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Home My WebLink AboutPermit Mechanical 1989-5-16 '[I, jlli>l'lcr lUll 726-37';9 llilE. .. . IWORllAT: .:4 ll,.:. 726.3753 So. FlQ. /':ain ~q. HI), Access. So. Ft9. Other Ilel" Add fl. 1 ter ~eo. --rence oCimo Change/Use Other - - e. r;l?~~ e..""";.::.-....Q~~ Job Address 9~ B~k" . /H.125lP~..&~ ~~ , . I.eqal Oe"ription/?~_/<:::".O&'~ a//"",.::::> LIlY IJf SI'RIIIGf l(LlJ COIIBIIIATION APPllCATlOIl/PERMIT EIIERGY SOURCES: lIeat Ualer Ileater RaOfJe Valuf of Hark: :3i1Pa::::>. =-tS Uui t;infl l'ermi t Info: r.'r.lilv P.esidenc:e tlith Owner Z:J~ J../ArPD :j?e::>y/ F5 Address ~<;I~."- '"7? ALL) Y J;;:;"e,'t..v f...q Phone ~ <"'N/~fi"""-~~ ~ 97<7:?? .. I Uescr\he I.Jorkl i.e.. ^tt3ched r.araoel Construction lender ,Iddress ,}/77 .#,tI:r';n:r/9 Ul~luU I [J\ri" tndlllCJ /..,,""~ //1 .....n:;'. -~- - .~-~ ~-'--- .,2'~",4..~', ~ hLL ~.~ ./l'AOP,":!y ~.N t::Jv~VEU:>,Z-~~ p~~, (I ics. no. I 7~-f?YY~ Phone {address 1 (clloirps) Structural ....t:?' .." Primarv f7~ 5z;v.h'~~. '2.1'2 a ~/:.:5~. =R. ~~ j Electrical !1echanical CONTRACTORS (ntlllle) Genera 1 Plumbino Electrical t1f'?r.h"n;c,,1 PLUIIBIIIG --8L. H F I CH^Rr.r Each single fixture -I Relocated bui lding (new fix. additional) IS. F. r.e s i dence (I bath) -IOUPlex (1 bathl each jAdditional bath I~!ater service I Sewer I Storm SCI'/er -, -I I I I I I , I I I I 1= I I I ,_. I I Zone Tyne/Cons t. Bedrooms Stories Fire 70ne Flood Plain (addres..) (1 irs. no.l (p)(nirpc:. \ (llhonp nn ) ELECTRICAL MECHANICAL TOTAL ClIARGES TOTAL ClIARGES I HIlEP.E STATE L.\I~ REQUIHES that tile Electrical \'Iork be done by an Electricil1 Contractor, the electrical portion of this perr.1it shall not be valH until the label has been signed by an Electr.ica1 Supervisor ilnd returned to the Building Oivision I HAVE CAHUUllY EXN1Jr1(1) VII:' complClell aprlication for ryermit. ilnd do hereby certify that all information hereon is true and correct, and I further certify that any and all \'Iork nerfonned shall be done in accordance with the Ordinances of the Cfty of Soringfield and the laws of the State of OrerlOn oertaininl) to the work descrihed her"ein. and that 110 OCCUPAllCY \~i 11 be mdde of any structure without the permission of the lllJildin~ Division. I further certify th.lt Il1Y rC!1istration "lith the Builder's Board 15 in full force .1nll effect as required by or:S 701.055. ttl.ll if exempt the basis for exemntion is noted hereon, and that only subcontr,lctors and employces .''4ho are in conm1iance with Or.S ]01.055 ,.dll be used on this r)ro,iect. /lA:1E(please nrint) ..l:..... tJ...w 1....-.. Slr.IIATURE ,0 ~ fO~ OrFI(~ /lSE iiiV"- sC'!.-1""t~. rlain x Value SQ. Ft/]. Access x Value Sq. Ftq. Other ~~ ~~~ ~ Value TOTAL VALUATlOtl , JILl ~ Res idence of SQ. FT. New circu~ts alts. or extenSIons 'SERVICES -, '" CHARGE ...llil..... furnace/burner to BTll's - - -,Floor (urnace and vent I Recessed wa 11 _ c;o;,rp ~p,. .lnti I I Temporary Construct ian C/lanqe in existing r!,~ idp.nrr. Imultifamily, conwn. or Indu"tria I 10f amns.1 I COI~1.11 NO. FEEOERS -llnslall/alter/relocate rfi"trih fpprfpr" 10f "mps,1 I I I I' Apol iancc vent o:;pnal',Hp I Stationary evap, cooler I Vent fan l'4ith sinole duct I Vent system apart (rom I heatinq or A.C. I I Nechanical exhaust hnnc1 .1nd c1ur't ,-, Uood stove/heater I I I I I SSIIANCF OF PFP.!ll T I TOTAL CIIARGES lJni ts Ocey Load Occ,Y Group BUILDIIIG PERJ.