HomeMy WebLinkAboutPermit Mechanical 1983-03-03iIISPECTIOII LIIIE
726-37 69
CITY OF SPRTNGFiILD
COMBI iIATION APPL ICATION/PERMIT
INFORI1ATION LiNt
7?6-37s3
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Leqa l Descri ption
Job Address
l.later Heater
Ran rle
EIIERGY SOURCES
Hea t
ocTqo
Sq. Ftg. Access._
Sq. Fto llain
Value of l;lork: {. cc6Oo-Owner ,In [. n An,]",*ou .e. r Build SingleDescn
'I
it Info
Hi
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Addr es s Phonee
Construction Lender
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Addres s Phone
ohone no-exDl reslics. no.addressnameDESIGN TEAI.I
Pri ma
St ructura I
E l ectri ca l
l''lechanical ohone no.lics. no.'( expi res ladd res sn ameCONTRACTORS
Ei ec
fL oq
I''!echa n i
7 t6.-Lo?'t
MECHAN I CALELECTR I CALPLUtlB I NG
FFF THARGF NONOFEE furnace/burner to
BTLI' s
Residence of
FTsQEach single fixture
Floor furnace
and ventNew circuits alts
or extensions
Relocated building
(new fix. additional)
Recessed wal l
Snace heatpr and ventSERV I CESS. F. Res i dence(l bath)
Duplex (l bath) each
, t-b.I Apol iance vent
se*+a*e l( 4x-Temporary Constructi onAddi ti onal bath
Stationar)'evap
cool erEe in existing
dence
Chan
rpc iIlater service
Vent fan with
sinole ductmultifami lY, cornm. or
Industrial
-
Sewer
Vent system aPart from
heatinq or A.C.imps.0fStorm Sewer l,techani ca l exhaust
hood and ductc0r4r.1./IND. FEEDERS
l.lood stove/heaterInstal I /al terlrel ocate
dictrib. feeders
amp s.0f
ISSUANCE OF PFRI1IT IE.N
'lectrical Contractor, the electrical portion
upervisor and returned to the Building Divisi
TOTAL CHARGES of this pernit
onATE L,1N REQUIRES that tlte Elect
vai i'l unti I the Iabel has been
TOTAL CHARGES TOTAL CHARGES
WH
shal l
ERE ST
not be
anE
cal S
E,u'
rical work be done bY
signed by an Electri
IGNATUREllAl'lE(please print)
l'la i n
BI
x
teris
Sq. Ftg
Load
TE.1
Val
F
1.5.1
Grouo Sq. Ftg
C'ity
madeny
of
xempt
5 wi'l
on'I reonhe s'I trueaI,l
n'I LformarCEItthatfydohedantrebyfocat0nrtedepEDNtheapcompULLF ncena oS f theOrd itheth'I a ordacc nceIhaIbedoneIDEworksrformedaIdaLanefu rth r 'Irt thandaIfyndcco rre ta w1At'lcY 1I bedhatNCtCUP0c'Ir hbed 'Iere n antJOhedrksctarnIttong0e0regonawsLtofStetahe'Ir t ei dI dan hetofSpng tI thh D Iu deI r strasItn0v,''I ath t refucrtherrtm.y g'ieIfy.I D 'I 'IS onBu
,l'I dthetheS'I 'Is of0n ngttrucuret'I utho perm tsaofthaandhereonny0n1noted,l sSIforSexempttheba.I fthta e05500RS7dffa+s red'I fr iu fo rceI an e requi by'I SrdBoa tthons'IIusbeed roj ecp05thus007wi1Ia,l encIwhorean'IACtrandtors c0mDnoIubconempoyeesSv
P an
P an
Comm/ I
!q. Ftg
opment
ES
Pe
Flood Plain Stories
BUILDING PERMIT
Clrarges anC
Su rcha rges
Access x Val ue
;;;;; fr ?<trd- / * r-' ut u "-6& . 6Zone TYoe/Const' Un i ts
Fire Zone Bedrooms 0ccY
ToTAL VALUATI0N-
Fence
0emo
PLUI4BING PERMIT
Charges and
Surcha rges
Sidewalk
Tota'l Comb. Permit
ELECTRICAL PERI'IIT
Charges and
Surcha rges A/C Pavi ng
Curb CutIlECHAIIICAL PERMIT
Charges and
Surc ha rges
14 ,'-
.6y TOTAL /6. <y
re l^iork(
Ga raoe/4 ? "
-1-
COMBINATION APPLICATION/PERHIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference 7.170343 ,
2. example- Lot 1. Block 3, Znd Addition toSFiTnlFietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
a iti forced a i
2.e ec r ca 0r oE. Squa val uat on, etc
- TY OF SPRTNGFIELD
City Halt
Springfield, Oregon
Deparlmenl ol public Works
OFFICTAL RECEIPT
No. B 60509
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-
Date
Rec'd
Address
19
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Fleceived For:A
1. example- l?50 sq. foot house, 500 sq. foot gararz. example- if new project, check new - if additiorcheck add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. example --.er6dei existing garage into fami ly rrJ. example - convert single family residence intorestaurant (change of use)G. Value of work ai defined in Section 303 (a) of theStructurai Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contatt appropriitepersons regarding design informat.ion or job s.itecorrections, etc.
Abbreviated Plumbing, Mechanical, & Eiectrical ScheduleA. Except urhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjai
- t0 the appropriate item(s) to be installedB. FulI Plumbing, Mechanical, and Electrical Schedu.lesare available at the Building Divis.ion1. To conserve space on the-permit form the scheduhave been abbreviated2. If the item(s) to be installed are not coveredthe abbreviated schedules you shou)d consult thful I schedulesC. BUILDING DIVISION STAFF l^lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to cneelectrical contractor for signature by his etectriiai -
supervisor. The general contractor i! not authorizedto sign the elec+,rica l labelApplicant to sign and date
Whenever possible, the initiat application wi.l.l be used asa.worksheet oniy. Where possible, Bu.ild.ing Division Staiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued foi nissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiil-be processea untli tf,.r.lees are paid. AII other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
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Amount Received E,C j/
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BRIC6S PRINTERS/LITHOORAPHEiS, EUCENE. ONEGON
Permit Clerk
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PLANS REVIEWED BY:
PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY:
icant exempt from registration with the Builder,s Board because:Permit appl
name Si gna tu re da te 3-?_?5.>
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Additional Project Information:
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