HomeMy WebLinkAboutPermit Mechanical 1987-12-10
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'I INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORlIATIDN UN" ,
726-3753
Sq. Ftg. I"ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Job Address /_2,2,5> _~ :/.eUltb." /
legal Description ~
(1/ ' J A_ ~o .
Owner .11.ffJr1.JAh~ (/IUtu e'j .'1-
Address'""" -,,--_/ ~'A," ,(5 Pone
-' e><-=>,"">!,/"::.. ~j",.K7r
Construction lender
EilERGY SOURCES:
Heat
l-later Heater
Range
Va 1 U€ of l'lor~:
BuildlnQ Permit Info: , Describe Work.(Le. t Build Single
Familv ~esidence Hith JI..ttached Garaoe) .
liM/VdQ //D ~ ;1/,d;;;
o (j ;1'--'
Address
DE,IGN TEAr1
(name)
Phone
(address)
(l ics. no,)
(exni res)
(ohone no:\
Primary
Structura 1
t:)..{l 112.2-
'&""11/ j",\
Electrical
Mechanical
CONTRACTORS
(name)
(address)
nics. no.)
(~l(n;rp,,'
(nhnn,:l no_)
Genera 1
Plumbina
//i ~ 1/-
.~ (~tVlrLI,
/1
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.Je;u/~
Lfs-tj c;r; J-/2-fff
"3 rB-//5f
Electrical
~1echanical
PLUI,IBING
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
I FE"F I f.HARr,F ND.....-'
Residence of
J:H. I rl-1llR.G.E.. NO
. ~~~ . rl:lARG.E.
SQ. FT.
furnace/burner to
BTll's
Relocated buildin9
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl V,:lnt
Sewer
I
I
I
I
I
I
I
1 ---= ,
I ('to)
I~.
1
Temporary Construction
Change in existing
rp',j. i (tPJ'l"'1'l
Imultifamily, comm. or
Tnrlll"t.rial
I Of amps.
I com-I. /IND. FEEDERS
I Install/alter/relocate
r!i"trih fpp{ip,.c.
,"Of -amps.
I
I
1
I App 1; ance vent
<;eo;:!r~tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
I Mechanical exhaust I
hnn{i ",mj rfurt
I H~~d stove/heater I
1 U I
I I
'I I
Water service
Storm Sewer
ISSUANCf OF PFRIIlT
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali1 until the
TOTAL CHARGES TOTAL CHARGES
that tile 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 ~ivision
I HAVE CAREFUllY EXN11NEO 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. Derformed 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 fW OCCUPAUCY 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 exem t the basis for exemption is noted hereon, and that
only subcontractors and, employees who are in comoliance with OP.S 701.055 i be US:d ~iS project.
HAt,IE(please print)5:#1.~nud W 5IGrl Vg.../:4'1H~ OAT~.:2-~OA 7
fOr. OFFICE'US1:-orILY r / I',
Sq. Ftg. riain x Value
Sq. Ftn. Access x Value
Sq. Ftg. Other x Value
Zone
Tvpe/Const,
Bedrooms
Stories
Units
Occy load
Occy Group
Fi re Zone
Flood Plain
TOTAL VALUATION
BUILDING PERHIT
Charges and
Surcharges
Plan C~.
___________ 65%/Bldo
Plan C~.
30%/Bldo
I Fence
I Demo
I'S1dewal~
1 A/C Paving
\5 ' 0,0 I Curb Cut
-------.-=;5-1
Conm/lnd
Ppr ~pp
Res
Per Fee
Systems Development I
Charoe t1.5~) .
PLUl1B ING PERMIT
Charges and .
Surcha rges
ELECTRICAL PERt:IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and ,_
Surcharges V
Total'Comb. Permit
"
TOTAL
IS ,75
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp'le~ Tax Lot 100, Lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinqjor forced air Qas
2. example- waterheater/electrlcaJ/or solar
E. Square footage or valuation, etc. -----
I. examole- 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. exam~le - construct single family house with an
attached garage
2. examEle - remodel existing garage into family room
3. 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.
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 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 DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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 permit is issued.
(rtJ~ fo 3
(2. - ro -81
V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFI ED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date