\IT Char']cs an~ Surcharges ------------ .::::0. ....,. PLU'-IBING PERMIT C~arges and SurCharges ,ELECTRIUL PER':IT CharQes and Surcharges Plan Ck. Comm/lnd 65!/BldQ Per Fpe Plan Ck, Ues 30t/Oldo Per F~e JSystCr.lS Development Charlie (l. 5",) I I I I I I I I . I Curb Cu t' I ~.z>I_~} '7(&. Fence Demo ___________-' Sidewalk ..1 A/C Pavin9 11ECIlMIICAL PEP./11T Chargcs and Surchar'les .,.... . ITotal r:OfTlb, rp.rmi t I TOTAL Bui Id Single 1% (X) ~ 'l! II~ \ I I I I I I (nhone no.' 7Y~-~"'?";:> I ! ! I J I , I ....,.nt IJJ:L .CJILIRl:iE I I I I I-I I , I I 'I I I I -I I I I O~,TE => -(1I..18'! I ~ 79. .-::> I \ . . , . I . J . .. , . . i COMBINATION APPLICATION/PERMIT (CAP) PERMiT VALIDATION , , I. App) icant to furnish ,A. Job Address 8. legal Description J. example. Tax lot 100, lane County Map Reference II UJ 4J 2. CXolnlple- lot I. Olock 3. 2nd Addition to Springfield [stales C. .Name. ete. or owner and construction JenrJcr O. Energy Sources . 1. example- heat/electrical cejlin~ior'forced air Qas 2. examole- waterheater/cICCll"iccll/or solar E. Square footage or valuation; elc. - 1. examoJe- ~ SQ. foot hOl/se. 500 sq. foot garage 2. example- if new project. cheCk new _ if addit'ion... check add, etc. .' . F: Building permit information: . 1. "examole - construct sin!Jle family house with an attached garage 2. examole - remodel existing garage into family room J. examole. Convert single family residence into restaurant (change of use) G. Value of ''lark as defined in Section 3D3 (a) of the Structural Specialty Code II. DESIGN TENI ANO COIITRACTORS To avoid desi9n or construction 'delays, Buildillg Division Staff must be alde to contact appropriJte persons regarding design infonmation or job site corrections. etc. If. Abbreviated Plumbing. Nechanical. & Electrical Schedules A. Except ",here blank spaces OCcur in the description portion of the Mechanicaf and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s} to be instcllled B. Full Plumbing. Nechanical. and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated Z. If the item(s) to be installed are not Covered on the abbreviated schedules you should consult the full schedules C. BUILDING OIVISION STAFF HILL FILL OUT ALL FEES AlID CIIARGES 011 TIlE 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. - fII. 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 fces are due aild payable at the time of the application, and no plans ''Iill be processed until these fees are paid. All other fees and chJrges are due and payable when the permit is issued. .1 Permit'Clerk V. FOR OFFICE USE OIiLY n PROJECT CONOI nONS TO BE sAn SFI ED BEFORE OCCUPAtJCY: 'Permit applicant exempt from registration with the Builder's Board because: , Additional Project Infonnation: PLANS REVIEWED BY: .. , name / />~V ~ .Pee-;.:.::--? Signature~~~~:~~~ da te 5""-4" --' ~/. ,~ 1rI~l'lcr lUll L1i1l LilY 1)1 ~1'lllll(;F1ILU 72/i-3709 COImlllMlOIl APPLlCATIOIl/PERMIT J b Add .0 .P;l?~<!i'"D e~~..,,-6" "';;0:0' E!lERGY SOURCES: o rC"9~ ~~~ /H~~/..,......-- ~~ IIcat I.e~al OcscriPtion/?03_/<:;;""'Oa::>~ ~//_~ Hator lleater Rc1nrJC fII0l1fIAT: .:1 ll..:. 726-375; So. fLq. '.iaio ~q. ft~. Access. SQ. ft9. Othcr f1e\~ Add Alter ~CO. --rencc Demo Change/Use Other - - i% % i I (j "II \lli V\ I i , I I I I \~ Owner ZJ~L./_T.:> "d=o/'/F'\" . , - - .'