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HomeMy WebLinkAboutPermit Mechanical 1990-9-7 "'l 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 - - ~ ~ '- I INSPECTION LINE 726-3769 '. ValUE of Hork: ~~ ~, 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: , ".'~ '. .. .. ,...,--' -'., ;'-: .:.;e....\ .' -., PERMIT VALIDATION I$z.;> ?--,. ,'. -"'',)',..,.-::;.~,,1,''.,,/.,_'_.) "', "--.. "7~ -._'-. "~",:~ q~~?~~P . ~'"''\''' ",~ , " . ,:.(" -... '.:> " ", ... -":.;.""" ........ I , <'. ~. ~ ... "4,..:. " c::a /fbb0 , ; \., . ~ .. ~, .," Pennit Clerk~~~ .. r e;rc, 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 ..~