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Home My WebLink AboutPermit Mechanical 1980-10-28 J ...;) .'-::J .1 . INFORllATlON UN, 726-3753 Sq. Ftq. l.la1n ~q. Ftg. Access. Sq. Ftq. Other Ilew Add Alter Pep. --Fence Demo Change/Use' --Other -- -- '~ 1 INSPECTION LINE 726-3769 . CITY OF SPRINGFIELO COMBINATION APPLICATION/PERM1T EIIERGY SOURCES: Heat 'Hater Heater Ran~e Job Address Owner Address :T I')(] Y'\ 7 _l~ ffif> X"fY'.O h 1"]41 tyJt ~ Phon'l")41_qgq~ Valu, of Hork: CO I' (}b~. . Builriirta Pernlit Info: Describe Work(i~e" Build Single r-. Familv nesidence I-lith Attached Garaae) ~ u. "hI\smlY'/; t-n""ped-fflbt KO'-j - C9'f' ('j Lj f'rl A.S Anh'ol ~~~ ~\)f --' 01 :(Yl n. fPm1)Al ~ flies: no.) {exoiresl (ohane no.') :::::: - Construction lender Address DES I GN TEN! {namel Phone (address) Primary Structura 1 Electrical !1echan; ca 1 CONTRACTORS (name) (address) (lies. no.) (pxoirp<:;) (ohonp nn \ Genera 1 1 Electrical I~ ~chani~al ~6-' PLUI1BlIlG ELECTRICAL ~. ~ff ~ MECHANICAL Plumbina '.0 I '1 Each single fixture IRelocated building (new fix. additional) IS. F. Res i dence 11 bathl louPlex (1 bath) each IAdditional bath ~Ja fer servi ce FEF rHARc,E ~ r~~ ('~~ NO :ELI~ Residence of SQ. FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent I SERVICES I Storm Sewer Of .::I.mps. I App1 iance vent <;poaratp I' Stationary evap. cooler I Vent fan wi th sinale.duct I Vent system' apart heating or A.C. I Mechanical exhaust hood and du/":t, I \./ood stov~/heater I I I from I I I' I I I Recessed wa 11 ~o~rp hp~tpr ~nri vpnt Sewer jTempOrary Construction IChange in existing re,55 rlencp Imu1tifamily, COIl1l1. or Industrial I I I I I CO~j./1NO. FEEDERS Install/alter/relocate ni<:.trih. fppdpr<:. Of amps.! TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be vali~ until the ISSUANCF OF PFRlllT TOTAL CHARGES I TOTAL CHARGES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EX~lINED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all ,work perfonned 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 UO OCCUPAIlCY will be made of any structure without the permiss~on 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 OP.S 701.055 will be used on this project. IWIE(please print) Jet)]\ ll)')')t'Y\.QYmLLV\ S](,IIATURE ~~ DATE ItJ/?-R'/gj FOP. OFFICE USE omtY 1/ Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy load Occy Group Sq. Ftg. riain Sq. Ftn. Access Sq. Ftg. Other x x Value Value Value x TOTAL VALUATION BUILOING PERHIT Charges and Surcharges Plan Ck. Comm/lnd 65~/Rldo Ppr F~e ------------ Plan Ck. Res 30%/Blda Per Fee I Fence ------------ I D~mo !SidewaIk Systems Development Charae (1. 5~) PLUt1BING PERMIT Charges and Surcharges !.. l I I "leI I Total.Comb. Permit ELECTRICAL PERI~IT Cha rges and Surcharges A/C Pavi nq NECHAN1CAL PERMIT Charges and Surcharges - J5. Ll2 Curb Cut ---- -- -I . In{ TOTAL . .l5,(fJ/>-: ,'. I',,;~ '. . .,;',~;f.i:" . ;~:,.' ~,I.tt :"1' '-.ll'" 'I"' .... J.... j"l V": ,: '1:' f I I , . i j I . j l , . ~ . . I II. t i I I , ! I j I 1 t j ~. ~ . COMBINATION APPLICATION/PERMIT (CAP) t. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. lane CountY ~ap Reference 11 03 43 2. example- Lot I. Block 3. 2nd Addition .~o' Sprlngtleld Estates C.' Name: etc. of owner and construction lender D. I Energy Sources 1. example- heat/electrical'ceil;~q/or forced air Gas 2. examole- waterheater/electrical/or solar E. Square footage 0'( valuation,'etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project, check-new -if addition, check add, etc. . ,"', F. Building perla information: 1. example - construct single family house with an "attached garage examele - remodel existing garage into family room examole - 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 NG. Boxes adjacent , to the appropriate item(s) to be installed "8. