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Home My WebLink AboutPermit Mechanical 1981-8-31 (2) '~ CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: , INFORMATION LINE 726-3753 INSPECTION LINE 726-3769 Job Address .5":1 q 8 C~~ . legal Description 17 - f) '!: - ~1'- 3ij -Ill! J IJ h ~~..4- ~g ~~~..... '711. .~r t) ~. I b::.L::'5 ~~., L-C.Phone 7'Ih-'A7Jt.~ Z ~~.. IJP. C/7//-77 I T-" Construction lender (!:C Heat Water Heater Range Value of Work: 1154'7 t$- 'Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached Garaae) Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _New_Add_Alter_Rep. _Fence_Demo_Change/ Use _Other ~ "~ c:) c:-.. ......; Owner Address Address Phone ~. .-'..J.~ dc-t,l';.l tJL mAil ~ A JuL ~':A.Iu.a..- ~~d,)r:.IL ~ DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lies. no.) (ex~ires) (phone no.) General ()-U.}-;u1jr , Plumbina , Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. I FEE CHARGE NO.' FEE CHARGE NO. FEE ' CHARGE SERVICES furnace/ burner to BTU's Appliance vent separa te Stationary evap. cooler Vent fan with . -""0' single duct . . Vent system apart from heating or A.C. Mechanical exhaust hood and duct .' Residence of Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) sq. ft. New circuits, alterations or extensions Duplex (1 bath) each Temporary Construction Additional bath Amps. Water service Sewer / VL.. Wood stove/heater:S~ '- ...J) ~'lTV Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10,000 CFM Amps. ISSUANCE OF PERMIT IO,~. TOT AL CHARGES TOTAL CHARGES TOTAL CHARGES 111-' (J"1J WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical 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 HA VE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further certify that a~y and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPAN,CY will be made of any structure without the permission of the Building Division. I further certify that my registration wit'" the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Boord exemption: t1::J If'.'!. Cf-~J! L P)t SIGNATURE e ~,~. Y'l1 FOR OFFICE USE ONLY D.JPA~L~ DATE ~~ Nfi J NAME (please print)C lc ~ .p ;, c e . '( Value' Value Value lone Type/ Canst . 'Inits Fire Ion". Bedrooms nccy Load Flood Plain "tori,.. 0ccy Group BUILDING PERMIT Plan Ck. Comm/lnd Charges and 65%/ Bldg Per Fee Surcharges Plan Ck. Res 30%/ Bldg Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and Sidewalk Surcharges AIC Pavina MECHANICAL PERMIT Charges and _ _ _ _-15: j..T-() Curb Cut Surcharges . feU Sq. Ftg. Main '\q. Ftg. Access Sq. Ftg. Other '{ x TOTAL VALUATION Systems Development ChaF!:Je (1.5%) Total Comb. Permit TOTAL 1/ is. b () COMBINATION APPLlCATION/PE (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/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar . E. Square footage or valuation, etc. 1. example-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, checl add, etc. F. Building permit information: 1. example-construct single family house with an attac 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 Divisic Staff must be able to contact appropriate persons rega design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description pori of the Mechanical and Electrical Schedules, the applica need fill-in only the No. Boxes adjacent to the appropri item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the ( ated schedules you should consult the full schedules C. BUilDING DIVISION STAFF Will Fill OUT All FEES ANI CHARGES ON THE SCHEDULES Date flu./)' ~; 19 g I Rec'd From (1'~L,~_~J3Ut~t! Address ,-S-:l Ci?\ (!~ tf;. (J 03 ( ( ( i., ~g ( ( .r, ( +- Ill. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten copy and return it 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: Additional Project Information: PLANS REVIEWED BY: name <;ignaturf' City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT CITV.F Received For: SPRI.N GF I E LO I - \_ 1 " No. B 57199q !I 'f . L-t :iJ /..~. ~ Amount Received ::1 f~, .t~1J (I (I q 4 f/ I~ 60 ~ BY ~~~~SIGNATUR/ J . i SHELTON-TURNBUL.L P"INTE"~ ~UGIlNI. OR IJ7.0..... 581111-1. " , ( . '. Permit Clerk (1 (I ~atf'