HomeMy WebLinkAboutPermit Mechanical 1982-6-8
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I INSPECTION LINE,
726-3769
CITY Uf SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
.
I NFORlIATI ON liNt
726-3753
Sq, Ftg, I"ain
~'1. Ftg. Access.
Sq, Ftg, Other
I~ew Add A Iter P.ep,
-Fence Demo Change/Use
Other- -
~
J
3
Job Address
3825 International Court
EIIERGY SO~Rfeh
Heat
!-later Heater
Range
Valu' of Hork:
Legal Description
Lots
5 & 6, Commer.cial Park Subdivision
Nils Holt
401 East 10th
Phone
Builriino Permit Info: Deser,be Work(i~e.. Build Single
Familv nesidence With Attached Garaae'
Owner
Address
Euqene. Oreqon
Construction Lender
97401
686-8282
Revised mechanical plans bv Harvev &
PriG' ComOllnl/ " r"r:,,; w.d .1ulle...l.. 1 qR?
Address
DE,lliN TEAll
(name)
Phone
(address)
flies. no.)
(exoiresl
(ohane no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lic;s. no.)
(expires)
(phone no. )
Genera 1
Plumbino
Electrical
flechanical Larry L. Grimes. Harvev & Price. 2015 Nuqqet Wav. Euqene. OR
746-1621
PLUIIBING
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE Nn
~~~ r~~ NO
~~L ..tllARG[
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
(] bath!
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl vpnt
Sewer
Temporary Construction
Change in existing
res. i de.nee
multifamily, COI\1T1. or
lnrluc;triiil
6
App 1 i ance vent
c;eoariite
Stationary evap.
cooler
Vent fan with
s.inole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood find due t
3.00 18.0C!
~Iater service
Storm Sewer
I
I
_I
1
I
I ISSUANCF OF PFRI1lT 10.0(;
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES 88. OC:
WHERE STATE LW REQUI RES tha t the E1 ectri ca 1 work be done by an.'El eetri ea 1 Contractor. the e 1 ectri ca 1 port i on of thi s permi t
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
Of
amps.
CDMI,\. IIND. FEEDERS
I Install/alter/relocate.
n;c;;tr;n. fppdprc;
10f
-I
1
I
Wood stove/heater
amps.
.....5.... HVAC Uni t<
'..JlO.. .1O..Jl.[;
<;
!-IPt:l t Pllmnc:
, nn in nn
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 oerformed 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 herein. and that fm OCCUPAllCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7D1.055 will be used on this project.
<IJ G.;>(p erkAs. (0 ; bj (/ X'"" /' /
IlAI-lE(please print) <.:3>~ <:;'Y\A.A rf 1~ SIGIIATURE ~c;/ff'
FQP. OFFJGF USE miL Y
Sq, Ftg, 11ain REVISED MEC~ANICAL ~~fWS ONLY
Sq. Ft~. Access
Sq, Ft9, Other
DATE ~M2.-
Zone (;-4
Fire Zone NA
Type/Canst. ~-lhour
Bedrooms NA
Stories 1
Units
Occy Load
Occy Group
94
B-2
x
Value
Value
Flood Plain
x
TOTAL VALUATION
BUILDING PERfl1T Plan Ck, Comm/lnd Shstems Development
Charges and ------------ 65t/Blrln Ppr ~p~ C aroe (1. 5~)
Surcharges Plan Ck, Res 11ECHANICAL PER. 91.52
30%/Bldo Per Fee
PLU'1BING PERMIT Fence :REDIT FOR PRIOR 56.50
Charges and ------------
Surcharges D~mo 'ER. FEE OWED 33.75
ELECTRICAL PERI~IT I'Sidewalk .(% State S.C, 1.27
Charges and ------------ I A/e Paving
Surcharges Total Comb. rermit
11ECHANICAL PERMIT 88.00 1 Curb Cut 135.02
Charges and
Surcharges n---1':'92---- I TOTAL ,
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COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax lot 100, lane County Map Reference
'17 03 43
2, example- Lot I, Block 3, 2nd Addition to
spnngtield Estates'
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. 'eX31r!P1e- waterheater/electncalior ~
E. Square footage or valuation, etc.
1, examole- 1250 sq, foot house, 500 sq, foot garage
2. examole- if new project. check:new - if addition,
check add, etc,
F. Building permit information:
1. exam~le - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exam~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 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, 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, Mechahical, 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
0, 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, ---
Ill, 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 DCCUPANCY:
.
PERMIT VALIDATION
(2J..G +1-5~ l~/
'--'YN-ck '
410
3~,l5
),d1
Permit Cl erk
CUIoLcL
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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