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division __. 1. To conserve space on the permit form the schedule~ have been abbreviated 2. If the item(s) to be instal.led 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 SCHEOULES D. 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. --- 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. .' 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. 2. 3. II. IV. V. FOR OFFICE USE ONLY . I , I I ! ; 1 ; . , . I I I ! PERMIT VALIDATION Permit Clerk ". ..-,.- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 1 \.",,, i , I I , . . ~ , . j , , I I ] I '\ (I~ Permit 'applicant exempt from registration with the Builder's Board because: Additional Project Information: ." '"- ~~ '. PLANS REVIEWED BY: name signature -, \ ~...., '~.;J-: -;J date ..:. " 1 IrISPECTlOtl LIIIE 726-3769 . . .... ~CITLOF SPRIIIGFIELU." .... COMBlIIATlON APPLICAHON/PERMIT E!IERr,y SOURCES: Heat . Hater Heaterl . I1IFORlIAHON liNt .1 726-3753 So. Ft9. '-lain ~q. Ftg. Access. Sa. Ftg. Other Ilel< Add Alter Rep. -Fence Demo Change/Use Other- - . ~ Job Address '14, ~ 0 1 Lv\.. (j . '.:;'..,.,- >. ,. '. Legal De5cription Ranqe_ Owner Address :T (')(] Y' 7 _I ;....'" IY\ P\'Il'Y) '" ,]LJ,! ry J 10 Phon"l41.l)fi'1~ ValUE of Hark: CO ,. .$,~. . BullriirlQ Permit Info: Describe l~ork( he. I Far,,; 1 v nesidence l'lith JI.ttached l'laraoe) Build Single - --- 1- '~ Address Ut.~ r liU r EM1 (name'} Phone [address) u. 'J:rr-\f:,-mlf~; l'll~o&:h:d 6,/ KO'-l- (9-r II Li f'r1 Ad, Anne" ,t-..J' ~\ Jr ~ (i\~l ~ (\~VA l ~hone I no. \ Construction Lender Primary Structural Electrical ;~echan;cal CO:iTRACTORS (name) (address) (1ir:~. no. (exoirec;) (ohnnp nn \ Genera 1 Pl umbi no ., 1 Electrical L I- . ~t..r.J...!'~Chan;cal e" PLUt1SWG I FFF 'rHI\Rr.F tm ELECTRICAL , I r~t" I n..lc..pr.r: 1JfL MECHANICAL :,,',.. ~H rHADr.~ lEaCh single fixture IRelOCated buildino (~ew fix. additio~al) IS.F. Residence (J bath) Duplex (1 bath) each Additional bath Residence of SQ. FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 ~n~rp hp~tpr ~nrl vpnt Hater service Temporary Construction IChange in existing rp'l- j rlJ'llrp multifamily. comm. or lnrlll~tri<'ll Appl iance vent c;eoaratp Stationary evap. cnoler I V'ent: fan wi th sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood ~nd duct_ Wood stove/heater Sewer Storm Sewer Of amps. I COI~.1. /IND. FEEDERS Install/alter/relocate rli~trih fpprlpr~ Of amps. I I I SSUANCF OF PFRlll T TOTAL CHARGES I TOTAL CHARGES TOTAL CHARGES !iHERE STATE L\\i REQUIRES that the Electrical I<ork be done by an Electrical Contractor, the electrical portion of this pernit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAV~ CAREFULLY EXN11NED the completed ap~lication for permit. and do hereby certify that all information hereon is true and correct. and r' further certify that any and all work !lerformed shall be done in accordance with the Ordinances of the City of 50ringfield and the laws of the State of Oregon pertaining to the work described herein. and that rw OCCUPAIlCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderts 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 7~1.055 will be used on this project. IIANE(please