HomeMy WebLinkAboutPermit Mechanical 1987-10-16
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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./
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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 ,
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Meehan; ca 1
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r-PLUIIBINcV'
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~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