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HomeMy WebLinkAboutPermit Mechanical 1987-8-25 t 11 . CITY OF SPRINGfiElD COMBINAHON APPLICATION/PERMIT . INFOAMAJlON LINE 726-3753 INsPEcrrtiN LINE 776.-37~( Ow,", K. 1). '11WIfKA Add.... q 3L-k!e"~VD SP~LD Phon. .,.,.,. 7$+' I ENERGY SOURCES: Heat I Walf'lf Heater Ranqe _ Volu. of wO'::Jf) CP Building Permit Inio: Dewibe Work ii-e.. Build Single Familv Resideroce With Attached Gc;uoqel ,1=ISNI!A. ~JIJ"D ~(/!... IlL:# MI1//1.3K Sq. FIg. Main Sq. fig. Aceon. Sq. Fig. Other _New_Add _Aller_Rep. _.__Fence_Cemo_Change i U ,e _Other Job Addren (HI ~v &.vI) ~ Legal Delcription Conllruclio" lendlH Addreu Phone DESIGN TEAM (nome) C,,6/ I:- (addross) (lk.. no.)~tp:'.'1 Ar (phone no.) Primary Structural Electrical Mechanical CONnACTORS (nome) </f;'~ (address) (lies. no.) (0)(pi,8,) (phono no.l G..netol P:~'mbinQ Elecuical Mechanical PLUMBING I fEE ! CHARGE I NO. ElECTRICAL I CHARGE I NO. I MECHANICAL NO. I 'I FEE FrE I CHARG~ I Each ~inqle fiKlure R"lot~!ed building (new ti;Jl;. additional) S.F. Roelidln~e (1 balh) Iq: ft. New circuits. alrerolious or extension, furnace/burner 10 ll..TU/~ Appliance vent separa te Stationarj' evap. taoler Venl fan with sinqie dud Vent .system aport from . heatinq or 'A.C, Mllmanicgl exnau,t hood and duct Residence of SERVICES Dualn 11 balh) each Temporary Construction Addilional bOlh Amps. WOlllr ~ervicl!! Sewer I Wood ,tovel heotor ~O::.J Stor,m Sewer FEEDERS Heat Puma Air handler to 10.000 eFM Air handler aver 10,000 CFM Amp,. I I I'~ I r' I TOTAL CHARGES I I TOTAL CHARGES TOTAL CHARGES ISSUANCE ~F PERMIT/Q.OU is.OU WHERE STATE LAW REQUIRES Ingt the Electrical worle be done by the Elel1rical Contractor, the electrical portion 0' this permit sholl not b. valid until a label has be.n signed by on flettrical Conlractor and attached to the electrical panel. I HAVE C..\.REFULl Y EXAMINED Ihe 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 performed sholl be done in oC(Qrdgnce with the Ordinances of the City of Springfield and the lows of the Stale of Oregon pertaining 10 the work described herin. and that NO OCCUPANCY will b. made of any structure without the fHlrmiuion of the Building Division. I further certify that my registration witn the Builder's Boord is in full force and e#ect os required by ORS 701.055, that if exempt the . basis fOr uemption is noted heron, and that only subcontracton and employees who ore in compliance with ORS 701.055 will be used on thi, projed. Bo,is for Builder', Boord exemption: NAME (pl.... p,;nl) K./tfN/,1!./Y1I 1), MNAJdO SIGNATURE l'f'rz ~JI~___ ? . FOR OFFICE USE ONLY , /. ~... _ f!' - DATE ~ S-/i'L , . Value Value Value Zone Typel Canst. Unih c_. Ftg. Main Fire Zone ~drooms n,cy Load Sq. Ftg. Access Flood Plain Ctori-' "ccy Group Sq. Ftg. Other BUILDING P!:RMIT plan Ck. Comm/lnd Charge, and 65%1 Bldo Per Fen Surchorge, Plan ell.. Res :30%1 BIdet Per fee PLUMBING PERMIT Chargel and fence Surchargu Cemo elECTRICAL PERMIT Chargel and Sidewalk Surchargel A/c Pavina MECHANICAL PERMIT __l~ GO Charge, and Curb Cut Surchorges .( /) (') . . . TOTAL VALUATION Sy,tems Development Charae /1.5%\ Tolol Comb. Permit TOTAL ! 5. loG 's,l\l'V'S '\ . ~. iU ~.:.. "\ COMBINATION APPLICATION/PERI (CAP) I ' I. Applica~ ta furnish A. Jab Address B. legal Description 1. example-lox lot 100, lane County Map Reference 17 03 .\3 2_ example-Lot 1. Block 3, 2nd Addition ta Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. exomclc4water heater/electrical/or solar .. E. Square footage or valuation, etc. 1. example-1250 sq..foot house. 