print) Jffin lIYht'YlQY'ma.v\ SIGIIATURE ~1~ nATE ItJ/2J/~ FOr. OFFICE USE 0111 . Zone Fire Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy Load Occy Group Sq. Ftg. r1~in Sq. Ft~. Access Sq. Ftg. Other x Value Value Value x x TOTAL V ALUA T lOti - BUILDING PERI.IIT Charges anc Surcharges Plan Ck. Comm/lnd ____________ 65%/Bldn Ppr ~pp Plan Ck. Res 30%lBl do Per Fee Fence .lsyster.lS Development Charae (J.5~) I I PLUI1BING PERMIT Charges and Surcharges D~mo ELECTRICP.L PERI~IT Charges and Surcharges Sidewalk I A/C Paving --~-J5.-QQ-' Curb Cut . I . {rij I \ Total Comb. rermit MECHANICAL PERMIT Charges and Surcharges !---< ~ I I TOTAL ~ .._..l5,J()O 1. Applicant to furnish A. Job Address B. Legal Description I. examo]e- Tax Lot 100, l! 03 43 2. examole- Lot 1. Block 3. 2nd Additio J' ~prlngtield Estates C. Name, etc. of owner and construction len, O. Energy Sources 1. examole- heat/electrical ceilinq/or ~ ~ 2. examole- waterheater/electrJcal/or $( ... E. Square footage or valuation, etc. -- 1. examole- 1250 sq. foot house, 500 sq. 2. examole- if new project, checknew.. ,111.. chec~ add. etc. I F. Building penit infonnation: 1. examole - construct 5ingle family hou attached garage . Rec'd From 2. examole. remodel existing garage intI ~m. 3. eXdmo I e - convert s i n91 e family res i ct. restaurant (change of use) G. Value of work as defined in Section 303 (i f.' Structural Specialty Code H. OESIG;j TEAI.I AND CONTRACTORS To avoid design or construction delays. Bu Division Staff must be able to contact app persons regarding design information or jo ~t. corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical A. Exceot where blank soaces occur in the des, portion of the !>:echanical and Electrical SI d.u' the applicant need fill-in only the Na. Bo; to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical ~ are avai lable at the Building Division 1,_. 1. To conserve space on the permit form tr. have been abbreviated 2. If the item(s) to be installed are not the abbreviated schedules you should co '1.t full schedules C. BUILO!llG DIVISION STAFF WILL FILL OUT ALL FI CHARGES ON THE SCHEDULES O. As noted on the CAP, the label must be deli, ~d electrical contractor for signature by his f supervisor. The general contractor is .not c to sign the electrical label.. - Applicant to sign and date W~enever possible. the initial application will a wor~sheet only. Where possible, Building Oivi will prepare a type written copy and return it t applicant at the time the actual permit is issue ~r signature. IV. Fees 'nd Charges Plan check fees are due and payable at the time ( application, and no plans will be processed untii {:s fees are paid. All other fees and charges are dl payable when the permit is issued. l- . Ii - .... . COMBINATION APPLICATION/PERMIT'(CAPj . ~ PERMIT VALIDATION lane County Map Reference CITY '- . III. V. FOR OFFICE USE ONLY OF SPRI NGFI ElD r Date City Hall Springfield. Oregan Department of Public Works OFFICIAL RECEIPT No. B 5 5 0 41 c It) - dB - 198n ..... Tt1'1.o 2LMrY'rf7rff}f1l1 '7 L..J'7 ~.; iLL II \. ( ( . Address (' Received Far: ( ( - /1 )()/-d.,,;}ID CJef'-{JJ?mC( ---rn 10 -# p() III z/ '-J ( ( ( ( c. /5.Jp() cL ~ A. "'t ) f' /.-nr LU-/ . AUTHORIZED SIGNATURE ( 7.0' .,.".t SHl~TON.TU"''''ULL '.'0.'1'" . (UG....,. Oil . '.. Amount Received \.. ~r ( '. J "\ (I.udu./ r Permit Clerk PROJECT CONOITIONS TO BE SATIS~IED BEFORE OCCUPANCY: I ! I I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWEO BY: name signature J date .".:.. t::.. . , " ,.