.!dress -:?"/c>_<:""7JALl'/Y /6.c'f..,y L...o. I'hone ~;<>~/.h.~,j'Y,A=".::b ~ 779"7/ / ValuE' of Hor~: 3trP=_c=rC> Uui (;ino Permi t Info: r,lI:1i1v P.p.sidenr.c Ui th UCSCrlhc Hark( 1.e.. Bui Id Single J\ttachp.c1 r.,lraoc) Construction Lender hu. ~r # 7PRt!:>X C>AI t:.}v~I/~<::,o.;::>ED 73; f' ;;.; -';./;,L- (I ics. no. I /.~"""~O L.V. .,../)'; ;V.80~77' II / // 7~-i?Y,/7' ,\Jdrcss J/~ /V..r-h"'~)tt;? flhnnc UDIGU Ill\l1 lnamcf ,address) ~ \,., Primary O~ ~A/~/~.:2/2 a ::5/:,S~<:ZA.=R. ., / (l"xnirps I (ohone nO.1 77'~-~"'?/ Structural Electrical !1cchanical COIlTRACTORS (nclme) (addrp.s'i ) (lin. no.\ (pxoirp~\ (nhonp nn I , ! I I I I i .LEL .!JJAJlGL . Genera 1 Plumbino Electrical "p.ch"niC.ll PLUlm BIG ELECTRICAL MCCllAN I CAL ...llL CIIARGE JIQ... <r < U:lIARGf....ill' -'!.!hI lEaCh single fixture -I Relocated bui lding (new fix. ~dditionill) ~.S.F" P.esidence (I b.Hhl Duplcx (1 bath) e.ch jAddiliona\ bath I~!ater service ISewer I Storm Sel.ler -I -I -, -, I I Residence of sq. FT. furnace/burner to Oll!' s INew circu!lS ails. or extensions /SERVICES -, Floor furnace and yen l I I I-I 1 I 1 I lor ICOI~'I.IINO. FE[OCRS - Instolll/alter/relocolte _ .lti>.lLili...LcJ:Jler< or amps.j 1~__J~ecessed wa 11 I-----r-o~rp hp~t~nrl vpnt I Apol iance vent C;rOlll"iltp I Stationary evap. cooler I Vent fan '<Ii th stnole duct I Vent syster.! apart from I heatino or A.r. I 'Ncchanical exhaust hnnri "nri rillr r ,- ~~Od stOye/heater I ITemporary Construction IChanCJe 1n existing rP'iitJr:nrr" /multifilmily, conr.l. or I ndll~ r ri;\1 dmps.1 I I I ISSIJA/ICf nF PfmllT TOTAL CIIARG[S TOTAL CllARGESI TOTAL CllARGES WIIEnE STATE l,\ll REQUlIlES that the Electricdl '1Qrk be done by an Ele!ctric..!.1 (onlrdctor, the! electrical rortion of this pcrr.lit shall not be! V<lli-J untiJ thr. I.lbel has been signed by an (lectdc.,l Surervisor lInd returned to the Building Division I IIAVE (AI!(fULlY CXNlHlCll lhe <:olllplcted apflliciltion for I)erlllit, emd do her"eby certif.y that el11 infon:lation hereon is true and correct. and J further certify lhat any and all ,,,ork nedonned shall be done in accordance with the Ordinances of the! City of Soringfield and lhl! laws of the St.lte of Orenon !Jertaininn to the work descrihcd herein, and th,ll110 OCct!rAIlCY \.,ill be mJde of clny structure without lhe permission of till'"! lluildin!1 Oivisioll" I further" certify th.H J11.y rC!1istration \-lith the Guilder's Board is in full force and dfecl JS reCJuired by OIlS 701.055, tll.H if cxcllmt the bJsis for excmntion is noted hereon. and lhat on ly subconlrac tors and er:lploYe!es ".,ho are in coino I iance wi th Or.S 7(1).055 ,.,'i 11 be used on th i s oroject. Fon SIr.UATlJRE nrflr.~ IISE n;JWr S~.4"l!J. llain x Value SQ. Ft!). ^cccss x Value S~, Ftg. Other Nu. 6?N'<: 7Jf V.Jue TOTAL VALUATIOIl ()~ DATE :, )11./8"1 IIA!lE(please nrint) j: '"' lVw L-- Zone Fire lone Flood Plain Tyoe!/ConSl. Bedrooms Stories Uni ts Occy LQ.d 6cc.v Group OUILOIlIG PERl.llT (har'1es an~ Surcharges Plan Ck. COllmllnd 6S!/Oldo Ppr Fpp' Plan Ck. Ifes 30%/01do flcr F~c hO. -.:> Syster.ls Development Charlie (1.5') ------------ PL U'1B I NG P CRM IT C:-'ilrgcs ilnd Surcharges I Fence , Demo I ___ _ _ ___ '::"::_, ,II AS/lcdewalk r Pavin9 ------------ I I I I I' Curb "rut' I ~P/h.:J';~J.. ~/&, ITotal r.