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Home My WebLink AboutPermit Mechanical 1989-9-7 .~ NFORI1ATION 726-3753 ,Sq. Ftg. r4ain ~q, Ftg. Access. Sq. Ftg. Other Hew Add Alter Rep. --Fence Demo Change/Use --Other -- -- ~ Address HOlD ErlERGY SOURCES: Heat Hater Heater Range lL-u.-dJ PV1L ( Tr. ck:.t'/14, Valu€ of \'/ork: . (I JfYY}htJ/{lal JtW. Phone1~-J..!~~t~np-e~Td~~~e IQf~h ADeschi~er,Horkq.e.. Build Single :IhSf~ ';;: e ;;;;/ ~a fUJ/I~' ;)/)(J;MI BTt,( 1-/0<<15 ..... CITY OF SPRINGFIELD ,.., COMBINATION APPLICATION/PERMIT ~UaJ /TY{, ~ ~. \:::::) , ~ IN~:'i!l:TION LINE 726-3769 Job Address Legal Description Owner --- Construction Lender I Address DES I GN TEA/4 (name) Phone (address) (1 ics. no.) (exnires) (ohone no.'\ . Pri ma ry Structural Electrical r1echani ca 1 CONTRACTORS (name) (address) (1 ics. no.) (exoires) (ohone no.) 1 General Electrical r"}~ .!\ \JbV 1'\ ,~ ;Jf) Plumbino ~'echani ca 1 PLur,lB I NG ELECTRICAL MECHANICAL NO. ' FEE CHARGE NO, I FFF 'fHAR(;F j NO. 'p'r I fHAR(;,F SQ. FT. furnace/burner to 2/;0,1/00 BTlI' s . {f"ft ,75" Each single fixture , Res i dence of Relocated building (new fix. additional) New circuits alts. or extensions Floor fu rnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Soace heater and ve~t Storm Sewer Of COMM./IND. FEEDERS Install/alter/relocate distrib, feeders amps. Appliance vent seoa ra te Stationary evap. cooler Vent fan with sinale duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing residencf;' multifamily, comm. or Industrial ~la ter servi ce Of amps. ISSUANCF OF PFRMIT TOTAL CHARGES TOTAL CHARGES HHERE STATE L'\H REQUIRES that the Electrical work be done by an ,shall not be vali~ until the label has been signed by an Electrical TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAlllNED the completed application for permit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work nerformed 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 herein, and that NO OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this p~ ./:? ' /' ~/~ rW'E(ple~se print~L""/'l"/ K: IPuJ~5"'Fj,.... SIGrlATU -' :- " FO~ OFFICE USE ONLY DATE.9 r-7--r7 BUILDING PER~1lT Charges and Surcharges I' ' I Plan Ck. 65%/Blda Plan Ck. 30%/Blda Fence Comm/Ind Per Fee Res Per Fee Sq. Ftg. rlain x Value Sq. Ft~. Access x Value Sq. Ftg. Other x Value TOTAL VALUATION Shstems Development C arqe (1.5%) , Zone Fire Zone Flood Plain Type/Cons t. Bedrooms Stories Units Occy Load Occy Group PL1Ir1BING PERMIT Charges and Surcha rges 06mo ELECTRICJl,L PERrHTSidewalk Charges and ------------ Surcharges A/C Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges _-d.f;~~___ Curb Cut ~ . - TOTAL !b' 7~ , II. I I I. IV. e e . - <<;:. ~ .,. , . COMB I NA TI ON APPLI CA TI ON/PERMIT (CAP) 1. PERMIT VALIDATION Applicant to furnish A. Job Address B. Legal Description 1, example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot,l. Block 3, 2nd Addition to Springfield Estates C. Name, ~tc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrical/or solar E. Squa re footage or va 1 ua t i on, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family ropm 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 Division Staff must be able to contact appropriate -persons regarding design information or job site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To coriserve space' on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must electrical contractor for signature supervisor. The general contractor to sign the electrical label. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff wi 11 prepa re a type written copy and return it to the applicant at the time the actual permit is issued for his signa ture. 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. I be delivered to the by his electrical is ,not authorized V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " Permit applicant exempt fro~' registration with the Bui1der's Bo~rd because: Additional Project Information: PLANS REVIEWED BY: name signature date