HomeMy WebLinkAboutPermit Mechanical 1980-12-14
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1 INSPECTION LINE.
726-3769
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,'2.!1' 'CITY OF SPRINGFIELD "....
COMBI;IATION APPLICATION/PERMIT .
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INFORI1ATION LINt
726-375300 '
So" Ftc]. r'lainO
ErlERGY SOURCES: ~' , 0
Heat yC{s -.:5', /'11 ~,' ~q.' Ftg~ Access. "
Ha ter Hea ter '" r. Sq. Ftc]. Other 0
., rlel~ Add Alter Rep. . t\ '
Ranqe \Ala h /U ~
Fence_Demo_C ang,e . se ~
Xl 1 U€ o! l'/o!:!s: , 00 vOt~, ~r ~ I?'IlLti'U{V\ Ic.al-,
'-tf313':::>O. .....- 6\.J5DZVld!l.cl. ao...s, i:.e.o..tg '5'
Bui1c:ina Permit Info: Descr,be I'Jork(l.e., BuiTd'Sing:e,
Family nesidence With Attached Garaae) ,
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Phone
Address
DES I GN TEAr-1 .
(name)
Phone
(address)
/!O/E-1h1#:/~:#J ';;;AA'J"",-,d..,d<.I=.-'.J'
//(';/~.A!.~&;/ -J.M~r.hd '
&.J!1.//IlQ }/J~ - , '
.:I{iics. no.) (exnires) (phone no'-\
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Const ruct i,D,nLender:
Primary
Structural
, Electrical
,
,
t1echani ca 1
CONTRACTORS
40mh)K! F~//...J ./fft.""
- lria~e) ,
~~~-/.,),h~ ~L/4 j/6b
(address) (lies. no.)
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h ~/ ?-<:?/
(exoires)
3P-'<g'/d
(ohone no, ) J,
General
': Plumbina
,
?'?'Ss ..u~ .h"A ~ /?c-W'.
j/~L:)
6 -:/7 -<:;<' /
319- .?'/4/i',
PLUf1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF f.HARGF NO.
FFF rHARG,. ~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
.
./
Relocated building
(ne~ fix. additional)
S.F. Residence
,. -(rbalti) .
" Dupl~,x (1 bath) each
, Additional bath
New circuits alts.
or extensions
Floor furnace, '
and vent
SERVICES
Recessed wan
Soace he~tpr ~nd vpnt
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'ITempOrary Construction
Change in existing
residence
multifamily, comm. or
Industrial
[Of amps~
I CDr1r'1.1I ND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders
IOf amp~1
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Appliance vent
seoa rate
Stationary'evap.
cooler '
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood 'stove/heater
C:.t4S' "
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Ha'ter servi ce
Sewer
Storm Sewer
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:-1 ,,5ZJ I ,.s;c
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ISSUANCE OF PFRr1IT
fO-ro
<P;~_,'s"l'
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES, ,
, WHERE STATE L'H REQUIRES that tile Electricall~ork be done by an Electrical Contractor, the eleCtrical portion of this permit
shall not 'be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXNlINED the completed appl ication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of OreC)on pertaining to the work described herein, and that NO OCCUPANCY will be made
of any structure without the permission of the !3uilding Division. I further certify that my registration ,lith 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
on ly subcontractors and employees \~ho are in como 1 i ance with ORS 701. 055 I,Ji 11 be used o'n thi s project.
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Units
Occy Load
, Occy Group
0tis P~eM
Plan Ck.
65:~/Bl do
Plan Ck.
30;;/Bl do
I Fence
------------
I DtiRlo
I Sidewalk
lAIC Pavi ng
_...;.____u,5.12_' Cu~b Cut
/50 I
/,UY/'9T/ SIGrlATURE ~~/, ~j~
-" ::~f'-" .--/ - -,-
FO~ OFFICEUSIY-OtH?r/ /' .......... ~
.~...- .
So. Ftg. 11ain
Sq. Ftc). Access
Sq. Ftg. Other
DATE '~';:;J;;/,/-~;
rW1E(please print) JE.r-F~,k! y /~
,', .. Zone"
Fire Zone'
Flood Plain
Tyoe/ConsL
Bedrooms
Stori es,
,
.
.x
, Value
Value
Value
, x
x
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TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcharges
CommlInd
Per Fee
Res
Per Fee'
Systems Development
Cha rCle (1. 51,)
ELECTRICJl,L ,PERrm
Cha rges and ,
Surcharges
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Total Comb. Permit',
PLUt1B ING PERMIT
'Charges and
,Surcharges
MECHANICAL PERMIT
Charges and,
'Surcharges
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I TOTAL,
63,OCJ
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CITY OF
COMBINATION APPL! CATION/PERMIT ( CAP)
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I. A~plicant to furnish
A. Job Address
B. Legal Description I
1. examp 1 e- Tax Lot 100, Lane County Map Refe " I,.;
17 03 43
2., example. Lot 1. Block 3, 2nd Ad,dition to
SprIngfield Estates , "
C. Name, etc. of owner and construCtion lender'
O. Energy ,Sources
1. example- ,heat/electrical ceilinwor: forced
2. example':' waterheater/electrical/or solar,
~_ E. Square footage or valuation~ ~tc.
1. ~xample- 1250 sq. foot house~ 500 sq. foot
2. example- if new project, check new - if ad(
check add ,etc. '(,,'
F., Building permit information: ", '
1. example - Construct single' family house wit
attached garage '
2. example - remodel existing garage intofami
,3. example - convert single family residenc~ i
restaurant (chang~ of use) '.
G. Value of work as defined in Section 303 (a) of
Structura 1 Spec ia Hy Code
H. DES I GN TEAI'l AND CONTRACTORS . ,
To avoid design or construction delays; Buildin
Division Staff must be able to contact appropri,
persons regarding design information or job sit,
corrections, etc. ' " (,
II. Abbreviated Plumbihg, Mechanical, & Ele~trical Sch~.
A. Except where blank spaces occur in the descript'
portion of the Mechanical' and Electrical Schedui
the ~pplicant need fill-in only the No. ~oxes ae
to, the appropriate item(s) to be installed'
B. Full Plumbing"Mechanical, and Electrical' Sched~
are available at the Building .Division
1. To conserve space on the permit form the sch ~e'
'have been abbr~viated '
'2. If the item(s) io be installed are not cover
the abbreviated schedules you should consult
full schedules ' ( ,
C. ; BUILDING DIVISION STAFF WILL FILL OUT ALL FEES Ai
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be ,delivered '
. electrical contractor for signature by his electl (1,
supervisor; The general contractor is riot authol
. to sign the electrical label. . -".,
Applicant to sign and date
Whenever possible, the initial application will be us <~~ BY
a worksheet only. Where possible, Building Division
will prepare a type written copy and return it to the
app 1 i cant at the tlme the actual permi tis issued for
signature. ( .
Fees and Charges
Plan check fees are du~ and payable at, the time of tht-,. , ..
application, and no plans will be processed until these.'
fees are paid. All other fees and charges are due and
, payab I e ~Ihen the permit is issued'.,
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PERMIT VAll DATION
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SPRINGFIElD
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Received For:
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V. FOR OFFICE USE ONLY
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Amount Received
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. 'A 97.01 saSll'8
SHIU.TON.TURNIIULL ,.RINTERS . EU.GENE. 0
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIErrBEFORE OCCUPANCY:"
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Permit applicant exempt' from registratiQn with the Builder's Board because:
Additional Project Information:
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PLAN~REVIEWED BY:
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name. '
, signature..
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date
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