~b, rermit : TOTAL ~7B. -co , ,CLECTRICf.,L rCRl:1T Charqcs and Surcharges ~, IIECIIAtIl CAL PEP.llI T Charges and SurCharfJcs ------------ .,..b COMBINATION APPLICATION/PERMIT (CAP) I. II. Appl icant to furnish 'A. Job Address O. Legal Description 1. example- Tax Lot lOa, Lane County Map Re' "n~ II o'j 43 2. example- lot 1. Block J, 2nd Addition to ~prln9tield [slales "C. .Name. ctc. of owner and construction lender D. Energy Sources . 1. example_ heat/electrical ccflinq/or force Z. examole- waterhCcller/clectt-ic.ll/or smr- E. Square tootage or valucllioll, ele. - 1. examolc- 1250 sq. foot house. SOD sQ. foo 2. example- iTncw project, checknew . if at. check add. etc. F. Building permit illforllldlion: . 1. 'example - construct sinylc family house wi at laChed 9Jr~ge 2. examole. remodel existing garage into fam J. cxanll>le. COllvert single family residence restaurant (change of use) G. Value of h'ork as defined in Section 3DJ (a) of Structural SpcciJIly Code II. OESIGN T[AN ANO CUI/TRACTORS To avoid desil)n or cOnSll"Uction delays, UuiJdir Division Staff must be altlc to contact appropri persons regarding design information or job sit corrections, etc. Abbreviated Plumbing. Nechanical. .\ Electrical Sche A. Except Hhere blank spaces OCCur in the descript portion of the Mechanicaf and Electrical Schedu the applicant need fill.ln only the No. Boxes af ':er to the appropriate item(s) to be instcllled O. full Plumbing. Nechanical. and ElectriCJ) SchcdL are available at the BUilding Division 1. To conserve space on the permi t form the sch 'le' have been abbreviated 2. If the item(s) to be instJlled are not Cover the abbreviated schedules you should consult full schedules C. BUILOll/G OIVISION STAFF WILL FILL OUT ALL FEES AI CIIARGES 011 TIlE SCIIEOULES O. As noted on the CAP. the label must be deliveret.! electrical contractor for signature by his electr II Supervisor. The general contractor is not author to sign the electrical label. - Applicant to sign and date Whenever possible. the initial application will be USI as a worksheet only. Where Possi~le. Building Division: will prepare a type wri Lten copy and return it to the applicant at the time the actual permit is issued for his signature. Fees and Charges Plan check fees are due and payable at the time of the application. and no plans ,.,.ill be processed until these fees are paid. All other fees ant.! charges elre due and payable when the permi t is issued. 11 J. IV. V. FOR OFFICE USE ONLY .J___u CITY OF SPRINGFIELD City Hall Sprlngfteld. Oregon Office o' Community and Economic Development OFFICIAL RECEIPT 13886 Dale M~4<, 19 ~ , . n ;;>r> ~,c.-~., Rec'd From '/U'.?<:J...P-~t C ~ ~i::>- -' ?7Qf~. \,,?"/ e~ (A Address ~~~_:.. .....,. -~ ~ _ - ._ Received For:... h"g'# 8'B07~~C~ o ? ,.... ~ J>C/h12 nGV~rEc ~A';~ ~""',,:T ,::; C?:> _..I>" . -~/~-~ ,Gr~" -;:::712.-- CK 1/"':5/27 q78 _<70<:> Amount Received /Z~~~ .... P' AUTHORIZED SIGNATURE /' / ~ij ,w Frantler BUSINESS FORMS. INC. I!oOJI~2.I1U I 1 ~ Permi t Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY: .. I ] J '\" .\\Permit applicant exempt 'froll! registration with the Builder's Board because: Additional Project,:Infonllati,on: PLANS REVIEWED UY: ~.' ! ~-o/V~ 7l~~ . ~~ . name signature ,. date S""-~ -----' ~/