HomeMy WebLinkAboutPermit Mechanical 1981-05-20TiON LIIIE
69 COMB I L
RIlA
377
ress EIIERGY SOURCES:
l,later Heater
Kd
Ftq, tlain_
Sq. Ftg. Access._
Sq. Fts 0ther
_l.lew_Ad d_A1 te r_Pe p .
_Fe nce_Demo_C ha nge/ U se
0ther
?ac
("Ir
:/)
L")
l-egal Description
l-10 "T( 5 Value of lJork
,\-0wner V;t,*r-t-
Address Z O Z -Ll- o o ..Phone tJul l (, t
Fami I y
no Pernlit Info: Descnit' Res idence I,li th Attachet
.e., Build Single
t 211 -81 zS 4
Construction Lender J i
-l-t^^1 n^-) eJA 4t) rJ,^.,
Addre s s Phone
a /t./
DES I GN TEAI'I name s ICS. nO.exDr res
Primary
Structura I
Electrical
l'lechanica'l
n ame lics. no.PYN] TPq nhonp no- )
Genera I
Pl umbi nq
El ectri cal
q o-
PLUIlBI NG ELECTR I CAL MECHAN 1 CAL
FFF CHARGF NO FFF l.HAPG F NO FFF
Each single fixture Residence of
SQ FT
furnace/burner to
BTLI' s
Relocated building
(new fix. additional )
New ci rcui ts al ts
or extensions
Floor furnace
and vent
S. F. P.es i dence
( l bath)SERV I C ES /Recessed wal l
Soace heater and vent ((,o o
Duplex (l bath) each hrl=-I J oc)
Additional bath Temporary Construct i on Apol iance vent
qF na ra te
[,later servi ce Change in existing
rpc'i dpncp
Stationary evap
cool er
Sewer multifamily, comnn.or
Industrial
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
COMI.I./IND, FEEDERS
Mechanical exhaust
hood and duct
I n sta I I ,/a I ter/ rel ocatedistrib. feeders tJood stove/heater
0f
IssuANCF oF pFRrlIT lo'o)
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I,,HERE STATE LAI,J REQUIRES that the Electrical work be done by an Elec
shall not be vali,J until the label has been signed by an Electrical Supe
trical Contractor, the electrical portion of this permit
rvisor and returned to the Building Division
idohereb.ycertifythatajlinformationhereonistrue
and correct, and I further certif-v that any and all work performed shall be done in accordance with the 0rdinances of the City
of Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC OCCUPAI{CY will be made
of any slructure-without the permission of the Buildinq Division. I further certify that my registration urith the Builder's
Board.is in fuil force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and ernployees who are in compliance with OPS 701.055 will be used on this r;roiect.
I'lAtlE(please print)G- E, Pr tce r !@aS IGiIATURE
Zon e__________Ty o e/ Co n s t
Fire Zone Bedrooms
nits Sq.Ftg. l'lain x Val ue
0c cy Load Sq. Ftg. Access x Va lue
Flood Plain Stories Occ.y Group Sq. Ftg x Value
TOTAL VALUATI
0ther
BUILDING PERMIT
Charges and
Surcha rges
Plan Ck. Comm/Ind
65"1,/81do Per Fee
S v s terls
Cha rqe
Deve
(1. 5%
opment
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rge s
Fence
Demo
ELECTRICAL PERIIiT
Charges and
Surcharges
Sidewalk
A/C Pav i ng
Curb Cut
Total Colrb. Permit
I4ECHANICAL PERMIT
Charges and
Surc ha rge s
s t-,or^, f ? ?z-
)e
I
Work
Garaor
rnnp nn
:TORS
:d)
COT'BINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal DescriptionL examole- Tax Lot 100, Lane County l,lap ReferIroT":2. example- Lot l. Block 3, Znd Addition toSpringfield Estates
9. Name, etc. of owner and construction lenderD. Energy Sourcesl. examole- heat/electrical ceilinq/or forcedz. .dilE- "ate.Fffi#i;' r"fti:i. SqrraE-TGrage or vaiuaEioI. examole- 1?50 sq. foot house, 500 sq. foot?. exadie- JT-iew'p"o;.ct,-iteik=n.,, - if addEfrEEI-i-dd, etc.F. Building perr,rit information:1. example - construct single family house witattacned garage?. exarnole --rem6del existing garage into fami'3. exaffiiE - convert single iufiifv'res.idence irrestaurant (change of use)G. Value of work as defined in Section 303 (a) of.Structural Specialtv CodeH. DESI6N TEAi.I AiID CONiRACTORS
To avoid design or construct.ion delays, BuildinrDivision Staff rnust be able to contalt'upp.op.iipersons regard.ing des.ign information or job site
- corrections, etc.. Abbreviatect plumbing, I,lechanical, & E.lectrical SchecA. Except rvhere blink spaces o.iu" in-ih. ats..iptiportion of the Hechanical and Electricai Schedulthe applicant need fill-in only the No. Boxes io_ to the appropr.iate item(s) to -be instal ledB. Full plumbing, tlechanicif, ina-ifecirical Scheduare avaiIable at the Bui lding Divis.ionl. To conserve space on the-permit form the schhave been abbreviated2. If the item(s) to be instal.led are not coverthe abbreviated schedules you should consultfull schedulesC. BUILDI|iG OIVISIOi\I STAFF WILL FILL OUT ALL FEES ACHARGES OiI THE SCHEDULESD. As noted on the CAp, the label must be de.liveredelectricai contractor for signature Oy iris eieiisupervisor. The general conlractor is not auti., to sign the electrical labelApplicant to sign and date
lJhenever possib'l e, the.initial application wi.l I be
.a-worksheet only. lJhere possibte, Auilding 0ivisicwrll.prepare a type written copy and return it to tapplicanr at the time the actuii permit is issued fsignature.
Fees and Charqes
Plan check fe6s are due and payable at the time ofapplication, and no plans wjil-be proceiied until t,rees are paid. All other fees and charges are due ,payable when the permit is issued.
FOR OFFICE USE ONLY
CITY OF SPRINGFIEL
City Holl
Springfield, Oregon
Deportment oI Public Works
OFFICIAT RECEIPT
J
B 56543
Dole I9
t
Received For:
ror {
{
(
(
II
{
(
{e
(r'BY
(Amount Received
----rl
Dote
F
(
III CITY OF SPRINGFIELD(,
Ciry Hol!
Springfield, Oregon
Deportmenl of Public Works
OFFICIAT RECEIPT
ilo. B 56544
19
(l
u
il
(
{
(
i
(
L
L
IV
V
e
PROJECT CONDITIONS TO BE SATISFIED BEFORE
-=
\r{
Received For:
r
I
I
L
\c2>
Permit applicant exempt from registration
Additional Project Information:
PLANS REVIEWED BY:
Amounl Received m
SIGNATURE
SX€LION-TURXEULL PRIN'ER5 EUGENE Oi 97'OI
'45!I'A
L
v
name s'l g .l_na tu re
BY
da te
t-
I
(
rArm-;