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Home My WebLink AboutPermit Mechanical 1980-10-08L COMB I ON CAT I ERMITL 726-37 53 Job Address 3C bl/\(_EIIERGY SOURCES: Hea t lJater Heater Ra Ftg Sq. Ftg. Access.'--- Sq. Fto. 0ther__ J{ewJdd_A1ter_P.ep. _Fence_Demo Change/Use -other---=o QI UAI -l Legar Description \ b \{ - 11 DZa I q+ Value of l,Iork:36G DOowner{;ynet{.A Address Phone Bui Farn' t In Descr Hi At .e., Build Single lql'7Dq%S Construction Lender Addres s Phone -7 q 5 ':2.7-F, I]ES i GN TEAI{name address 1CS. nO.exo l res ohone no. Pri mary Structura I E I ectri ca i Mec han i ca I CONTRACTORS n ame add res s (exo I res (ohone no. eenerat f)lr'Y\-Q-lf- Pl umbi nq 'I l''lechanical PLUIIB I NG ELECTR i CAL I'4EC HAN I CAL FFF CHARGE NO FFF (.HA PCF NO FFF CI,lAPGF Each single fixture Residence of SQ FT furnace/burner to BTLI' S Relocated bu.ilding (new fix. additional)New ci rcui ts al ts. or extens i ons Floor furnace and vent S. F. Res i dence(l bath)SERVICES Recessed wal I Snace heatpr end vpnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate [,later servi ce Chan res i ge in existing dence Stationar.v evap cool er Sewer multifamily, comm. or Industria l Vent fan with single duct Storm Sewer 0f amps.Vent systen apart from heatino or A.C. COI4I.I./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/relocate di stri h fppdprc l'Jood stove/heater 0f _amps. TOTAL CHARGES ISSUANCF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES I,JHERE STATE LlI.J sha I I not be val i'l I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of thjs permituntil the Iabe1 has been signed by an Electrical Supervisor and returned to the Building Division I comp eted a p !')I 'I c a t 'I o n for Derm j t an d do he reby rt I fy t ha t a j o rma t 'I o n hereo n 'I s true Ci ty made a nd co rrec t and I fu rth e r ce rt 'I fy that any and al'l State of 0regon sion of the Buil wo r k pe rfo rmed s ha I I be don e I n ac cordanc e 1 t h the 0rd 'I n an ces 0 f thofSDrtnsfieIdandtheLaws0ftheoe rta 1 s to th e work descri bed he re!n and tha t NO OCCUPAI,I CY wl I I be 0 f a ny s t ruct ure 1 t ho ut the pe rmt s d ing Division. 701.055, tha I fu rt he r ce rt ,1 fy t ha t m.y reg i s tra t 1 n tl 1 t h the Bu I I der sBoard is in full force and effect as required by ORS t 'I f exempt the ba 'I s for xempt 'I o n 1 s n0 te d hereo n a nd th a t n I v subco n tr a c to rs a nd ernp 'I 0yees who a re 'I n comD I 'I an ce wl th 0t?s 7 0 1 05 5 wl 'I I be used 0n t hi s pro,j ect llAl'lE(p1ease print),, S I GiIATU _a'DATE Z o n e___________Ty D e / Co n s t Fire Zone Bedrooms Uni o Ftg Ftg Ftg l''1a i n x Val ue 0ccy Load S q Acces s 0ther x Value Flood Plain Stories Occ.y Group Sq X Val ue TOTAL VALUATI NN BUILDING PERNIT Charges and Su rcharges Plan Ck. Conrn/lnd 65%/B1do Per Fee Svs Cha terns Deve rqe (1.5% opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgrno ELECTRICP.L PERIIIT Charges and Surcharges Sidewalk A/C 'Pavi nq Total Cornb. Permit I,IECHANICAL PERMIT Charges and Surc ha rges __15 cc Curb Cut TOTAL t5"@ 3Grrtt , COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description l. example- Tax Lot 100, Lane County i 17 03 43 2. example- Lot 1. Block 3, 2nd Addit SEilngfield Estates C. Name, etc. of owner and construction lr D. Energy Sources 1. example- heat/electrical ceiling,/ol 2. example- waterheater/electrical/or E, Square footage or valuation, etc. Map Reference ion to ender r forced air gas sol ar l. examole- 1250 sq. foot house, 500 sq. foot garage 2. example: if new proiect, check new - if addition, EIEEEIa-dd, etc.F. Building permit information:1. example - construct single family house with an atTaEIea garage 2. example - remodel existing garage into family room 3. eiimple - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or iob site corrections, etc, II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except vrhere blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be 'instaIled B. 