HomeMy WebLinkAboutPermit Mechanical 1982-2-3
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INSPECTION LINE
726-3769
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Job Add".. lo~tJ ~.. f5'(\ ~ ~~
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Construct;::- Llder D ( -
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORMATION UNE
726-3753
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Legel Description
I ENERGY SOURCES,
Heat
I Water Heater
RanQe
Value of Work:
Sq. Fig. Main
Sq. Ftg. Acc:eu.
Sq. Fig_ Other
_New_Add_Alter_Rop.
_Fence_Demo_Chongel Us.
_Other
Building Permit Info: Describe Work (i.e.. Build Single
Family Residence With Attached GClrQQe)
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Address
Phone
DESIGN TEAM
(name)
(address)
(lies. no.)
(expires)
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(u?ires)
(Dhone "0.\
General
Plumbina
Electrical
PLUMBING
A~ c\q\El~I;Al \C\'W\ \ ,,11 ~ ')G
I\Q \()- llfa!
Me,honi,ol l' nn. \i) ~ \ If0
MECHANICAL
Residence of
I
furnace I burner to
~TU's
Appliance vent
separate
Stationary .vap.
cooler
Vent fon with
sinqle duct
Vent system aport from
heoting or A.e.
Mechanical exhaust
hood and duct
FEE I CHARGE
I 0)
o.
I NO. I
I
I
I
I
I
I
I
I
FEE
CHARGE
NO, I
FEE
CHARGE
NO.
Each sinql. fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
1q. ft.
New circuits, alterations
or extensions
SERVICES
Duolex (1 both) each
Temporarv Construction
Additional both
Amps.
Water service
Sewer
Wood Itave/heoter
Storm Sewer
FEEDERS
Heat Puma
Air handler to
10.000 CFM
Air handler over
10,000 CFM
Am!)s.
TOTAL CHARGES
I TOTAL CHARGES
TOTAL CHARGES
ISSUANCE OF PERMIT /!) (JCi
1(0- c)j
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFULLY EXAMINED the campleted application for permit, and do hereby certify that all information hereon h true and correct, and I further
certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the lows of the Stale of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Oivision. I further
certlfy that my reghlTatian with the Builder's Boord is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontra~tors and employees who are in compliance with ORS 701.055 will be us&d on this project.
Basis for Builder's Board exemption"
NAME (please print)
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MlA....4co1.QV"
c:.IGNATURE
~Q 1...J\l'\., ~~ DATE.;:t- .'"t - R'..=:l.
fOR OffiCE USE ONLY
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Value
lolue
Value
Zan~
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
l:torie~
Units
nccy Load
nccy Group
l:q. fig. Main
Sq. Fig. Access
Sq. Fig. Other
x
TOTAL VALUATION
BUILDING PERMIT
Chorges ond
Surcharges
plan n. Comm/lnd
65%/ Bldo Per Fee
Plan Ck. Res
30%/ BldA Per Fee
SYlotems Development
Chorae n.5%\
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
Total Comb. Permit
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
AIC Pavin..,
MECHANICAL PERMIT
Charges and
Surcharges
_Jj-'!1iiq-
Curb Cut
TOTAL
/1.P.&4
rrc-
'~OMBINATlON APPLICATION/PER. (CAP)
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L'I., Applicant to furnish
,...; A, Job Address
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_:~: B, Legal Description
1. example-tax lot 1'00. Lane County"Map Reference 17 03 43 .
2. example-Lot 1. Block 3, 2nd Addition to Springfield Estate~ '
C. Name, etc. of owner and construction lender' ~,,J l
:~ r. .~
D, Energy Sources ~7 ..
". 1. example-heat/electrical ceiling/or forced air gas
2. example-water heater/electricai(~~;~lar;,
Square footage or valuation, etc. ~-. --.
1, example-1250 sq, foot house, 500-S"q: foot garage
2. example-if new project, check new-if addition, check
add. etc, '
F. Building permit infor;"otion:
1. example-construct single family house with an attached
garage
2. example-remodel existing garage into family room
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 Division
Staff must be able to contact appropriate persons regarding
~ design inf?rmation or job site corrections, etc:
" - . '. .
I II, -Abbreviated Plumbing, MechCinlcal & ElectricaISch~i1ules .
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
l item(s) to be installed
-' , \
B, .F(,II Plumbing, Mechanical, arid 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 abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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E.
III, Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only, Where pcssible, Building Division Staff will
prepare a typewritten 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
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY,
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