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HomeMy WebLinkAboutPermit Mechanical 1987-10-16 I , ~ Jjl1~I~rJ //?f1J1) /~/)/Yt/AL eel PhoneS03 AJIlAIt./.a(jy) VI? t!7;Uf' (P 11 iP5/oS I INSPECTION LINE 726-3769 Job Address Legal Description Owner. Address Construction lender Address DESIGN TEAr1 Primary Structural Electrical Mechanical CONTRACTORS Genera 1 Plumbina Electrical -. . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Range Valu( of Hark: g~55 ~.hi.uJ Jl./ (/ INfOR1IATION LINE 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- - ~ ~ ~ ~ (name) Phone (address) BuilriinQ Permit Info: Describe Work(i~e," Build Single Familv ~esidence With Attached Garaoe) Ii/:UV ~ ~ cv-d ' "J/-V' vwJ / (l ics. no.) (exo;res) (ohane no. '^._ <::'}r." '1'"1 ~ - - - (name) /,1 (address) nics. no.) (pxnir~c:) (ohnnp nn , \J \b\t>; r:~1 ~J~ Meehan; ca 1 / /)A;>N/" r-PLUIIBINcV' (\ I i / /l (':_;: , I' \ ~t/YAd 1 /~ ~~ tffinA2-f!tu~O. J :... ELECTRICAL . ,0 (/ M~ANICAL I ~i=~ J rI-lAR~i= NO_ I ~n' I n-lA~r,j:' NO.1 Each single fixture I FEF 'CHARr,E NO Residence of furnace/burner to BTU's SQ, FT. Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each IAdditional bath I ~Ia ter servi ce I Sewer IStorm Sewer INew circuits alts. or extensions ISERVICES I Floor furnace and vent Recessed wall So~rp hp~tpr ~nn vpnt ITempOrary Construction IChange in existing rp~ j dJIJ1CP Imultifamily. comm. or Tnduc:trii'll IOf amps. ICOffi1./IND. FEEDERS I Install/alter/relocate rlic:tritL fpprlprc:. Appliance vent C:POi'l r~ te Stationary evap. coolpr Vent fan with sinole duct Vent system apart from hpi'ltino or A.C. Mechanical exhaust hood i\nct l'iut"t Wood stove/heater Of amps. ISSUANCF OF PFRrIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,'li REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM11NED 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 rw OCCUPAIKY 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 emPt, ionj. noted hereon. and that only subcontractors and employees who are in compliance with OP.S 7nl.05~will ~d on hi project. lWIE(please print) Lft(2.f... '-I <;0 I Jit{ t:. i2b SIGIIATURE ::-D_ ~. . <2 om lO-}I." ~"c5'J FO~ OFFICE USE ~~- . ~ Sq. Ftg. t1ain x Sq. Ftg. Access x Sq. Ft9, Other x Zone Fi re Zone Flood Plain BUILDING PER~IIT Charges and Surcharges PLur~BING PERMIT Charges and Surcharges ELECTRICAL PERIilT Cha rges and Surcharges MECHANICAL PERMIT Charges and I _ Surcharges 'P Tvpe/Const. Bedrooms Units Occy load Occ.y Group Value Value Value Stories TOTAL V ALUA Tl ON Plan Ck. Comm/Ind 65%/Bldo PE'r Fee ------------"'Pian Ck. fes 30%/Bldo Per Fee Fence Systems .Development Char~e (1. 5~) ------------ I D~mo L I S1dewalk ~ --- -- --- ---I A/C Paving ;I~. 01? I Curb Cut -u-----7~-1 I ITotal Comb. Permit I I TOTAL - (S,7..s- . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 17 oj 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examjple. heat/electrical ceilinq/or forced air Qas 2. example- 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, check 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. 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 TEM~ 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 schedul es 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION IJ356 /D-Ih ~ftJ Permit Cl erk c.C/ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date