500 sq. foat garage 2. example-iTnew project, check new-if addition, check add, etc. F. Building permit information: 1. examole-construct sin'gte family house with an attached garage 2. example-remodel existing gorog€:- into faniily 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 Division Staff must be able to contact appropriate perso'ns regarding design inf~rmction or job site corrections, et~. II. Abbreviated Plumbing. Mechanical & Electrical Sched~les A: Excepf where.blonk 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) 10 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 hove been abbreviated 2. If the item(s) to be installed are not !=overed on the abbrevi~ ated schedules you should cansult the full schedules C. BUILDING DIVISION STAFF WILL Fill OUT All FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible. the initial application will be used os a worksheet only. Where possible, Building Division Stoff will prepare 0 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 ore 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 ore due and poyable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , Additional Praiect Information: PLANS REVIEWED BY, nome _signatur... . Permit Cler~ . I, PERMIT VALIDATION'" I I I Jato "I I ! , ',. ',. INSPECTION LINE 77~376~ ) CITY OF SPRINGfiELD COMBINATION APPLICATION/PERMIT . INFORMAJlON LINE 126-.J7.S3 ., Job Addren fl3/ ~'" &..tD ~n ENERGY SOURCES: Heat Waler Heater Ronqe _ Value of Work: i Sq. Ftg. Main 151:1, Fig. Actus. Sq. fIg. Olher _New__Add _AII.t,_Rep. . _fence_Cema_Chong_l Ute _Oth.r JJ - IJ 1) .~ I I Legol DelCription Ow,,, r. V_ -rANIlKA Add,... q 3L-KeU '" /3I-vo <l.P.FL" PhOM 7+1.. 1$+1 Building Peun;1 Info: Oetcrib. Work {i.e.. Build Sing I. Famil.,. Residenc.. With Alloch.d Goraqe\ .Gs~EA. ~b"D S7iJ'e. (JL ~ MI1I/2.3K Conu,uClion lende' Addren Phone DESIGN TEAM (Mme) < EA J;. (addr.,,) (Iics. no.) (eJl.pirlltl (phone no.) Primary Structural electrical M.echanical CONT~ACTORS (nomel <'~(.,P (oddress) (lies. no.) (expinu) (phone no,) Genllrol Plumbil'lo E!r!l~lricol Mechanical PLUMBING ELECTRICAL MECHANICAL NO. I F::IO I CHARGE NO. FEE i CHARGE NO. FEE 4 CHARGF ~ i I Eaen single fixture R"lacal.d building (n..... lix. addirional) S.F. il.niden~e (I bath) Sq: ft. New circuit" alterotious or extensions. furnonl burner !o llTU's Appliance ve"t separate Slationar~' ovap. cooler Vent fan with singie duct Vent system apart from heati~a or A.C. M.chanical exhaust hood and dvct Residence o~ SERVICES Ouolu (l both) !!!oen Temporary Construction Additional balh Amos. Wat!!!r u""iee S.wer I Wood stove/heotor ~O.J Slor.m Se....er FEEDERS Heat Puma Air hondler to 10.000 CFM Air handler over 10.000 CFM Amps. TOT "L CHARGES TOTAL CHARGES ISSUA"'CE OF '''MlrtU.ad I rOtAl CHARGES { S .0 u WHERE STATE LAW REOUIRES Ihat the Electrical work b. den. by the Elertricol ContraCTor, the electrical portion of this permit shall not b. valid until a label has been si9ned by an Electrical Conttactor and attached to the .Iectrical ponet I HAVE CA.REFULLY EXAMINED the completed application for permit. and do hereby certify that 011 information hereon is true and <<I"ect, and I further certify that any and all .....ork performed sholl b. done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon pertaining :0 the work descrio.d herin. and that NO OCCUPANCY will b. mad. of any s!fucture without the permission of the Building Division. I furth.r certify thot my regiltration witr. the Build.r's Board is in full force and eff.ct 0' required by ORS 701.05.5. that if ex.mpt the. basi, for ex.mption is noted h.ron, and thot only subcontractors an~ .mployees who ore in (Ompliance with ORS 701.0.55 will b. used on this project. Bosis for Builder's Boord eAllmprion: NAME (please print) r./mll.e.eN V MNA.A::'4 SIG"'ATURE ~ ,U,'.,/.'