HomeMy WebLinkAboutPermit Mechanical 1985-05-22ECTIi
37 69 RMITCATIcoilB I
Job Address F*-?<E?
Legal Descri Ption / ? -a7-zz/o, c>72&
EIIERGY SOURCES:
Heat
Range_
lJater Heater
Owner ?*< Busr% <./,P.Value of tlork
Sq. Ftg. Access._
Sq. Ftg. Other_
_l'lew_AddJ1 ter_Pep.
_Fence_Demo Change/Use
0ther
l'1a
Addres s lfie )/a<csZ V,rq fu-vtonu scr
Farni l
n t
dence
.e., Build Single
&'#*fure22-{,/DD 4fuE ,/lZ< ry^/-7 rc
Construction Lender %zz>*a,ma./r-
Address Phone
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DESIGN TEAM name address lcs. no.exot res phone no.
Primary
Structura l
El ectri ca I
Hechani cai
CONTRACTORS name addres s exDI res 'ohone no-
Genera I
Plumbinq
El ectr i ca I
-{qcrpnical .1/*nrcf / h.e- Ca,-Za/; ,z</cxez l{rr-742- /42/
PLUI{B I NG ELECTRICAL MECHAN I CAL
FFF CHARGE NO FFF CHARGF NO FFF (. HAAGF
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(1 bath)SERV I CES Recessed wal I
Soace heater and vent
Duplex (1 bath) each /,/Ytf < /),?r 5o'
Additional bath Temporary Constructi on Apol iance vent
seDa rate
tlater service Change in existing
rps i dpncp
Stati onar,v evap
cool er
Sewer
I ndus tri a I
multifamily, conrn. or Vent fan with
sinole duct
Storm Sewer 0f Vent system apart from
heatinq or A.C.
coMr.r./IND. FEEDERS Mechanical exhaust
hood and duct
I nsta I I /a I ter/ re1 ocate
di cfri h fccdcr<l'lood stove/heater
0f amps
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
aa
WHERE STATE Llli REQUIRES that the Electrical work be done by
ri,
an Electricai Contractor, the electrical portion of this pernitshall not be valid until the label has been s.igned by an Elect cal Supervisor and returned to the Buiiding Division
rtaining to the work described herein, and that N0 OCCUPAI,ICY will beDivision. I further certify that my registration vrith the Builder's
055, that if exempt the basis for exemption is noted hereon, and that
who are in comoliance with OPS 701.055 will be used on this project.
llAtlE(please print)f-e*tG?gatarl S IGNATURE
llermi t
'formed ty
made
Boa
I HAVE CAREFULLY EXAMINED the completed ap nl ication for , and do he reb.v certify that all information hereon is true
andI correct, and I further certify
Springfield and the Laws of the
that any and a'l I work oer shall be done in accordance with the 0rdinances of the CiofState of 0reqon oe
ssion of the BuiIdiofany structure without the permi
rd is in full force and effect as required by ORS
ng
701
only subcontractors and employees
J*ruer D
l.one fr/V lyge/Const-Wr.ffinits Sq. Ftg
. Ftg. 0ther x Value_
ToTAL VALUATIoII_
Fire Zone
Flood Plain Stories.
xBpdroomsFtgAccess
l4ain x Value_
Val ueLoad Sq
croup ^F- ? sq
Plan Ck. Conrn/Ind
65%/81do Per Fpe
Svstems Deve
Charqe fl.57.
opmeotBUIL0ING PERI'IlT
Charges and
Su rcharges
ee
Plan Ck. Re
30%/Bldq Pe
srF
FencePLUI4BING PERMII
Charges and
Surcha rges D6mo
SidewalkELECTRICAL PERIIIT
Charges and
Surcha rges Tota l Comb. Perm'i tA/C Paving
Curb CutHECHANICAL PERMIT
Charges and
Surc ha rge s
oc,
z€t 2o5TOTAL
)e tlork (
I Garaop
_____t_
COMBINATION APPLICATION/PERHIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. SIggElg: Tax Lot 100, Lane County Map Reference17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield Estates
PERMIT VALIDATION
9. Name, etc. of owner and construction IenderD. Energy Sources
l. examp l e-2. exampl e-E. squaFE-TFta
hea t/ el ceilin forced air gas
wa or solar
I
ge or valuat Orl'
examol e-
examp i e-
check add
1250 sqif new
foot house,500 sq. foot garage
2 proj ect, check new - if addition,, etcF. BuiI d ing permi t
example - cr
attached gar
information
I onstruct single fami)y house with an
?
rage
3
examoi e
examo I e
- remodel existing garage into fami ly roomconvert sin gl e fami ly residence .i ntores ta u ra nt. (change
as definr
of use)(5 2,/xu
G. Value of work ed in Section 303 (a) of the
(,0Structurai Special ty CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contait appropriitepersons.regarding design information or job iitecorrections, etc.
Abbreviated Plumbi!r9, Mechanical, t Electrica.l SchedulesA. txcept where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedu.les,the applicant need fil'l-in onty the No. Boxes iOjiient_ !o_lhg appropriate item(s) to 6e instat.ledB. Full Plumbing, Mechanical, and Electrical Schedulesare avaiiable at the Building Divisionl. To conserve space on the-permit form the scheduleshave been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated scheduies you shou.ld consult theful I 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 theelectrical contractor for signature by his electricai -
supervisor. The general contractor ii not authorizedto sign the electricaj labeiApplicant to sign and date
I,lhenever possib)e, the initial application wi.l .l be used asa.worksheet only. Uhere possible, Build.ing Division Staiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theappiication, and no plans wiil-be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
7
II.
III.
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit app]icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEHED BY:
name s'l gnature date
/rV2