HomeMy WebLinkAboutPermit Mechanical 1990-3-30
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'1 INSPECTION L1I!E
726-3769
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CITY OF SPRINGFIELD .
CDMBIIIATIDN APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Ha ter Hea ter
Ranqe
I
INFDRltATlDN liNe
726-3753
Sq. Ftg. 1.lain
~q. Ft~. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
--Fence Demo Change/Use
Dther- -
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Job Address 1 O()~\\U~ I\.s\TI 00 r
Le~a1 Description \l\{)~~~f\ \ nRllrYJ
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Dwn~ ~~~\f\ Q ~ ~~ l~ 'f-5L ~ er\ ValuE o~o"{tl)
Addre>(sV A Cl-: " 0~ Q99 Phone. BUilGino P~rflnit Info: Describe Nork(Le.. Build Single
,,~~;\\\) \) o\ffi),~V .U'11l1 FDD~ AttacC\ l\a~\ ~\
~.,,'""~ Co.", "*\ I - " ~ \' N\ 5\0 6'~~ \ ~ ~
~~~~~~\EAM (name) Pho(:eddressl .l cA.~V~~[;:;,~_' iexni;esl '.Wn~ no. '_
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Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrp.s~\
f1ir~ nn \
lexcires\
~h,~""" "'" 1
General
Plumbino
Electrical
~lechani~a1 C -'1C\ rt
I'N'\ Lf! ~(\\ 4l'lf)() u:J <:;-.;\1'\ t. ~ 4;-\1~ \
PLUIIBING \) ELECTRICAL . ~ I
\!lh Iqn<..'344.2.4~]
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MECHANICAL
NO.
FEE CHARGE NO
FF~ r~4Rr,F Nn
HF rI-l4Rr,F
SQ. FT.
furnace/burner to
BTU's
Each single fixture
I
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
F1 oor fu rnace
and vent
Stonn Sewer
Of
CDMfI./IND. FEEDERS
Install/alter/relocate
di~trih. feeders
amps.
Recessed wall
~~~r"" hp~tp~ ~"~ ~""nt
l ~D\)lIn (\1'\0_"
App l\i a\.ce, vent
$Pl"'.:lr~tp
S;tatiorlary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood itnd duct
Wood stove/heater
cO.co
S.F. Residence
(1 hath I
Duplex (1 bath) each
Additional bath
SERVICES
Water service
Temporary Construction
Change in existing
r~..jrl..e.nce
multifamily, comn. or
lnctustrial
Sewer
Of
amps.
~(\~~\1'3
<..3.00
TOTAL CHARGES
WHERE STATE L~N REQUIRES
shall not be v.li1 until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
I
ISSUANCF OF PFRIII1 ~ .
TOTAL CHARGES \ "::> ~
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the cnmp1eted 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 UO OCCUPAIlCY 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':: US~~iS p~j:ct.
UAf.lE(please print) UkU)7.,6'. frL//n c:. SIf,UATURE /7/// ~'-<- DATE .3hc>~C)
FOr. OFFICE IISE 0111 Y
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Dccy Load
Occ'y Group
Sq. Ftg. 11ain
Sq. Ft9. Access
Sq. Ftg. Other
x
x
Value
Value
Value
.x
TOTAL VALUATIQrI
PLuP1BING PERMIT
Charges and
Surcha rges
Plan Ck. Comm/lnd
65%/Blda Ppr Fpp
------------ Plan Ck. lies
30%/B1dq Per Fee
Fence
Systems Development
Charpe (1.5~)
BUILDING PER~IIT
Charges and
Surcharges
Demo
ELECTRICAL PERrHT
Cha rges and
Surcharges
Sidewa I k
liECHANICAL PERHIT
Charges and
Surcharges
A/C Paving
_ _D..: a.2 _ Curb Cut
,rrs
Total Comb. rermit
TOTAL
\'5.'7-5
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 03 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
SprIngfield Estates
C. Name, etc, of owner and construction lender
O. Energy Sources
1. exam21e. heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cheek add, etc.
F. Building permit information:
}, example - 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 (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 schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted nn 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;
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PERMIT VALIDATION
3.W.QO
\ laD Co \
Permi t
Cl"k H f)Q
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Permit applicant exempt from registration with the Builder's Board because:
Additional Pro~ect Information:
PLANS REVIEWED BY:
name
signature
date
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