HomeMy WebLinkAboutPermit Mechanical 1990-6-14
Job Address
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, CITY UF SPRINGFIELD. INFORtlATlON LINt
COMBINAT!ON APPLICATION/PERMIT' 726-3753
EilERGY SOURCES: Sq, Ftg. 1,lai n ,,9
.Heat ~q, ftg, Access, ~
Water Heater Sq, Ftg, Other
flew Add Alter Rep, I
9 -Fence Demo Change/Use
::~u~ tl) Other- - I
Phone7'JII- BU11CllnQ emit Info: Descr1be Work{i.e.t Build Single ~
q7~77 ~~ '&~:~I~~'l'ru\( ~
Phone '\' \ I
{addressl - (lies. no. l (~xniresl (ryhon~ n~
no L{ Of)
iNSPFC1"lON LI~E
726-3769
Legal Description 17 (') 327 77
Owner. IJI7/rLj VYJfl..-!- '
Address - wi I J 1M. r1 filii! e-d
5on~fif'jd Q..(L.
Construction lend
Address
DE' I oN r tAf1
{name}
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
(address l
(lies. f1O.)
(exo;res)
(ohone nn. )
Genera 1
Plumbina
Electrical
~lechanical ~~ -Pfw.J H--"JJ1iYi3 S'S6 [,V lSl-d)/L- (J()4/o0
PLUNBING ELECTRICAL
LQ !E.!lj q [)
MECHANICAL
...llQ..,.
FEE CHARGE ~O
ccc r~ NO.
rrr rl-l'1R.G.E..
SQ. FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building .
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
App 1 i ante' vent
seoaratp.
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.~.
Mechanical exhaust
hnnd and dud
Water service
Sewer "
Temporary Construction
Change in eXisting
rec;iqeflca
multifamily~ comm. or
I Industrial
CO~1./INO. FEEDERS
Install/alter/relocate
rl;~tr;h. fppdprs
Wood stove/heater
Of
amps.
I SSUANCF OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE Ul~ REQUIRES that the Electrical work be done by an, 'Electrical Contractor, the electrical portion of this pennit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINEO 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 accordanca with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAr~CV 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 7Pl,055 w~used ~ ::oject,
IIAl,IE(please prin~~~ r~I<;;I-/~J/)c:;e"t SIGrIATuRE~d.~~ O^TE~-f4'-9,:
/ '\. ' FO~ 'OFFICE USE mlLY .?-'
Zone _Type/Canst. Units Sq. Ftg. r1ain ,x VallJe
Fire Zone Bedrooms Occy load Sq. Ft9. Access x Value.
Flood Plain Stories' Occy Group Sq. Ftg. Other x Value
TOTAL VALUATIOt.
BUILOING PERflIT
Charges and
Surcharges
, Plan Ck, Co"",/lnd
____________ 65%1Rldo P.l'r c..
Plan Ck, Res
30t/Bldo Per Fee
Fence
.Systems Development
Charqe (I.5~) .
PLUI~BING PERMIT
Charges and
Surcharges
Demo
'Sidewalk
ELECTRICAL PERIHT
Charges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
A/C Paving
Total Comb. Parmit
__~~~w- Curb Cut
.,S
TOTAL
\ ::s ,W
.
... ...."".. ._, .l.
-
'COMBINATION APPLICATION/PERMIT (CAP)
".'-.
I. App1icant to furnish
A. Job Address ,. I
B. Legal Description ; " ,
I, example- Tax Lot 100, Lane County Map Reference
II 03 43
2, 'example, Lot I. Block 3, 2nd Addition to
Sprl,ngtield Estates . : I)
C. Name~ etc. of owner and construction lender
0, Energy S'ources l . : ! 1 \ '
1. example- heat/electrical ceilinq/or forced air Qas
2. examyle~ waterheater/electrlcal/or ~
Eo . Square footage or valuation. etc.
1, examole- 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. examele - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam21e - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (al 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
. t" 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-1n 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 be~n 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 SCHEOULES
0, 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, ---
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.
.':;'--
,-I--
III.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.a
"
~.
II
PERMIT VALIDATION
G- \4-QO
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P,mit Clock ~ ![)Q)
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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,
date
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