HomeMy WebLinkAboutPermit Mechanical 1990-9-7
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Job Address /9/,? Uv7i>.d
Legal Description IJ()'~ '"}iJ(')'. n.~')("'()
CfTY UF SPRINGFIELD
CDMBIIIATIDN APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
.
'- j
fNFDRllATION LINE
726-3753
Sq. Ftg. '.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other - -
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'-
I INSPECTION LINE
726-3769
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ValUE of Hork: ~~
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BuihfinQ Permit Info: Describe Work(Le., Build Single
Familv nesidence With Attached Garaae\
;P;C7'~E ~A"/? ~"'*'..-~ .-2-
'~.c-~~~#'~.#r O/Y/?-
c!) l' ~-) L6~A.-7" /;1? <;"'
Address /"J /"7 Zj~~~fL ~7"^ Phone
<,P~_p . ViA q?o/??
Construction lender /'
Owner'
Address
DESIGN TEAll
(name)
Phone
(address)
fl ics. no.
(exniresl
(ohone no.)
Primary
~~
----; .-
- ~
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(l ic~. no.)
(PXO; rp<:;)
(l)hnt1p I'In, ,
General
Plumbina
'-
'.
.~--
Electrical
flechanic'alh...?o ~r-;Z:C~ ~~"..y-....-::. .
PLUllBING
ELECTRICAL
~Y'.c:;;;:~ - ?-/-~/, "?t:/<~a/(!)I
,
MECHANICAL
NO.
FEE CHARGF rw
~~~ r~~ NO
<:.E..L .cHARliE.
Each Single fixture
Residence of
SQ. FT.
I
furnace/burner to
,r -- ..." BTU'~
~~/ rl -"""r.
Floor furntce
and vent
;"C'IIC>
.~
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
Il bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tp~ ~nrl ~P"t
Storm Sewer
Of
amps.1
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart from
heatinq or A.C.
I Mechanical exhaust
hood and due,t
I ~Jood stove/heater
~6r"77?,/~
?-
~Iater service
Temporary Construction
Change in existing
rpSi dJ'nr:p
multifamily, conm. or
Jndus,trial
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
d;~trih_ fpprlpr~
Of
amps.
'.
\--. '
'.,
'.,
....... -
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valiJ until the
TOTAL CHARGES
ISSUANCf OF PFR!IIT .d:!?-
TOTAL CHARGES /.?'7/P. /,":;)--. ...
that the Electrical work be done by an. 'Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 oerformed 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 tlO 'OCCUPAr~CY 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 ORS 7n1.055 will be used on this project.
IWIE(please print) C:;;;:c"r ;yCJ /l/~/Q NS~SIr.!lATUREL~~:>,.. OATE9-) "'5'n
FO~ OfFICE USE QiJL Y ,,/
Sq. Ftg. Ilain
Sq. Hg. Access
Sq. Ftg. Other
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
x
Value
Value
Value
Fi re Zone
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERflIT Pl an Ck. Conm/lnd
Charges and ------------ 65%1Bldo ppr Fpp
Surcharges Plan Ck. Res
30%/Blda Per Fee
PLU!lBING PERMIT Fence
Charges and ------------
Surcha rges Demo
ELECTRICAL PERr~1T Sidewalk
Cha rges and ------------
Surcharges A/C Pavin9
!lECHANICAL PERMIT ::?2';: - Curb Cut
Charges and ----- _:..._---
Surcharges /.;;;>.~
syste.ms Development
Charqe (1.5%) .
Total Comb. Permit
TOTAL
c--- ,
I '26, 'ZS- .
~
.
COMBINATION APPLICATION/PERMIT (CAP)
.-
I. Applicant to furnish
A. Job Address
B. legal Description r-....-. ) ,
1. example- Tax Lot lOa, lane 'County M'ap Reference (-'~
17 o'j 4'3
2. examele- Lot I. Block 3, 2nd Addition to
Springfield Estates . " ,,-,' '.,
.::SC...... 'Name';'et-c. "of' owner 'a"nd-..construct1onie'nder \. . .
.~ D. Energy Source? ~', ... ":"~ . '" ....., '_~
. ''-''.' .~.L:......examl?le--...neat/electrfcal~ce'Unl"q/or 'forced air Qas
2. exa~~e- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
cneel< add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. exam~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aJ of the
Structural Specialty Code
H. OESIGN 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.
I!. . Abbreviated Pru~bing,-Mefhanical.""& 'Electrical Sc.hed.ul.e~,;...
. 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 BuiJding Division
1. To conserve ,space on the permit form the schedules
. liave" 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
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. ---
Ill. 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~penmi.t. is issued.
'.. ~', . ~'.' ",
V. FOR OFFICE USE ONLY
.... ,
'P~OJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
, ".'~ '.
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PERMIT VALIDATION
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Pennit
Clerk~~~
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Permit appl icant exempt from registrati on with t.h.e _Builder's -Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
l
date
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