HomeMy WebLinkAboutPermit Mechanical 1989-10-26
Phone
INFUR1lAnON LIRr'"
726-3753
Sq, Ftg. 14aln
~q. Ftg, Access,
Sq, Ftg, Other~
Uew Ad Iter Rep,
, -Fent Demo Change/Use
ValUE OfrTk/RJ .L. 0 er- -
8ull0;no Pe~it Info: Oescrlhe Work(i.e,. 8u;ld Single
Familv nesid~nce Ilith Attached Garaoel
.
I INSPECTION LINE
726.376g
.
Job Address ( 0 I / /1)() If} 2St .
Legal Description VItJ3"'6 ~ 1 fYI~
CITY UF SPRIN6FIELO
COHBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Ilater Heater
Range
-
~
Owner. ~("'){"'\
Address
l'n \I_~_OE-)
. (nameI'
Phone
(address)
llJn J\ !un1 Lru
. ()
I:::::
~"
()11
Construction lender.
Address
OESI6N TEAr~
{Ucs. no.1
'"..,~ "M"" ""
I
Primarv
Structural
Electrical
Hechanica1
CONTRACTORS
{name)
(address 1
(1ic~. no.l
(exniresl
(I)hon~ no.l
General
P1umbina
Electrical
t\rlffiN\O (0 \O.Q
~\e
c\)lo4 I W ~C;'(-f1...
,
f.-OCt.. ?ftS'rl6' /q
~HANICAL
FI.chanica1
PLUllBING
ELECTRICAL
Each single fixture
FFF rH~Rr,F ".0....... <<F r'JAllliE...llil......
Res idence of furnace/burner to
SQ, FT, OTU's
J:'J:'J:' r'1AB.G.E
Nn.
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 hath\
Duplex (1 bath) each
Additional hath
SERVICES
Recessed wall
So~~~t~~ ~n~ ~~nt
Storm Sewer
Of
amps.
Appliance vent
"eoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood and durt
Water service
Temporary Construction
Change in existing
rp~ j rtE'Jlrp
multifamily. comm. or
Incluo;.triar
Sewer
Of
amps.
1
I
, "._1 )
I CO I.) Ntr:-v
1 I
Wood stove/heater
COR/-I. /lNO, FEEDERS
Install/alter/relocate
c1io;.trih_ fpprlpro;.
ISSUANCF nF PFRlm <..-L)
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES 1.5,
WHERE STATE L\II REQUIRES that tile Electrical work he done by an-'E1ectrica1 Contractor. the electrical rortion of this permit
shall not he va1i1 until the lahe1 has been signed hy an Electrical Surervisor and returned to the Building ~ivision
I HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City
of Sprin9field and the Laws of the State of Oregon pertaining to the work descrihed herein, and that UO OCCUPAIICY 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 t a f exemption is noted hereon. and that
only suhcontractors and employees who are in compliance with OPOS 7nl,05 . h ~;;~
IWIE(p1ease Prfntl}?/;1CK. ,~IJI>IN ~/ ~
Zone Tvpe/Const. Units
Fire Zone Bedrooms Occy Load
Flnod Plain Stories Occy Group
BUILDING PERFlIT Plan Ck, Comm/lnd
Charges anrl ------------ 65%/Bldo ~pr Fpp
Surcharges Plan Ck, Res
30%/B1do Per Fee
PLU'~BING PERMIT Fence
Charges and ------------
Surcha rges OeRlO
ELECTRICAL PERllIT 'Sidewa1k
Charges and ------------
Surcharges A/C Pavi n9
HECHANICAL PERHIT _J0~_~u Curb Cut
~ Charges and
Surcharges
.
Value
Value
Value
x
.
TOTAL VALUATIOtl
Systems Development
Charoe (I, 5~ .
I
i
ITota, Comb, rermit
1
I TOTAL
1:5,7S
.
t
.
'*
II
II
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
I. Appl ieant to furnish
A, Job Address
B, Legal Oescription
1. example- Tax Lot 100. lane County Map Reference
17 03 43
2. example- Lot I, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- 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.
cneck add, etc.
F.. Building permit information:
'--1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3., exa~le - 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 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. Abhreviated Plumhing, 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 Plumbin9, 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. ---
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.
"
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10 -db -g1
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V. FOR OFFICE USE ONLY
Cl,,;j~
./
Penni t
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date