HomeMy WebLinkAboutPermit Mechanical 1984-11-29
Il1lSPECTIOrl LiIIE
726-3769
.
,CITY OF SPRINGFIElD
COMBIrIATION APPliCATION/PERMIT
E!IERGY SOURCES:
Heat
['la ter Hea ter
.
INFORIIATION LINt
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
Fence_Demo _ Change/ Use
_Other
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'01:>
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ex
Job Address
'7/(2 ?11/l/A-1 ' ,
\lD?A~74L r5'ff.YY)
legal Description
~::::;Yvl ti~~~ Phone)ll7_
Construction 'l~ O~ V7(/Y.J
~
UA.Jl.tf ~'
Ranqe
Valu, of Hork:
~;'{ L
BUilriino Pernlit Info: Describe Work(i.e., Build Single
Familv nesidence ~ith Attached Garaael ~~
fltLtL _U 4dJ
(J rJ a7.L/J A,)
Address
OESIGN TEAll
(name)
Phone
(address)
(lies. no.)
{exoiresl
( ohoM no.
~L
"~
( ohone no. \
Primary
Structural
ElectrIcal
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(exn;res)
Genera 1
Plumbina
Electrical,'l "f....
~lechanic'allU'l/Jt( ~ lid (pj),
PlUllBlNG
,/)
~ ~CTRICAl
MECHANICAL
-1.!Q.:.1
Each Single fixture
I FEE I CHARGE .JiO.....-.'
Residence of
. ffL'....c.HARG.E.. NO.
I FFF
'rH~
SQ. FT.
~ce/burner to
,noo BTU's
,
Floor furnace
and vent
Relocated building
(new fix. additional)
INew circuits alts.
or extensions ,
I SERVICES
I
Recessed wall
$nac~ h~atpr and vpnt
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Jsewer
lstorm Sewer
I
I
I Of amps. I
I I
I I
I I ISSUANCE OF pm/lIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L.'W REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical porlionof
shall not be vali1 until the label has been' signed by an Electrical Supervisor and returned to the Building Divis10n
IOf
ICO/~t./IND. FEEDERS
I Install/alter/relocate
di~tr;h, fppdpr~
amps.1
I App 1 i ance vent
5.eDarat~
I' Stationary evap.
cooler
" Vent fan wi th
sinole duct
I Vent system apart from I
heatina or A_C.
1 Mechanical exhaust
hood and duct
Il.,ood stove/heater
I
I
I
Water service
ITempOrary Construction
IChange in existing
, res_i dJtnce .
Imultifamily, comm. or
,Indl'strial
/IJ.~
this pem; t
I HAVE 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 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 here ,and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further cert' my egistration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt t for empti -is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7n . eat ~
UA/IE[please printl.7!:7/;clC: /f'/JJ11U/1I/ SIGUATURE ~..J-v w',e /J/~r/jlf
FOP. OFFICE USEIOKL YI / /
Zone Type/Canst. Units sl Ftg. x Value I
,
Fire Zone Bedrooms Occy Load Sq. x Value
Flood Plain Stories Occy Group Sq. Other x Value
TOTAL VALUATION
BUILDING PERI-lIT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65~/Rldo Pffr Fp~
------------"""i5"'fan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charoe (1.5~) "
PLU'1BING PERMIT
Charges and
Surcharges
D~o
I
I
ITotal
1
I TOTAL
'j
ELECTRICAL PERI~IT
Charges and
Surcharges
I Sidewalk
I Ale Paving
_____LI2~~1 Curb Cut
.~~I
Comb. rermit
~
MECHANICAL PERMIT
Charges and
SurCharges
/0. '/0
r '
.
COMBINATION APPLICATION/PERMIT (CAP)
.
I. Appl ieant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
17 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
~pr'ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air OdS
Z. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. exampJe- if new project, check-new - if addition,
cneck. add, etc.
F. .Building permit information:
1. example - construct single family house with an
a ttached garage
2. exam~le - 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 TEAfl 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. 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 ANO
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. ---
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
.\ \
,
.
PERMIT VALIDATION'
.'
f# /:;.) 9~<-(
/!J-If/Jr
/Ill
tJ
,
!
Permit Clerk
Dj)
..
Pe'rmi t appl i cant exempt 'from ,.,regi strati on with the Buil der.!\ Boa I'd' because:
"
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.,
,
date