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HomeMy WebLinkAboutPermit Mechanical 1990-6-5 .... l IN'P~CTION LINE 1726-3769 . CITY Of SPRINGfIELD . INFORllATION liNe COHBIIIATiON APPLICATION/PERMIT 726-3753 E!lERGY SOURCES: SQ. Ftg, '.1, i n He, t ~Q. Ftg, Access. :3 H'ter Heater SQ. Ftg. Other flew Add Alter Pep. I Ranqe -Fence Demo Change/Use _. .___ ValUE of l'lork: Other- - ~'\ \ ?--- '\ 1 nConc7J' BUji1tiinQ P~rmit Info: Describe Work.{Le., Build Single D..:..\ ~!''' 7::::jFa""1V nesldence "l1th A.ttached Garaoel (:)"i, 1/ IV CIa') r-aA/10).C- ';{ ( f Ye c...fvlL.- +-00 c, Co\S ') c. ~- Job Address ''JO 3 . mtw ill st--" Legal Description 1/03367; I - 12.-70V Owner T '^^ ~I'V\e<, Address 3:::>.", VY\ D-..:\ t/\ S+- 50 r7 t/lc, h' (> / J.. 01Z. 7 7 L/ 7 7 .' dJ ~ Constructlon Len er v Address DES I oN I EAr~ (name) Phone (addressl (lies. no.) (exn;res\ (ahaM no. Primary ~ Structural Electrical Mechanical CONTRACTORS (name} (address' (1 ics. no. \ (pll'n;rpc:,\ fnhfl"'" n... \ Genera 1 Plumbina Electrical ;? 'flech;jni~a1 (I:.~,;.; ~/~. J 'PLU/1BtNG' (lj-b C;l,C>v " , .... -'? /7" ELECTRICAL MECHANICAL Each single fixture FEE . r:HARGF" . Nl' F'F'F . rH'iRG.E. NO_ ' FF'~\.GliARG.E. Residence of furnace/burner to SQ. FT. BTU's NO. . Relocated building . . (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~hp~tpr ~nrl vpnt amps. Appliance. vent ~roarate Stationary evap. cooler Vent fan with sin~:J1e duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing rps i QeJ1('p multifamily, comm. or lnd.J,l<:.trial ~Iater servi ce Storm Sewer Of COffi1./IND. FEEDERS Install/alter/relocate distrih. feeders Of amps. TOTAL CHARGES '. TOTAL CHARGES WHERE STATE L.\\~ REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical I SSUANCf OF PFRfllT -~. TOTAL CHARGES \ tl, ~ 'Electrical Contractor, the electrical p6rtion of this permit 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 /10 OCCUPAllCY 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 a~e in compliance with ORS 701.055 will be used on this project. IlAf.1E(please print) SIGIlATURE FOr. OFFICE USE QlILY Zone Tvpe/Const. Uni ts Sq. Ftg. t1ain Fire Zone Bed rooms Occy Load SQ. FtQ. Access Flood Plain Stories. Occy Group SQ. Ftg. Other .ryATE I x Value Value. Value , x TOTAL VALUATION BUILDING PERfllT I Plan Ck. Coom/l nd Charges and ------------ 65%/B1do Pj'r Fpf:l Surcharges Plan Ck. Res 30%/B1do Per Fee PLUl1BING PERMIT Fence Charges and ------------ Surcha rges Demo ELECTRICAL PERrlIT Sidewalk Cha rges and - --- -- --- --- Surcharges 6 ~~ A/C Paving MECHANICAL PERMIT \ .~ Curb Cut Charges and -----"1----- Surcharges <~ , , ISystems Development I, Charoe (L5~) Total Comb. Permit TOTAL j \ 6."15 II!' . . ,. , ...Il1 ,_'.1., COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION. __, J. Applicant to furnish f A. Job Address B. Legal Oescription 1, ~xamp'le- Tax Lot 100. Lane County Map Reference ~ II 03 qJ 2. example- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinqjor forced air Qas 2. exa~le- waterheaterjelectrical!or solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, Check add, etc. F. Building pennit information: 1. examele - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. exa~le - 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. OESIGN TEAM ANO 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 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 Building Division 1. To conserve space on the permit form the schedules have bee~ 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. --- 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. Put' ~+t (\.L-GJ:- . n?<-t~ V. FOR OfFICE USE ONLY Permi t Cl erk l~l~ - , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit appl icant exempt from registrati on with the Buil der' s Board because: Additional Project Information: PLANS REVIEWEO BY: I name signature date