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 iiem(s) to be installed are not covered on the abbreviated schedules you should consult the ful 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 the electricai contractor for signature by his e.lectrical supervisor. The general contractor is not authorized to sign the electrical label.III. Applicant to sign and date Whenever possjble, the initial application wil l be used as a worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna ture.IV. Fees and Charges Plan check fees are due and payable at the time of the appiication, and no plans wil l be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. v. FoR oFFI CE USE oNt,Y PERMIT VALIDATION Perm'i t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit appf icant exempt from registratjon with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name Si gnature date PECT I -37 69 LIIIE D PERMITCOMBITAPPL I CAT I 726-3753 =\J a r*V Job Address '=\f\bn PL EIIERGY SOURCES Hea t l,later Heater Ranqe Sq. Fto. I'lain_ Sq. Ftg. Access.- l-ega1 Description Value of l.lork:3f, G. DOowner-{g1-r1e V-, f1 L Address rYLL Phone u nq rnri t I n Des l,Jork ng e Farni I Res dence I.J,i Atta c h Ga ra L Construction Lender Address Phone -l:Lo52-z.sDTS I Gi,I TEAI{name address 'I ics. no.exD I res phone no Pri mary Structura l Electricai l'lec ha n i ca I TR n ame address 'I i cs. no.exD I res ohone nn- General bt l;-Y\,-Ut- Plumbinq El ectri ca I lleche n i ca.l PLUI,IB I IIG ELECTR I CAL MECI-IANICAL ti0.FFF C HARGE FFF CHARGF il{l FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BIL|' s Relocated bui ldinq (new fix. additional ) New ci rcui ts al ts or extensions F'l oor furnace and vent S.F. Resjdence(l bath)SERV I CES Recessed wal I Snacp hpatpr and vpnt Duplex (i bath) each Addi ti onal bath Temporary Constructi on Apol iance vent seDa ra te lrlater servi ce Change in existing res i dence Stationar-v evap cool er Sewer multifamily, comrn. or industria I Vent fan with srnole duct Storm Sewer 0f .amps. Vent systerx apart frorn heatinq or A.C. cor'{r.!./IND. FEEDERS Mechanical exhaust hood and duct- Instal I /a i ter/rel ocatedistrih- feederc ['Jood stove/heater 0f TOTAL CHARGES ISSUATICE OF PFRIlIT TOTAL CHARGES IOTAL CHARGES i'IHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshafl not be vali'l until the labei has been signed by an Electrical Sunervisor and returned to the Building Division I lco Sor any rd HA VE CAR EF UL L Y +comp e d ap r)ca 'I o n for DE TIX i t an d d o her eb.y cert i 'fv th a t a I 1 i n fo rma t I 0 n he reo n I s true a nd rrec t and I fu rthe r cer t I f v tha t any an d a 'I I wo rk oe rfo rmed S ha I I be do ne 'i acc o rda nce th t he 0rd 'I nan ce 5 o f th e C 'I tyfin9fieIdandtheLa ws of t he S Ld t e of 0reo o n oe r ta I n I n g +^th e work des fu rthe r exempt 055 wil] c r i be d here i n d n d th a t i,t0 OC CUPAI I IV',l I I b e ma de 0 s truc i ure i t ho U t the perm 1 ss i on o t he Bu i I d 1 n9 D I 'l s 'I 0 n cer ti fy th a t m.y reg i s t ra t i 0n tli th the Bu 'I I der s Boa s in full force and effect as required by ORS 701.055, that if the ba s 'I 5 f 0 r EX emp t i 0n i s n oted he reo n a nd tha t I bco