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Home My WebLink AboutPermit Mechanical 1984-11-28 owner0 ~ U j:.do _^ Addressqj c,;;;XO ~ ,So kl[;,fltf). oM.. () 7<;/7 Y construction ender ' ... I INSPECTION LINE 726-3769 Job Address legal Description Address Ue,IGN TEAr~ Primary Structural Electrical Meehan; ca 1 CONTRACTORS Genera 1 Plumbina . .. CITY OF SPRINGFIElD COMBINATION APPlICATIONIPERMIT E!lERGY SOURCES: Heat Hater Heater Range V'lfpE of Hark: 'II. ~OO- ut> / BiJildino Pennit Info: Describe Work(Le.. Build Single Phone7<1"" Fami~~ nesidence liith A.ttached Gar~) _ , rl <<'/ ~ (1 ~ 11.-1 t7..f2. ~~/P/ .f/rf'/Jk;.y... . i' u INFORlIATION LINe 726-3753 Sq, Ftq. 1.lain ~q. Ftg. Access. Sq. Ftq. Other New Add Alter Rep. -Fence Demo Change/Use Other- - / 32'S-t5? rIJn/! /~ d ~ \.S) () ~ ~ ( name) Phone (address) (exo;rl'lc; ) (ohon€> no. ') (lies. no.) * (name) (address) (1 ice:.. no.) (pxnirpc:.) (ohonp no_) Electrical _ ~Iechani~a< \]:,~ (J!jj i~ PlUI1BING NO, ltJ.vy ()cr/J~ ~-t~f ElE~ICAl;( :11\-<11 r.r~ V7chs- {,~7-/ '2, f/ MECHANICAl FEE CHARGF Nn ~~~ fHARr,F NO. FF1=" r~ADr.F Residence of furnace/burner to BTU's Each single fixture SQ. FT. Relocated building (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent S.F. Residence (1 bath) Ouplex (1 bath) each Additional bath \<Iater servi ce Sewer Storm Sewer Recessed wall ~n~~p hpa!_pr ~nrl vpnt I SERVICES Temporary Construction Change in existing rpc;idp.:nrp multifamily. C01TlT1. or Indtlc;tri~l IOf amps. I COMr,!. /INO. FEEOERS I Install/alter/relocate rtic;trih. fpprlprc; IOf amp~1 I I I I App 1 i ance vent c;eoaratp I Stati onary evap. r:noler I Vent fan with c;inole duct I'Vent system apart from I hea t i na or A. C. I Mechanical exhaust hood ilnd durt I Hood stove/heater 1~4f1~ I}u;f~ I I I I I I I-I JOJrr;. I I ISSUANCE OF PFRtllT TOTAl CHARGES TOTAl CHARGES TOTAL CHARGES lo-~ WHERE STATE L\l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit shall not be va1i~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXArlINED the completed apn1ication for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Ore~on pertaining to the work described herein, and that rm 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. SIGllATURE ~.~ FOr. OFFICE USE Olll.;?' , UAJ.lE(please print)_G'a_"" S,('h, s~....... / Zone Fire Zone Flood Plain BUilDING PER~IIT Charges and Surcharges PlU'1BING PERMIT Charges and Surcharges ElECTRICAl PERI\IT Charges and Su.!"~harges /lECHANICAl PERMIT Charges and Surcharges OATE //-28 -8~~ I Tyoe/Const. Bedrooms Stories Units Occy load Occy Group Sq. Ftg. t1ain Sq. Ft9. Access Sq. Ftg. .other x x Value Value Value x TOTAl VAlUATION , Plan Ck. Conro/lnd 65%/R1do Ppr Fpp ------------ Plan Ck. R-es 30%/Bldo Per Fee Fence .syste.ms Development CharQe (1.5~) , ------------ I 0fj1l10 -__________J Sidewalk I A/C Pavi n9 ~_____LO.:oQEJ Curb Cut .L/() I ITota1 Comb. Permit I I TOTAl /0_ C/o 8<.I00f1~ . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100. Lane County Map Reference 11 oj 43 2. example- Lot 1. Block 3, 2nd Addition to :sprlngfield Estates . . C. Name. etc.- of owner and construction lender O. Energy Sources 1. examele~ heat/electrical ceiling/or forced air qas 2. example- waterheater/electrlcal/or ~ E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. examJPle- if new project, check:new - if addition, check add, etc. F. Bu11ding permit information: L' examele - construct single family house with an <attached garllge 2. exam~le - remodel existing garage into family room 3. 'examJPle - 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 TE~1 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. ~ II. Abbreviated Plumbing, Mechanical; & Electrical Schedules A. Except where blank spaces occur in the descrip~ion 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 conserve 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 O. As noted on the CAP, the label must be delivered to the electrical contractor for Signature by his electrical supervisor. The general contractor is.not authorized to sign the electrical label. --- III. 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 type written 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: . PERMIT VALIDATION pI! .. . ~" \ h 390. V ({J . lI)>rfr Permi t Clerk/M (' . I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date I