HomeMy WebLinkAboutPermit Mechanical 1987-11-10INS
726
CITY OF SPRINGFIELD
COMBI NATION APPLICATION/PERMIT
Job Address G 8D
Descri pti on
EIIERGY SOURCES
Heat
llater Heater
Ran
alue of l,lork:
. l.lain
Sq. Ftg. Access.-.--
Sq. Ftq. 0ther--
_l{ ew_Ad d_A1 te r_P.e p .
_Fence_Demo_C han ge/ U s e
0ther
4
(5
DA
S\'
tN
L,
Addres s Phone
u0
n scr e
i dence [,li
D
Constructi on t-*r*a=e"/I 4+t
Addres s Phone {
DEsIGN TEAFf nan','e address l ics. no.exDt res 10ne no
Pri
Structural
El ectri ca I F{t
l,lechan'icaX
n&,me addres s lics- no-)(exn rpq ohone no.
Genera I /^\
PN.UI{BtrIJ€U
EL ECTR I CAL I'4ECHAN I CAL
N0.FIFF CHARGF NN FFF CHA QGF NO FFF CHARGF
Each s,imEne f;.1-xture Residence of
SQ FT
furnace/burner to
BTU' S
Rel ocateci lru"ildinE
(new -fix. addritl'omall )
New ci rcui ts al ts.
or extensions
Floor furnace
and vent
S,F. Residernce(1 bath)SERV I CES
Recessed wal I
Snaap hpaicr and vpnt
Duplex (1 hatllrr) each
Add'itionail ',batilr Temporary Constructi on Apol iance vent
seDa rate
l,later serviice C han
res i
ge in existing
dence
Stationary evap
coo I er
Sewer multifamily, comm or
T ndrr ctri a l
Vent fan with
sinole duct
Storm Sewer 0f Vent systenn apart from
heatinq or A.C,
c0Mr'1./IND. FEEDERS Mechani ca l exhaust
hood and duct
Instal I /al ter/rei ocate
d i stri h. feeders liood stove/heater
0f -amp s.
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE ILII{ RIQU
shall not be vanid,untiI
IRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVI'CAREFIIjIL:LY EXAI{INED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correct, arnd tr further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfielld armd the Laws of the State of 0reqon oertaining to the work described herein, and that NC OCCUPANCY will be madeof any stn;rct,ure uitho,ut the permission of the Building Division. I further certify that my regis
Board is l-ttt tInlll force and effect as required by ORS 701.055, that if exempt the basis for exempti
only subcontn.actors ar,rd ernployees who are in comcliance with 0l1S 701.055 will be used on this oroj
tration vrith the Builder's
on is noted hereon, and that
ect.
tlAl''lE ( pl ease print)Lo-r.I\4" G^-\.iCNA l\- to -8,
Zo n e_________-__Type/Co n s t
Fire Zone Bedrooms
Uni ts, - Krtg ffi
Load Ftg Acces s x Va ue
Flood Plain Stories 0cc.y Group
TOTAL VALUATION
.Sq. Fts 0ther
BUILDING PERI.IIT
Charges and
Su rcharges
Plan Ck. Cornm/Ind
65%/B1C'o Ppr Fee
Svstems Deve
charqe (1.51 opment
Plan Ck. Res
30%/81dq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERI,IIT
Charges and
Surcha rges
Stdewal k
A/C Pavi ng
Curb Cut
Total Cornb. Permit
14ECHANICAL PERMIT
Charges and
Surc harges
? "5D
z TOTAL a3, L3
I
iul
:arn
I fl
(n
ue_
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 1. Block 3, Znd Addition to
Springfield Estates
C, Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1, exampl e-2, examp'l e-E. Square foota
air gas
I
2.
example- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addition,
check add, etc.
c Building perm
1. example -
a ttac hed
it information:
construct single family house with an
garage
2. example - remodel existing garage into family room3. example - convert singie family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. 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 P)umbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building 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 consult thefull 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 thee'lectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto s'ign the electrical label.III. Appiicant to sign and date
Hhenever possible, the initial application will be used asa worksheet on1y. Where possibie, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.IV. Fees and Charges
Plan check fees are due and payabie 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.
V. FOR OFFICE USE ONLY
c5/?
I 1-[0
.g/
Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name sig nature date