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HomeMy WebLinkAboutPermit Mechanical 1989-11-1 Job Address -s-,pp ~d//"/ 57 · CITY OF SPRINGfiELD ~COHBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater ~ INFORltATlON LINl 726-3753 Sq. Ftg. I.'a I n ~q. Ftg. Access. Sq. Ftg. Other Hew Add Alter Pep. -Fence Demo Change/Use Other- - ~ 'S::. ~ ~, jINSPECTIOH LINE . 726-3769 Legal Description 1i~~>-r .......-:: ."\~ 7!f,' ';-PT Wd!:'?J' (. z;:, Address '~a?~~#/ ::37. "5#/..D. _L?.;? . ..r: . . , ,- '... ---'." --""<'~-"'.R:/'o/~ ,x:::;1!'n'~, -_/ Phone Range ValuE of Work: 17'~~ ~e:> Building Pennit Info: Oeser be Work(Le.. Build Single Familv Residence With Attached Garaoe' &.NV~-"y~ ~~??L. Cb~2A' Tp~c::- .' (name) Phone (address' (lies. no.1 (exniresl (ohane no.' Address OlSIliN TlAlI '. Electrical * Primary Structural Mechanical CONTRACTORS (name) (address' flies. no.) (exoi res 1 (ohane no. \ General Pl',Jm~ino Electrical Hechani~al~~X'r ~-..A:27$ijC?_ ~~W / ~_e~~C"7?Yp2 ~;C>-R/C:::>/ / / PLUIIBING ELECTRICAL MECHANICAL NO. FFF 'CHARGF N~ ~~F fH~Rr.F NO. HF fllARr.F SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence 11 bath' Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall : li.n;lt'p hpi'ltpr i'lnrl vpnt amps. Appliance vent seJarate S-tationary evap. cnnl~r Vent fan with sin~le duct Vent system apart from heatina 01'" A.C. Mechanical exhaust hood and duct ~Ia tel'" servi ce Temporary Construction Change in existing re5idr,nce multifamily, COnIn. or tndu<;tri"l Sewer Storm Sewer Of COffi1./INO. FEEDERS Install/alter/relocate di<;trih. fppdpr<; Wood stove/heater Of amps. ~ 7fF?.- ISSUANCE OF PFRIIIT TOTAL CHARGES WHERE STATE L~W 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 label has been signed by an Electrical Supervisor and returned to the Building Division /->~l:> thi s pelTolit I HAVE CAREFUllY EXNHNEO the completed ap!"'l ication for permit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work performed 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 110 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 exempt the basis for exemption is noted hereon. and that only subcontractors and employees who a~e in co~oliance with ORS 701.055 Wi~ used on this project. 1lAt-IE(please prlntlCC(/)'VCt il'IS~(qVJsc=.11 SIr.IIATURE d~~L~TE//-'/-'iS1 FOR OFFICE USE OilLY ,/- ,So. Ftg. 11a;n Sq. Ftg. Access Sq. Ftg. Other x Value Value Value Zone Fi re Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy load Occy Group x x TOTAL VALUATION PLUI1BING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/Rldo Per Fee ------------ Plan Ck. lies 30%/B1dQ Per Fee Fence Syste~s Development Charae (L5tl '. BUILDING PERfllT Charges and Surcharges 06mo ELECTRICAL PERIHT Cha rge.s and Surcharges .Sidewalk 'A/C Paving. . ...... .. Tot~l Comb. Permit . MECHANICAL PERMIT Charges and Surcharges ___/.z;;~__ Curb Cut , _7S " TOTAL /~,,?S I' I ! I I - e . COMBINATION APPL~CATION/PERMIT (CAP) 'PERMIT VALIDATION I. Applicant'to furnish A. Job Address B. Legal' Description 'I. .example- Tax Lot 100, Lane County Map Reference II oj 4J 2: example- Lot I. Block 3, 2nd Addition to Sprlngfield Estates . C. 'Name, etc. of owner and construction lender D. Energy Sources '1. examele- heat/electrical ceilin3/or forced air Qas 2. examyle- waterheater/electrlcal/or solar E. . Square footage or valuation, etc. I. exam~le- 1250 sq, foot house, 500 sq. foot garage 2, examJPle- if new project, check new - if addition, cneck add, etc. F. Building permit information: 1. .exam~le - construct single family house with an a ttached garage 2. exam~le - remodel existing garage into family room 3. examele - 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 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 payab~e when the permit is issued. I I I. V. FOR OFFICE OSE ONLY Permit Cl erk 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 Ip/?,//c 72 i"-~~ ~n/~ ."date " ,IY : p~/ 6> :;? signature Job Address '5"".?>~ ,/?//I(F/ 57 Legal Description · CIn OF SPRINGFIELD ""'COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat lIater Heater Range_ ValuE of Work: 17"~~ ~e:o Bui1<iino Permit Info: Describe Work{he" Bulld Single Farni1v Residence lIith Attached Garaoe' ~,.....v~_".~ &?r ac... '&~~ Tp~~ ' e INFOR/lATlON C'"< 726-3753 Sq, Ftg. '.la i n ~q. Ftg, Access. Sq. Ftg, Other "ew Add Alter Rep. -Fence Demo Change/Use Other- - ~ 'S::. I~ 'I INSPECTION LIIIE 726-3769 ~ ~..:t=-.J'''TWd?:'7i'(2) Address ~~' ~/;y ::j7. -5.PF/ Z'. ,.