n tra nd Ionvsuctorsaerir)oyee s who a re ,l n com D I 'I a nce th 0i?s 7 0 1 be ed on th I s Pro.j ec t l.lAl"lE( pl ease pri nt)IGiIATURE 'z DATE r./ r,/:''- F Zone Tyoe/Const. Uni ts So Ftg Ftg Ftg l''la i n x Value Fire Zone Bedrooms 0ccy Load Acces s 0ther al Flood Plain Stories Group Sq x Value TOTAL VALUATION BUILOING PERI.IIT Charges anC Su rcharges Plan Ck. Comm/Ind 65t{/B ldrr Per Fee Systens Deve Charqe [1.5X opmen t Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Demo ELECTRICAL PERI,:IT Charges and Surc ha rges Sidewalk A/C -Pavi ng Total Comb. Permit I,IECHANICAL PERMIT Charges and Surc ha rges co__[_a Curb Cut TOTAL t5@ 0ther 4/ coMBINATT0N AppLICATIoN/pERt4rT (CAp) I. Applicant to furnishA. Job AddressB. Legai Descri ption]. example- Tax Lot 100, Lane County Map Rel 1/ UJ +J?. examcle- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources i l. examo_le- heat/eiectrical ceiling/or forcr?. exancl-e- waterEETETEJEETFlcITor sSTaFE. squaiET6otage or valuatifil-Ete]_l. examole- 1250 sa. foot house. 500 sq. for2. Exam,pie- if new project, check-i-ew - if I EIec r<-Edd , etc .F. Bui )ding permi t information:1. exanoje - construct single family house rattaaled garage ?. exancle - remodel existing garage into fi3. E&mDTe - convert single iamity-residenc, FEiaurant (change of-use)G. Value of work as defined in Section 303 (a) , Structural Specialty CodeH. DES IGi,I TEAI.i AND CONTRACTORS To avo'id design or construction de)ays, Bujl,Division Staff must be able to contact appro persons regarding design information or job correcti ons , etc.. Abbreviat:d Plunbing, i'lechanical, & Electrical SA. Except vrhere blank spaces occur in the descrportion of the tlechanical and Electrical Schthe applicant need fill-in only the No. Boxet0 the appropriate item(s) to be installedB. Fui l Plumbin-o, l'lechanical, and Electr.ical Scare available at the Building Divis.ion1. To conserve space on the permit form the have been abbreviated2. if the item(s) to be installed are not cthe abbreviated schedules you shouid conful I schedulesC. BUILDIiiG DiYiSiON STAFF i,lILL FILL OUT ALL FE CHARGES Oi{ THE SCHEDULESD. As noted cn the CAP, the label must be delivelectrical contractor for signature by his esuoervisor- The general contractor is not ato sign the electrical iabel.. Appl icant to sign and date Whenever possib)e, the initial application w.i11 a vrorksheet only. tr^Jhere possible, Building Diviwili preoare a type written copy and return it tapp)'icant at the time the actual permit is issue s i gna ture.IY. Fees and Charges Plan check fees are due and payable at the timeapplication, and no ptans wili be processed unti qnc Ciry Holl Springfield, Oregon Deportment of Public Works OFFICIAI RECEIPT No. B 54939 Dote l9 ro riic f\ Received For PERMIT VALIDATION CITY OF SPRINGFIEID I5 Amount Received I SIGftATURE EUGEf,€ OR 97'OI I rU Ii III \dj.( 0.' f.r ( I i I these t ,{.1 s 8Y sxEt fees are paid. All other fees and charges are due andpayable vrhen the permit is issued. V. FOR OFFI CE USE OIII.Y Permi t Cl erk PROJECT CONDITIONS TO BT SATISFIED BEFORE OCCUPAIICY: Perm'it appf icant exempt from registrat'ion r^/'ith the Bu'iIder's Board because: Additional Project Information : PLANS REVIEWED BY: datenameSignatu re ( \ 4 ( ( ( crTY oF SPRTNGFTELD, OREGU Bulldlng DePartment CERTITICATE OF COMPLIANCE Thle certlftes that the butldlng and property located at has been inepected and of Sprlngfleld, Oregon. found to comp ly wlth the ord lnancee of th e Clty ly'Orfirers Name Addrese City Iteme of apeclal conelderatlon are: , ,fi -t ,/) Date endent Bulldlng I