~",,/... FOR OFfiCE USE ONLY - DArE ~ s-/n Zone Type/Canst. Units fire Zone Bedrooms _ ':;Iccy Load Flood Plain O:;lori., Occy Group BUILDING PERMIT Plan Ck. Commllnd Charge, and 65~:.1 BldQ Per Fee Sl,Irchor9.s Plan Ck. Res 30%1 Bldq Per fee PLUMBING PERMIT Charges and Fence S...rcharges Demo ElECTRICAL PERMIT ChQrge' and Sidewaik Surcharg., AI C Po...ino MECHANICAL PERMIT __l~ 00 Choroe, ond C...rb Cl,lt Surch-argel '//1/) . C_. Ftg. Main Sq. ftg. ....cc.n Sq. Fig. Other Value -1/01". Volv. TOT....L VALUATION . . SYltem, Development Chorq. (1.5%) Tolal Comb. Poermit I I TOTAL 15. ~C> A. Job Address B. legoJ Description . 1. eXam ole-tax lot 100, lone County Map Reference 17 03 43 2. examOle-lot 1. Block 3. 2nd Addition ta Springfield Estates C. Nome, erc. of owner and construction lender D. Energy Sources 1. exomo/e-heat/electrical ceilinq/or forced air gas 2. examoie.water heater,. electrical/or solar E. Square footage or valuation, etc. 1. examole-1250 sq. faot house. 500 sq. foat go 2. examcie.jf new project, check new.if additic odd, etc. F. Building permit information: 1. exomole.construct single family house with c garog~ 2. exomole.remodel existing 90r09& into faniily 'on J. exompie.convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) af t~, 'Structural Specialty Cede H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building I (=0: Stoff must be able 10 contact appropriate persol'l! I..., design information or job site corrections, etc. -~- COMBINATION APPlICATlON/aIT (CAP) I. Applica~ to furnish II. Abbreviated Plumbing. Mechanical & Electrical Schec A: Except where.blcnk spaces Occur in the descriptio: of the Mechanical end Electrical Schedules, the aF need fill.in only the No. Boxes adjacent to the apF item(s) to be inslolled B. Full Plumbing, Mechanical. and Electrical SchedulE ore available at the Building Division 1. To conserve space on the permit form the sched have been abbreviated 2. If the item(s} to be installed are not covered on ated schedules you should consult the fuil sched. C. BUilDING DIVtSION STAFF Will Fill OUT All FEES CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible. the initial application will be used worksheet only. Where possible, Building Division Stafi prepare a typewritten copy and return it to the applica the time the actual permit is issued for his signature.. IV. Fees and Charges ~l Plan check fees ore due and payable at the time of the and no plans will be processed until these fees are paid other fees and charges are due and payable when the I is issued. V. FOR OFFICE USE ONLY PROjECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: name -signature doff" It '. \ PERMIT VALIDA Tlo';'\J l ~ .\1 CITY OF SPRINGFIELD Date City Hall Springfield, Oregan Department of Public Wark. OFFICIAL RECEIPT No. B llli~ .oHo 16\ 11<>-. ~ ~~(\ Fram -.)\Jl.J rI.1. ' C\~\ ~1),\Di_~~J-~ ( 57167, Rec'd Address Received Far: e ( ',r '- '-LI' },'- A\, ~ 'R...._ { 'L. '- J~\_ l\. \~ .c::t::j 4~o . loa ,. (" ( f. ( ( ~i \l~ ( ( _I';:). \.Q ~_ Amount Received \ . ~1J1J. ~ Al).t'HORIl;ED SIG".ATUln: s..lElTO...TUIll......LL ~.,..n"s. I[UCOE><I, O. .,,.0' n."" ( ( 1"" \J~I f !-, \ , I I I .