HomeMy WebLinkAboutPermit Mechanical 1986-03-17J^^ifwj@
INSPECTION LINE
726-37 69
m
COHBI NATI ON APPL I CAT I ON/PER},I IT TilFOR'IATIOil ITNE
726-37s3
Job Address /25a /1/, /?ri
Legal Oescription I
Hea
Ranqe.
EIIERGY SOURCES:
llater Heater
0wner
Value of l,lork
Sq. Ftg. l.lain_
Sq. Ftg. Access._
Sq. Ftg. 0thef_
_Iewjddtql ter_Rep.
_Fenc e_Demo_C ha n ge / U s e
0ther
addtess 1?05 La-.rza- a-d< .
^/,E.
erc'.e/)[n t h
re., Build Single
1zsry'3s at
Construction Lender ltn* /nil
Addre s s Phone
oa
N
G
6-
$a
name exDI res phone no.
Pri
Structura I
E I ectri ca I
Hechani ca I
:TORS name 'lics- no-'cYnl rpq ohone no- l
Genera l
P l umbi nq
El ectrical
Qoz ?4'r-4tx
rJ,ruur6 ELECTRI CAL MECHANICAL
FEE CHARGE NN FFF .I.IA PAF NO FFF
Each single fixture Residence of
FTsQ
furnace/burner to
BTU' S
Relocated building
(new fix. additional)New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence(l bath)SERV I CES Recessed wal l
Soace heater and vent
Duplex (I bath) each
Additional bath Temporary Constructi on Apol iance vent
sepa rate
Hater service Cha
res
nge in existing
i dence
Stationary evap
cool er
Sewer multifamily, co[m. or
Industrial duct
Ven
sin
'an wi thtf
ole
Storm Sewer 0f Vent system apart from
heatino or A-C-
c0Mr.1./IND. FEEDERS Mechanical exhaust
hood and ducf
Insta l I /al ter/rel ocatedistrib. feeders l,lood stove/heater
0f amps J^mlurc
e,I a),r\-(,s,rd*r.xc /S oc
,/7.bo
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I'IHERE STATE Llt,I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Buildin! Division
pertaining to the work described herein, and that N0 0CCUPAI.ICY will be
ding Division. I further certify that my registration with the Builder's
tlAl'lE ( pl ease pri DATES-/7.84€{L I
Ci ty
made
fy
the
I HAVE CAREFULLY EX/\IIINED thc completed application for permit, and do hereby certify that all information hereon is trueand correct, and I further certi that any and al
State of 0regon
'I work performed shall be done in accordance with the Ordinances of theof Springfield and the Laws of
structure without the permi ssion of the Builof any
Board i s in full force and effect as required by ORS 701.055, that i the basis for exemption is noted hereon, and thatonly subcontractors and employees who are in comoliance with ORS 701
f exempt
.055 wilI be used on this Droject.
Snor Srna
: USE ONL\
Fire Zone Bedrooms 0ccy Load So
Ftg
Ftg
Ftg
TOTAL VALUATION-
ts
0c c.y Group Sq.
x I
st.
ValueFlood Plain Storie
Access
0ther
Plan Ck. Conm/lnd
65%181do Per Fpp
Svstems Deve
Charqe fl.57
opmeotEUILDING PERNIT
Charges and
Surcharges
Fee
Plan Ck. Res
30%/Bldq Per
FencePLU4BING PERMIT
Charges and
Surcharges Dgmo
SldewalkELECTRICAL PERIIIT
Charges and
Surcharges A/C Paving Tota'l Comb. Permit
Curb CutHECHANICAL PERMIT
Charges and
Surcharges D
/5. oo /€6CTOTAL
0 3
l'lain x Value_
C0MBINATT0N AppLICATToN/pERMrT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Referenceli 03 43
PERT4IT VALIDATION
2 exampi e-
SffinsFi
Lot 1. Block 3, 2nd Addition to
eld EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. example- heat/electrical ceiling/o'2. example- waterheater/eletiilcaVor
E. Square footage or valuation, etEl. example- 1250 sq. foot house, 5002. exarele- r'f new project, check-new
check add, etc.
r forced air gas
r"laF-
sq. foot garage.- if addition,
F. Building permit information:1. example - construct single famiiy house with an
attached garage
2. example - remodel existing garage into family room3. examole - convert singie family residence into
ESTiIIrant (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 sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedujes,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Fu11 Plumbing, Mechanical, and E'lectrical Schedules
are ava'ilable at the Building Divisionl. To conserve space on the permit form the scheddles
have been abbreviated2. If the item(s) to be insta'lted are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING OIVISION STAFF I.IILL 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 authorized
bt'b
?
(/
{),\
.),t
II.
to sign the electrical labelIII. Applicant to sign and date
llhenever possible, the initial application will be used asa worksheet only. Where possible, Building 0ivision Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gnature.
IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these
. fees are paid. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name si gnature date
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