HomeMy WebLinkAboutPermit Mechanical 1984-11-30IIISP
7?6-COMBI AP ICATION 726-37
Job Address EIIERGY SOURCES
Hea t
l'later Heater
Ran
Ftg l'la i n
Sq. Ftg. Access._
Sq. Ftg. Other_
_l,lewJdd_Al ter_Rep.
_Fence_Demo_C hange/ U se
-other--
'o
\9
+o$0o
Leqal Description
(f
Valr-re of l,lork:fl /5, Don-(rc0wner
Address 3
77qo
Cons tructi on
tI Desc l,/ork €. r
Farni'l
Addre s s Phone
/
DL5]GN ILAI.,I name address ICS. nO.exo i res ohone no.
Primary
Structura I
El ectri cal
I'lechani ca I
name addres s lics. no.exDt res ohone no^
Genera l
Pl umbi no
Electrical I N
? qztoz
\ pr-ur(He ELECTRI CAL 14ECHAN ICAL
N0.FFF THARGF NN FFF CHAPNF NN FFF .HAAGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTLI' s
Relocated building
(new fix. additional)
New circuits aits.
or extensions
Floor furnace
and vent
S. F. Residence
( I bath)SERV I CES
Recessed wall
Snacp hpater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
l,later servi ce Change in existing
rpsi dencp
Stationary evap.
cool er
Sewer mult'ifami1y, comm 0r
Indrrstrial
Vent fan with
sinole duct
Storm Sewer 0f emps.
Vent system apart from
heatino or A-C.
COMI.I./IND. FEEDERS
l,lechanical exhaust
hood and duct
I nsta I I /a'l terlrei ocate
dictrih. fpeders l'lood stove/heater
0f ampa Ar 0ef
lSSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHAR6ES TOTAL CHARGES /i ln
WHERE STATE LAl{ REqUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
shall not be valiC until the label has been signed by an Electrica"l Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAIIINED the completed apnlication for oermit, and do hereb.y certify that ali information hereon is true
performed shall be done in accordance with the 0rdinances of the Cityand coffect, and I further certif.v that anyof Springfield and the Laws of the State of
and al l work
0re gon oertaining to the work described herein, and that N0 OCCUPANCY wi'll be made
Building Division. I further certify that my reqistration with the Builder'sof any structure without the permission of the
Board is in full force and effect as required by ORS 701.055, that if ' exempt
055 wi'l 1
the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comcliance with ORS 701.on this
l{A}.lE(please print)I
Zone____Tyoe,/Const. Uni tc S o. Ftg. l'lain
Fire Zo Bedrooms 0c cy Load_q'Ftg . Access x Value
Flood Plain Stories Occy Group 1
TOTAL VALUATION
s
Ftg 0the r
BUILDING PERT'IIT
Charges and
Su rcha rges
Plan Ck. Conm/Ind
65%/B1do Per Fee
Svs
cha
tems Deve
rqe (1.5%
opment
Plan Ck. Res
30%/Bldo Per Fee
PLUI4BING PERMIT
Charges and
Surc ha rges
Fence
Dgrno
ELECTRICAL PERI|IT
Charges and
Surcha rges
5i dewa I k
A/C Paving Total Cornb. Permit
I1ECHANICAL PERMIT
Charges and
Surc ha rges ---/-t.ry)-
I a
Curb Cut
rcrAL /E-|L / N.7a
/a7 Y vU-t
e
I /
\CTORS
t7 XA xt '..^ /r l
4oq6a
coMBrNATr0N AppLICATToN/PERMrT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Description
l. glample- Tax Lot 100, Lane County Map Reference
17 03 432. examole- Lot 1. Block 3, 2nd Addition to
Spring'fi el d Esta iesC. Name, etc. of owner and construction IenderD. Energy Sources
I . examo l e-, .examp le-
quare foota
air gas
PU b7?d7
qd '//?/r'
PERMIT VALIDATION
E. s
2
I
2
example- 1250 sq
example- if new
EIEEF-a-dd, etc.
foot house, 500 sq. foot garageproject, check-new - if additio;,
II
III.
IV.
F. Euilding permit informat.ion:1. example - construct single family house with anattached garage
?. examp]e - remodel existing garage .into family room3. example - convert single family-residence inio
. restaurant (change of use)G. Value of work ai defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.1 AND CONTRACTORS
To avoid design or construction delays, Bu.i)dingDivision Staff must be able to contatt appropr.iitepersons.regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fil'l-in only the No. Boxes adjaient
- to the appropriate item(s) to be installedB. FulI P'lumbing, Mechanicil, and Electrical Schedulesare available at the Bu.ilding Division1. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor i!.not authorizedto sign the electrical labelApp'licant to sign and date
Llhenever possible, the initial applicat.ion w.iII be used asa.worksheet only. Where possible, Buiiding 0ivision Staffwill prepare a type written copy and returi it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payab'le at the time of theapplication, and no plans wiil be processed until thesefees are paid. Al l other fees and charges are due andpayable when the permit is issued.
FOR OFFiCE USE ONLYv Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from reg'istration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name dateSignature