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Home My WebLink AboutPermit Mechanical 1984-12-07INSPECTION LINE 726-37 69 CITY OF SPRINGFIELD COMBI NATI ON APPLI CATION/PERMIT INFORI{ATION LINE 726-37s3 Job Address l-egal Descri ption Range-- Hea EIIERGY SOURCES l,later Heater n ,,ilKPI,*gMPOwner Sq. Fto. l"lain_ Sq. Ftg. Access.-- Sq. Ftg. Other-_ J'lew____1Ad d_A1 te r_Re p . _Fence_Demo Change/Use 0ther Address hX/o a). ZfA * vnone /</f,g Pernrit Info: Describe Work( Residence l',lith Attached Ganaqe Builciin Fami I y :e.r Build Single t7 ConstructiJn (enaui' Addre s s Phone oq $. LNa v Do name address I ics. no.exDt res ohone no- Primary Structura l El ectrical Mec han i ca I name address (lics- no-exD l res ohone no. Pl umbi nq El ectri ca l l,lechani ca I PLUI{B I NG ELECTR I CAL MECHAN I CAL FEE CHARGE NN FFF CHARGF NO FFF CHA RI]F Each single fixture Residence of FTSQ furnace/burner to BTU' S Relocated buildinq (new fix. additional ) New circuits alts. or extensions Floor furnace and vent S. F. Res idence ( l bath)SERV I CES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent qeoa ratF [,later servi ce ge in existing dpncp C han res i Stati onar-v evap cool er Sewer Tndustria l multifamily, corm. or Vent fan with sinole duct Storm Sewer 0f amps,part from C. Vent systen a heatinq or A. COMI.I./IND. FEEDERS Mechanical exhaust hood and duct I nsta I I /a I ter/ rel ocate di stri h fepdprc l'Jood stove/heater I /-fl amp s.0f ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES /fl WHERE STATE L{l,l 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 Building Division I HAVE CAREFULLY EXAI1INED the completed application for oermit, and docorrect, and I further certify that any and all work performed shall beSpringfield and the Laws of the State of 0reqon oertaining to the work de ission of the Building Division. I further certify that my registration vrith the Builder's llAl'lE(p1ease print)S I GNATU,vLr Boa t055 hereb.v certify that all information hereon is true and done in accordance with the Ordinances of the Cityofscribed herein, and that N0 OCCUPAHCY will be madeofany structure without the perm rd is in ful] force and effect as required by ORS 701.055, that if the basis for exemption is noted hereon, and thatonly subcontractors and ernployees who are in compliance with 0l?S 701 'l I be used on thi {qvin Ciel, al ue Value Val ue TOTAL VALUATION- xLoad!q. r tg. Access . 0ther ts Fire Group Sq. FtS Ftg. l'lain Y x Stori esFlood Plain Zone Const. Plan Ck. Corm/Ind 65%/B1do Per Fee Svsterirs Deve charqe (1.5q opmentBUILDING PERNIT Charges and Su rcharges Plan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges DOmo Sidewal kELECTRICAL PERIlIT Charges and Surcharges A/C Paving Tota'l Comb, Permi t Curb Cut14ECHANICAL PERMIT Charges and Surc harge s /5. o*a 6o f t<6LGaT0TAL /lr l? ltsF otJt Y 8Yo&7s COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfiejd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources l. example- heat/electrical ceilinq/or forced a.ir qas2.ExamETe-waterrreater/el-6ct-FJcal-/orsoJar-: E. Square footage or valuationl-E,il- 1. examp-le- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, checkl-ew - if addition, check add, etc.F. Buitding permit information:1. example - construct single family house with anattached garage ?. example - remodel existing garage into family room3. example - convert single fam.i iy res.idence.into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Bu.ildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechan.ical, & Electrical SchedulesA. Except where blink spaces ociur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be instal'ledB. Full Plumbing, Mechanical, and Ejectrical Schedulesare available at the Building Division1. 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 thefull 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 theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date I'lhenever possible, the initiai application will be used asa worksheet only. Hhere possible, Building Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actual permit is issued for hissignature.IV. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION Pl b77o/ t&l/t (/ Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name Si gnature date gA