HomeMy WebLinkAboutPermit Mechanical 1989-10-26
'1INSPEoTlON LINE
7~6-3769
.
Job Address ( fLl ~ L Y U 1 LIZ ~
I.egal De<cription -1 fl ()'3C)Sd I ULJdQ
~00
CITY OF SPRINGFIEI.D
COMB illATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~a ter !tea tcr
.
INFORltATION LINt
726-3753
Sq Ftg, 1.lain
~q. t9. Access.
Sq. Ftg, her
Ilew Add r
-Fence Demo C
Other - -
1)
::D
-
ft
Adtlrcss
Phone
Ranqe
Val~' of (orfA .)
Bull(;ino-r~rtlit Info: Oeser be Work(Le.,
Familv nesi(ence With Attached Garaae'
Owner
l\O\lTQb
Build Single
Construction lender'
nJ H orrro j( )
AJdrcss
UESIGN TEAJ1
(name)
Phone
(address'
~01
(1 ics.' no. 1
(exnires)
(ohone no.)
Structural
I \
l'
Primary
Electrical
f1echanical
CONTRAC10RS
(namel
(address'
11 ice;.. no.'
(pxoirps' (ohonp nn.'
General
Plumbino
Electrical
I' ~\m n f\\_ \0(1 ~\e
r-.1ldl
LD. ~ '\-1\.
I
{P 06 ~~4S,;JJ24
~~N~AL
~lechanical
PLUIIB I IIG
ELEC1RICAL
NO.
FEE cHARGE N0
EEL J:!lAor.r NO.
I .Err rI'~
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
(] hath)
Ouplex (I bath) each
Additional hath
SERVICES
Recessed wall
I Snac~ hpo'!t.pr "nrt vp"t
amps.
Appliance vent
~poaratp
Stationary evap.
cooler
V-ent fan wi th
sinole duC".t.
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
( ~"(l/) N~'
Sewer
Temporary Construction
Change in existing
rp.~ j <je.nce
multifamily, COI11Tl. or
IInrllldrial
~Jater service
Storm Sewer
Of
COM/.I.IINO. FEEOERS
Install/alter/relocate
rl;~trih_ fppdpr~
Of
amps.
TOTAl. CHARGES TOTAl. CHARGES
WIIERE STATE L\\~ REQUIRES that tile Electrical work be done hy an
shall not be vali:J until the label has been signed by an Electrical
I SSUANCF OF PFR!IIT , )
TOTAl. CIIARGES .I.:s ,UU
Electrical Contractor. the electrical [lortion of this permit
~llrcrvisnr and returned to the Building ~ivision
I HAVE CAREFUllY EXAI'lINED 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 oerformed shall be done in accordance with the Ordinances of the City
of Spri 09 fi e 1 d and the laws of the Sta te of Orel]on perta i ni ng to the work descri bed herei n. and tha t rlO OCCUPAllCY wi 11 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 70I.O!:i5. that if exempt the ba is for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7~1.055 wil ed n thi project.
Zone
Fire Zone
Flood Plain
Units
Occy Load
Occy Group
SIGII^TURE
FOr. OfFICE IISF/i.'~'y / /
sn~~~~
Sq. U Access
Sq. FIg, Other
""'-- , DATE-<2<:.T. ~ L
0~ i7'
IWIE(please printlf?:r "'" (' !e
/?
/1 p,' WI A.I/,l J
,
Tyoe/Cons t.
Bedrooms
Stories
1//
//
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERHIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ ~/Bldo p.pr Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
CharQe (1.5~l
PLUt~BING PERMIT
Charges and
Surcharges
DfIllIO
EI.ECTR I CAL PERlm
Cha rges and
Surcharges
'Sidewalk
A/e Paving
Total Comb. rermit
11ECIIANICAL PERMIT
Charges and
Surcharges
'" L0 UU
Curb Cut
--- ,!-1J:.)--
TOTAL
I:; 710
-.,
.
.
;
oJ'
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALID~TIDN
,.
I. Appl icant to furnish
A. Joh Address
B, Legal Description I
1. examole. Tax Lot 100, lane County ~lap Reference
1/ 03 43
2, oxample- Lot I, Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilin%r forced air Q3S
2. exa~le- waterheaterjelectrical/or solar
E. Square footage or valuation, etc.
I. examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition,
check add, etc,
F. Building pennit information:
1. example - construct single family house with an
attached garlJge
2. examele - remodel existing garage into family room
3. example - convert single family residence into
res taurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEN1 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.1Mechanical. & 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 i os ta 11 ed 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
O. 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 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.
S 'J~1
fO.Jb .fJi
I,
V. FOR OFFICE USE ONLY
Permit Clerk
HVj~
.
PRQJECT 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