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Home My WebLink AboutPermit Mechanical 1979-12-20INSPECTION LiNE 726-37 69 CITY OF SPRIIIGFIELD COMBI NATiON APPL I CATI ON/PERI'1IT INFORIIATION LINE 726-37 53 (} dr 0J+ 't Job Address t2 rl nergy Sources q ma n accsy eat heeter new a terfence riemol iti6i" changeT[se _otheralue of work l-egal Description \' )56ry4\ l+(-I Owner (name/address/phone)u i no t wole fam. res. with detached \I I i rlcrd-\*fl a-- Construction Lender (name/address/phone) I.-nn n [()i N) DES I GN TEAI,I name address pxD rec nhone no- Pri ma ry Structura I E I ectri ca I Hechan i ca i CONTRACTORS ^name addrpss tas no-pYnt rps ohone no- L[bq--. Pl umbi nq El ectri cal I'lechanical PLUI4BI NG MECHAN I CAL ELECTR I CAL N0.FEE CHARGE NO FFF .HAPGF NN FFF .HA RG F Each single fixture furnace/burner to BTU' S Residence of SQ FT Relocated building (new fix. addjtional ) Floor furnace and vent New circuits alts. or extensions S.F. Residence(l bath) Recessed wal I Snacp hpatcr and vent SERV I CES Duplex (l bath) each Additional bath Apol iance vent seoa ra te Temporary Constructi on tlater service Stationar-v evap. cool er Chan res i ge in existing dence Sewer ;Vent fan with sinole duct multifamily, comm or I ndu stri a I Storm Sewer Vent systern apart from heatino or A.C.0f Mechanical exhaust hood and duct coMr.r./IND. FEEDERS tlood stove/heater rr( \!)- o Instal l /al ter/rel ocatedistrib. feeders 0f New circuits, alts nr pvtpnsions rssuANcE oF PERr{rr 3Po TOTAL CHARGES TOTAL CHARGES : o,o:)TOTAL CHARGES WHERE STATE LAl.l REQUIRES that the Electrical work be done by an Electrical Contractor, the shall not be valid until the label has been sisned by an Electrical Supervisor and returned to electrical portion of this permit the Bui lding Division. I HAVE CAREFTILLY EXAMINED the completed appiication for permit and correct, and I further certify that any and all work performed of Springfield and the Laws of the State of 0regon pertaining to th of any structure without the permission of the Buildinq 0ivision. , and do here shall be done e work descri by i certify that all information hereon is true n accordance with the Ordinances of the City herein, and that N0 OCCUPAIICY will be made NAt'lE (please print)S IGNA DA' FOR OFFICE USE ONLY Zones Flood Plain -_ Bdrrns Type Const. __ Sq Ftg Value Va lueOccy Load Occy Group,Stories Units Sq Fts BUILDING PERI'IIT Charges and Su rc ha rges Plan Ck. Comm/ind 65/"/B1do Per Fee Storm Sewer Connec Plan Ck. Re 30%/Bl do Pe srF ee 0t her PLUI4BING PERMIT Charges and Surcha rges Fence 0ther Sprinkler System 0ther ELECTRICP,L PERt.!IT Charges and Surcha rges MECHANICAL PERMIT Charges and Surcharge s C)C) Demo.Total Comb. Permit A/C Pavi ng SDC I Curb Cut TOTAL u4 Sidewalk .dl (zrp)n*n I €.?//Lt, t COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpIffiTieid EstatesC. Name, etc, of owner and construction IenderD. Energy Sources PERMIT VALIDATION ]' examcl e- heat/ 2 , exami-I-e- wa terE, Square footage or electrical cei 'I or forcq{qir gas a r e ec or solar 1 vai uat o[' iI 1. examplq- 12!0- sq. foot house, 500 sq. foot garage2. exampTar if-new project, check-i-ew - it adOitioi, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage2. example - remodel existing garage into family room3. example - convert single family res.idence .into resti-uFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI,I AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the applicant need fiil-in only the No. Boxes adjacentto the appropriate item(s) to be .installed B. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Divis.ion1. 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 theful I schedul esC. BUILDING DIVISION STAFF l,JILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the labei must be delivered to thee'lectrical contractor for signature by his electr.icalsupervisor. The general contractor is not authorizedto sign the electrical labelApplicant to sign and date l,Jhenever possible, the initial appl ication w.il l be used asa worksheet only. Where possible, Bui'lding 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. 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 v/hen the permit is jssued. III. IV V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY: Additional Project Information PLANS REVIEWED BY: name Si g na tu re da te L COMBI ION APPLICATI E RI'1I T 7?6-3753 -t Job Address Nl:n'lf\ UI t Sources ma n accsy t er heoter new a ter alue of work feni6 dEmol itioi- changeT[se _other u i n9 pe fam. rm n o desc r be e with d l-egal Description \7 C\! !