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Home My WebLink AboutPermit Mechanical 1989-1-19 LI INSPECTION LINE 726-3769 . . Owner' /I ,7 IJJ; ~ V;2/l /J /!l I/L1~ h1A-;t;.-r,4Mk /' d' CITY UF SPRINGFIELD COMBlIlATION APPLICATION/PERMIT EIIERGY SOURCES: Heat t~ater Heater Range ValuE of Hark: lNFORJIATION UN, 726-3753 Sq. Ftg. I"ain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Pep. --Fence Demo Change/Use Other -- -- ~ 18 I--c:.. ~. Job Address legal Description Address Phone Bul1dinQ Permit Info: Describe Work(i.e., Build Single '1;;;::;" :::;Z"" IudA_ Construction lender Address DESIGN TEAH (name 1- Phon~ {addressl-. (1 ics. no.) (exni res) lnhonf':' nn. Primary - t2J /i'7/ /' (- I c.+--- 630' (j Structural t; t/j/ 2 ,I.;VC-f , 1 ~ [ '/ Electrical Mechanical CONTRACTORS 1m....) (address) nice;. nn.) (~)(nir'pc:,' (l1hnnp nn , Genera 1 NO, ~~L '~mG d FFF rHARGE.JJn /7IJ / r- // / / 1;J~110A.1 /oU I Plumbino Electrical ~lechani ca 1 ELECTRICAL HECHANICAl rrL J:IlARliE. ..1!Q..... t'ct' ru.;&G,[ Each single fixture Residence of SO. FT. furnace/burner to BTU's Reloeated building (new fix. additional) S.F. Residalu (] bath I Duplex (1 bath) each New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall So~c.P hp~tpr ~nrl vpnt Additional bath Temporary Construction Change in existing rpc;. i d_p_nrp multifamily, COTml. or lnrlustrial 10f amps.1 ICO~4./INO. FEEDERS [~~~;~~~~a~~:~~~~locate I 10f amp~1 Appliance vent seo_arate Stationary evap. cooler I Vent fan with sinole duct I Vent system apart from I heatina or A.C. I Mechanical exhaust hood ilnd duct. [ \'lood stove/heater I I I ~Ia ter serv; ce Sewer Storm Sewer ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES , WHERE STATE lW 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 EXAMINED the completed apr1ication 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 1m OCCUPAHCY 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 are in compliance with ORS 701.055 ,will be use~ oJ this project. NAlIE(please print) Lt.),,,,,. I)) (JA:)~P""~ SIGIIATURE~IJ/ /J(N-4t, OATE~(qJ{q_ FO~ OfFICE USE OilL Y / / " Sq. Ftg. riain x Sq. Ft9. Access x Sq, Ftg. Other x Zone Fire Zone Tvpe/Cons t. Bedrooms Units Value Value Value Flood Plain Stories Occy load Occy Group TOTAL VALUATION BUILDING PERflIT Charges an~ Surcharges Plan Ck, Comm/lnd 65%/Bldo Ppr Fee ------------ Plan Ck. Res 30%/Blda Per Fee I Fence I D~mo I 'Sidewalk ------------ I A/C Pavi ng )5 ,00 I Curb Cut ---- ---,7sl Systems Development Cha rqe (J. 5~) PlUl1BING PERHIT Charges and Surcharges ;6\ 1n '""' ELECTRICAL PERIIIT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges ITotal Comb. Permit I I TOTAL JS-75 I . ,..' , ... . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address 8. legal Description l. example- Tax Lot 100. Lane County Map Reference 17 U3 43 2. exam~le- Lot 1. Block 3. 2nd Addition to spr,ngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example-'heat/electrical ceilinq/or forced air Qas 2. examDle- waterneater/electrlcal/or solar E. Square footage or valuation, etc. - l. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-n€w - if addition, eMek: add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. exam~le - 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. 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 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. --- 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 eheck 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. \ ~o5 't \---11-~9 ~ , V. FOR OFFICE USE ONLY Permit Cl erk cC-/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date