10n port1on of the Mechan1cal and Electr1cal Schedules. the appllcant need f1ll-1n only the No Boxes adJacent to the approprlate ltem(s) to be 1nstalled B Full Plumb1ng, Mechan1cal, and Electr1cal Schedules are ava1lable at the BU1ld1ng 01v1S1on 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 fun 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 del1vered to the electrlcal contractor for s1gnature by h1S electrlcal superv1sor The general contractor 15 ~ot authorlzed to S19n the electr1cal label III Appllcant to slgn and date Whenever posslble. the 1nltlal appllcatlon wlll be used as a worksheet only Where poss1ble, BU1ld1ng Olv1slon Staff wlll prepare a type wr1tten copy and return 1t to the appllcant at the tlme the actual perm1t 15 1ssued for h1S slgnature IV Fees and Charges Plan check fees are due and payable at the tlme of the appl1cat1on. and no plans w1ll be processed untll these fees are pald All other fees and charges are due and payable when the permlt 15 lssued V FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY J , PERMIT VALIDATION , ; ~ ~ j -, .J ., 11 , 1 ~ ~ ~ 'j 1 , ~ , . -! " Permlt Clerk !i-;- Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because Addltlonal Project Informatlon . PLANS REVIEWED BY name slgnature . date I UISPECTIOd LIIIE 726-3769 .. " ...- -- -- INFORt1AnON UNt 726-37S3 So Ftq f1aln :q C"tg Access SQ Ftq Other flew Add ftl ter [Jep .......,f-.eftEe-Jemo _ Cha ngel Use COther I , ~------- Job Address ) (( - ) "-")(r" " \\\\1 \C.....tr-CC'\\ C~TY Ur SPRINGFIELD C0/1BldATlOfl APPLICATION/PERMIT EIERry SOURCES Heat lJater Heater V'--~c 1(\ BUlltlnq Pernnt Info Descnbe \lork(l e . BUlld Farnlv Resldence (11th l1ttached (1araQe\ ~l ,~')\ \ Q \ - ~~ \'0 (\; \"-- '- _l X, \::,\n "'- T Slngle ~ G I" -- I I I' legal De~cr'pt'on Owner ~ \ "ChI \ \() \ \ C' \ -='( \ ~ Address -)~,I (~c -.: (, \ \ ~ \ i", ~\.C (~( , c;~ w\ f- L, -llll Constructlon Le~der{ ~- Ranq~ ValuE of \/ork Phone Addre~s Ul:.~ 1 GH TEAr, tname) Phone (address) (l, cs no ) il_ \-\\ J (exn, res) (ohone no ) Pnmary Structural Electrlcal Genera 1 (name) n r- r'.S? (' '-...-' - ~ (address 1 (llCS no ) (eXl)lrps) fohnne nO ) , , .' i J u .11echanlcal -CONTRACTORS Plumbloa Electrlcal t1echanl ca 1 -~ PLUI1BIIIG ELECTRICAL MECHANICAL 110 I lEaCh slngle flxture Relocated bUlldlng (new f1X addlL1onal) FFF rHARt;F Nn J~ Res 1 dence of FFF rHARGF NO FI='F CHARl.F so FT furnace/burner to BTU's New clrcu1ts alts or extenslons Floor furnace and 'lent S F Pesldence 11 bath) Duplex (1 bath) each SERVICES Recessed wall So~~p hp~tpr ~nrl vpnt Storm Sewer - I Of amps Apollance vent seoaratp Stat10narv evao cooler ~ Vent fan w1th slnole duct Vent systeM apart from heatlnQ or A C Mechan1cal exhaust hood ~nd duct Ilood stove/heater ") (~O Sewer Temporary Constructlon Change 10 eX1st1ng rpS1rlpncp multlfam11y, comm or Tnrlu<;tnal Addltlonal bath ~Jater serVl ce C0I111 /IND FEEDERS Install/alter/relocate rll<;trlb feedprs Of amps. TOTAL CHARGES I TOTAL CH~RGES WHEPE STATE L \11 REQUIRES that the Electrlcal work be done by an shall not be val1J unt11 the label has been slgned by an E1ectr1cal I I ISSUANCE OF PFR'HT ! L/ C-C~ I TOTAL CHARGES (") Cc, Electr1cal Contractor, the e1ectrlcal port1on of th,S perm1t Suoervlsor and returned to the BU11d1ng 01v1510n I HAVE CAPEfULLY EXNllNEO t'1e completed apnl1catlon for fJerm1t. and do hereby cert1fy that all lnformatlon hereon 1S true and correct, and I further certlfy that any and all work Derformed shall be done 1n accordance wlth the Ord1nances of the C,ty of SDrlngf1eld and the Laws of the State of Oreoon oerta1n1ng to the work descnbed here1n, and that tW OCCUPMKY w111 be made of any structure wlthout the permlS510n of the BUlld1ng 01V1S10n I further cert1fy