\ cccd-\$.ct A--, Construction Lender (name/address/phone))5 ) r rr--) name exoi res ohone no. P ri mary Structural Electrical Hechanical n arne lics. no.exoi res )ohonp no sNq--- Pl umbi nq E l ectri ca l llechan'ical PLUIIB I NG MECHAN I CAL ELE CTR I CAL rlt, -FEE CHARGF N0.FFF CHARGF N0-FFF CHA ANF Each single fixture furnace/burner to BTU' S Res i dence of sQ FT Relocated buiidinq (new fix. additional ) F'l oor furnace and vent New circuits altsor extensions S.F . Residence bath )(r Recessed wal l Soace heater and vpnt SERVICES Ouplex (l bath) each Addi tional bath Apol i ance vent sepa ra te Temporary Constructi on l,later service Stationary evap cool er Chang resid e in existing ence Sewer Vent fan with sinole duct mult'i fam'i 1y, comrn. or Tndrrstria l Storm Sewer Vent systern apart from heatinq or A.C.0f amps. Mechanical exhaust hood and duct c0Mr'1./IND. FEEDERS l,Jood stove/heater rli\J- o Instal I /al ter/rel ocate di<frih fccdprs 0f s. New ci rcui ts, al ts or pxtpns.ionc rssuAr'rcE oF PERrlrT 3Po^ TOTAL CHARGES TOTAL CHARGES : o,o.)TOTAL CHARGES WHERE STATE LAI'I REQUIRES that the Electrical work be done by an Eiectrical Contractor, the electrical portion of this permitshall not be valid until the iabel has been sisned by an Electricai Supervisor and returned to the Building Division. I HAVE CAREFI.ILLY EXAi4INED the completed application for permi performed t, and do hereby shall be done in certify that all information hereon is true accordance with the Ordinances of the Cityherein, and that N0 OCCUPANCY will be made and correct, and I further certify that any and alof Sprinqfield and the Laws of the State of 0regonof any structure without the permission of the Bui I work pertaininq to the work descri ldino Divisio n. SIGNATUNA!'IE (please print)Czrr)o*n I lilr^r..e FOR OFFICE USE ONLY Zones Flood Plain _ Bdrms Tyae Const Sq Ftg Sq Ftg Value Value0ccy Load 0ccy Group Stories Unit s A COUNT BUILDING PERI,IIT Charges and Su rcha rges P l an Ck. Comm/ lnd 55'{/Bldo Ppr Fpp Storm Sewer Connec Plan Ck. Res 30,i/Bldo Per Fee 0ther PLUI4BING PERMIT Charges and Surcha rges Fence 0ther Sprinkler System 0ther ELECTRICAL PERIlIT Charges and Sur:harges Demo.Total Comb. Permit A/C Pavi ng 5DC IlECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL ,-'lSi dewal k 0wner ( name/address/phone ) .e., o N I LAI{( / COMEINATION APPLICATION/PERMIT (CAP) I. Appl i cant to furni shA. Job AddressB. Legal Descriptionl. ejxample- Tax Lot 100, Lane County Map Reference T7-If-432. examole- Lot l. Block 3, 2nd Addition toS!'ilffiietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION CITY OF SPRINGFIELD l. examcle- heat/electrical ceil ino/oZ. exarole- waterheater/electr.ical/orE. SquaiE-T6oTage or valuat'ion, etc- CirY Holl SPringfield' Oregon o.oJ-.it of Public works- OFFICIAT RECEIPTr forced air gas :of*- Electrica l Schedulesin the ciescript'ion ectrical Schedules, the No. Boxes adjacent'installed'lectrical Schedules No. B 523 86 1. examole- 1250 sq. foot house, 500 sq. foot garage?. e-arple.-: -lf new project, check new - it aOOition, check add, etc,F. Bui lding permi t information:1. example - construct single family house with anattached garage 2. examole - remodel existing garage into family room3. EranLoiE - convert single iaijly-residence .inio resEilrant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AI,ID CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriite persons regarding design information or job site II III. IV corrections, etc, Abbreviated Plumbing, Mechanical, &A. Except vrhere blank spaces occurportjon of the Mechanical and El the appl icant need fill-in onlyto the appropriate item(s) to beB. Full Plumbing, Mechanical, and E are avajlable at the Building Divisionl. To conserve space on the permit form the schedules have been abbreviated?. lf the item(s) to be instailed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDIIIG DIVISION STAFF I^IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theelectrical contractor for signature by his electricalsupervisor, The general contractor is not authorizedto sign the electrical label.Applicant to sign and date llhenever possible, the initiai application wil l be used asa worksheet only. Where possible, 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. 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. Ail other fees and charges are due andpayable y,hen the permit is issued. V. FOR OFFICE USE ONLY SXELfOX'iURNAULL PRINTER3' EUGENE l=RIZED SIGNATURE nounl Recei'ved Permit Clerk 3a!rt_6 ess PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Additional Project Information : PLANS REVIEWED BY: da ienames'l gna tu re (