&? ~ . . . " ' , ... .....-:: 0...... -.-.... --"o_'~~.R:/'i'A~ ~-,15'f"~,;v Phone Address DESIGfl TtAl~ (namel Phone (address) flies. no.l (exniresl , (ohone no.l Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (address} (11C5.no.1 (exDiresl (ohone no. \ General Plumbino Electrical "echani~al~'2:>rr H~#~ ~._ &~//Y / .:?L:.C=~4?C.~?Yp2 -;;;9',;<-&'/e::>/ / / PLUlmIflG ELECTRICAL MECHANICAL NO.1 I FEE I CtlARGF Nn FFF fH4RhF NO. FH f11ARG..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 Sn~ce heater ~nrl vpnt Storm Sewer Of amps. Appliance vent S~Darat~ S-tadonary evap. ~.on]f!r Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hnnrl "nd dlJrt Sewer Temporary Construction Change in existing rp~ j rfr!"'p multifamily, COTl11l. or Tnrluo;.tri..l ~Iater service COI~'1. /lflD. FEEDERS Install/alter/relocate rlio;.trin. fppdpro;. Wood stove/heater Of amps. ~ ;Z;;r?.- I SSUANCE OF PERlHT TOTAL CHARGES TOTAL CIIARGES TOTAL CllARGES M/.fi. WIIEnE STATE L\U REQUIRES that tile Electrical work be done by an.'Electrical Contractor, the electrical portion of shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division /5" ~l> this pemit I IIAVE CAREFUllY EXAMINED 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 nerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of OrelJon pertaininC) to the work described herein. and that NO OCCUPAI~CY will be made of any structure without the pcrmission 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 OP.S 701.055 Wi~ used on this project. , UAf.lE(please print)CC(V-VC~JY;Sf(9.''''s~ >f SIGIIATURF.d~~TE//...c./-'2s'l FOP. OFFICE USE DillY //- S~. Ftg. Itain Sq. Ft~, Access' Sq. Ftg. Other , Value Value Value Stories Un; ts Occy load Occy Group x Zone Fi re Zone Flood Plain Tvpe/Cons t. Bedrooms , TOTAL VALUATlOII BUILDING PERfllT Charges an~ Surcharges Plan Ck. Comm/lnd ____________~/Rldo p.pr Fpp Plan Ck. Res 30%/BldQ Per Fee Fence syste,ms Development CharQe (1. 5~ . ' . PLUIIBING PERMIT Charges and Surcharges Demo ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Charges and Surchar!Jcs Sidewalk AlC Paving / c- -e:> Curb Cut r--ld~7~ I Tota1 Comb. PermIt TOTAL /~/s , COMBINATION APPLICATION/PERMIT (CAP) ,< I, Applicant.to furnish A. Job Address .' B, Legal Description . 1. ",exam~le- Tax Lot 100, Lane County Map Reference " ,17 0 43 ' , 2: example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. 'Name, etc. of owner and construction lender O. Energy Sources '1. example- heat/electrical ceilinqlor forced air oa Z. examDJe- waterheater/electrlcal!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. ,examole - construct single family house with an attached garage 2. exam~le - remodel existing garage into family roc 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 TEAM AND CONTRACTORS To avoid design or construction delays, Building Oivision Staff must be able to contact appropriate persons regarding design information or job' site corrections, etc. 11. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in thedescr1ptfon portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No, Boxes adjacen 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 schedule 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 i electrical contractor for Signature by his electrical supervisor. . The general contractor 1s .not authorizecr--- - 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 ~ivision Staff will prepare a type written copy and return it to the applicant at the time the actual permit 1s 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. Ill. V. FOR OFFICE USE ONLY n '-' eC~TY OF c~~~IN.GFIELD Sprlngfteld, Oregon Development Services OFFICIAL RECEIPT 152Sd . '."1 DateAlV'\/. /, 19 2?.:::3 / - Rec'd From ~/4~"'f/-:::-1'<;~ ,,)~~/~ 9.~ W t';aL 'Al~~- '" ' - Address 'PL/&::;,:=ch'c:,.:!I1? <3-::::Y"""2' _ ~ecelved::-' /,zsifC ~1/63 ~~.= v /' /. ')':=" .?::!> 4/.7< 147--':::>0 ~---- ;T;>-/ .:. 1~7S- ~#'597S Amount Received 15",?S' .!!L ~r,...,--_...........e-~ ,... P'UTHORlZEO SIGNA TURf /'- r . BU51NfSSFOAMS, INC. IW13.l110 ..., Permit Clerk PROJECT CONOITIONS TO BE SATISFIED 8EFORE OCCUPANCY: . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name (t?/7(/E ,It.r~~ signature ~U/~ -;date ,,, ,tV . P-/-/-~. .