that my req1stratlon w1th the BU11der's Board 's 1n full force and effect as requlred by ORS 701 055, that 1f exempt the bas1s for exemptlon 15 noted hereon, and that only subcontractors and eMPloyees who are 1n comnllance w1th OPS 7nl 055 w1ll be used on thlS project I~A~1E{please pnnt) Zone Fl re Zone Flood Pla1n Tyoe/Cons t Bedrooms S to n es UOl ts Occy Load Occy Group s rr.;rJATURF Fon OFFICE USE O,iL Y So Fto rialn Sq Ftl] Access Sq Ftg Other D~TE x Value Value Val ue TOTAL VALUATION x BUILDIIIG PERil IT Plan Ck Co"",/! nd Ctlarges an': -----------~ 65%/81~r ~ee Surcharges Plan Ck Res 30%/Bldo Per Fee PLU'1BING PERMIT Fence Charges and ------------ Surcharges D~mo ELECTRIClL PERI'IT Sldewalk Charges and ------------ Surcharges A/C Pavlng 11ECHANICAL PEPI1lT L':) CC Curb Cut Charges and -- --------- Surcharges l(J .Systens Development Cha rQe (! S') Total romb rermlt I TOTAL 1'5. uC ~ Appl1cant to furnlsh A Job Add res 5 B Legal DescrTptlon 1 example- Tax Lot 100. lane County Map Refe te 11 03 43 2 exampJe- Lot 1 Block 3. 2nd Addrtlon to Sprlngtleld Estates C Name. etc of owner and Constructlon lender o Energy Sources 1 examole- heat/electrlcal celllnq/or forced 2 exa~Dle- waterheater/electrlcal/or solar E Square footage or valuat1on, etc ----- 1 examDle- 1250 sq foot house. 500 sq foot 2 example- lfInew proJect. check-new - If adc check add. etc F BU11dlng pernlt lnformatlon 1 example - construct slngle fam,1y house Wlt attacned garage 2 examole - remodel eXlstlng garage lnto fam, 3 examole - convert slngle famlly resldence 1 restaurant (change of use) G Value of work as deflned 1n Sectlon 303 (a) of Structural Speclalty Code H DESIGN TEAll AND CONTRACTORS To aVOld deslgn or constructlon delays, BUlldln Dlvlslon Staff must be able to contact approprl persons regardlng deslgn lnformatlon or Job Slt correct1ons, etc ( Abbrev1ated Plu~blng. Mechanlcal, & Electrlcal Sche ~~ A Except \lhere blank spaces occur 1n the descrlpt portlon of the Mechanlcal and Electrlcal Schedu the appl1cant need fl11.1n only the No Boxes dl ft; to the approprlate ltem(s) to be lnstalled ~ B Full Plumblng. Mechanlcal. and Electrlcal Schedl are ava11able at the BUlldlng Olvlslon 1 To conserve space on the permlt fom the scl Il~ have been abbrevlated , 2 If the ltem(s) to be lnstalled are not covel the abbrevlated schedules you should consul, full schedules C BOILDING DIVISION STAFF WILL FILL OUT ALL FEES I " CHARGES ON THE SCHEDOLES o As noted on the CAP, the label must be dellVere( electrlcal contractor for 51gnature by hlS elect 5uperv15or The genera 1 contractor 15 not authc \ed Amount Received to 51gn the electflcal label - Appl1cant to 51gn and date Whenever p05s1ble. the lnltlal appllcatlon wlll be U a worksheet only Where posslble, BUlldlng 01V1510n (a.t- BY Wlll prepare a type wrltten copy and return 1t to th apPllcant at the tlme the actual permlt 1S lssued fa S 1 gna ture Fees and Charges ( Plan check fees are due and payable at the t1me of t appllcat10n. and no plans wlll be processed untll th~c fees are pald All other fees and charges are due and payable when the perm1t 1S 15sued - COMBINATION APPLICATION/PEPMIT (CAP) II III IV V FOR OFFICE USE ONLY . , 'II " . PERMIT VALIDATION . CITY . OF SPRINGFIELD (I City Hall Sprln9fleld, Oregan Department 01 Public Works OFFICIAL RECEIPT I ~ _ No. B Date ~_:.. V~ \ ,,'E19r/, ~_ Rec d Fr~~ ~\S\ \ \ \\0n ()\~ ~ ''Rc \ Address r)Lc5S~ ; C\ \\C v....'{ ~ (\~ __" C;-')6~ ~r-, .l.1 I~ 'm Received For . \ ' \ .- 'h- i_ ~(()r'.\ '=~;\l""'i _.;_ ,~\ \ !J1 "'-\- << . ~0---) ,SOU ! (I() << f i~ loC) tl\ \Tf'\...J (I): ; 4 4 (I A"ti'THORIZED SIGNATURE ~ft~"e \ ~><ELTON H'''''BUlL ~"'''TE..!I EUGENE Oil gH.O' 4 Perml t Cl erk 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