HomeMy WebLinkAboutPermit Mechanical 1984-12-12I NSPE
726-3 IT
Job Address SOURCES:
l-ega1 Description I'later Heater
lue of l,lork:
Owner
Ftg. l'1ain_
Sq. Ftg. Access.--
Sq. Ftg. 0ther_
_l{ew_Add Al ter_Rep.
_Fence_Demo_C ha nge/ Use
-other-
C
f..
\n
e
\ar
Address Phone n :e., Build Single
Construction Lender
Address Phone
f
DESIGN TEAI,I name address 1 CS. nO exDt res
Pri ma ry
Structura l
E I ectri ca i
Mechani cal
CONTRACTORS name addres s I ics. no.(exn i res )(nhone no-
Genera l -;"1 n tt lt
PI U .ro &.a 0 /e
El ectri ca l I a o
I'lechani cal
PLUI{BI NG ELECTR I CAL MECHAN I CAL
N0.FFF CHARGE NO FFF CHARGF NO FFF CHARGF
Each sing)e fixture Res idence of
sQ FT
furnace/burner to
BTU' S
Relocated buildinq
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
5. F. Res idence
( l har.h)SERV I CES
Recessed wal I
Snaac hpaier and vcnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
se Da ra te
l.later servi ce Chan ge
rps'i den
in existing
ce
Stati onar.v evap
cool er
Sewer multifamily, comm. or
Tndrrstrial
Vent fan with
sinole duct-
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
COMI'I./IND. FEEDERS
i"lechan ical exhaust
hood and duct
Instal I /al ter/re l ocate
di stri h fcpdprc [,Jood stove/heater
0f Qaxtuk)o
lntu
ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES lo*
WHERE STATE LAti REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be va'liC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that al'l information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that N0 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my registration vrith 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 comcliance with ORS 701.055 will be used on this project.
r{Ar.rE(please or;nt1S( D0 F t( 0 0 o
"
* n SI DATE ,a/,t/ru
Zone Cons t.its Sq. Ftg l,la i n al
Fire Zone Bedrooms Load Ftg Acces s x Value
Fl ood P l ai n Stori es Occy Group Sq. Ftg. 0ther_________x Va'l Up
TOTAL VALUATION
BUILDING PERT'IIT
Charges and
Surcharges
Plan Ck. Conrn/Ind
65'/"/B1do Per Fee
stems opmeot
Plan Ck. Res
30%/81do Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERIIIT
Charges and
Surc harges
Sidewal k
A/C Paving Tota'l Cornb. Permi t
I,IECHANICAL PERMIT
Charges and
Surc harges
____/_o_=q_
-'/ ()
Curb Cut 4orotar / g /o.alo
)e
I
tllork
Ga ra or
(r nn
8Vo s-7 O
coMBINATI0N AppLrCATr0N/PERMrT (CAp)PERMIT VALIDATION
I Applicant to furnishA. Job AddressB. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
l. examp]e- heat/electric?l ceiling/or forced air gasZ. examp Ie- waterheater/eiectrical/or solarE. Square footage or valuation,-EtE.-_l. example- 1250 sq. foot house, 500 sq. foot garage2. er.mple- if new project, cheik-new - if additio;,
EIEER*add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family room3. example - convert single family residence inlorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction detays, BuildingDivision Staff must be abie to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electr.ical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Ejectrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installed8. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Bui)ding Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consu'lt thefulI 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 .is.not authorizedto sign the electrical label
Appi icant to sign and date
Whenever possible, the initial app)ication will be used asa.worksheet only. Where possible, Building Div.ision Staffwili prepare a type written copy and return it to theapplicant at the time the actual perm.it is jssued for his
s i gnature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
@ ffiz&r
rc/a/ry
II
III
IV.
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project information :
PLANS REViEWED BY:
name SI g nature date