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Home My WebLink AboutPermit Mechanical 1985-12-164,.?tob16)0 CTION 769 CITY OF SPNINGFTELD- COI,,IBI NATI ON APPL IcATION/PERMIT 7? Job Address c EIIERGY SOURCES Hea I'Iater Heater Ran . Ftg.n_ Sq. Ftg. Access._ Sq. Fto. Other_ _l.lewJddJl ter_Rep. _Fence_Demo Change/Use -other-- x $ \ \ Lesar Description /?O 3 S_t 3= d/ OOe /Value of l,lork: //aa- ntU Permi t A c_ Sazze Bg>zs7Zr^z<z . Address Phone / DESIGN TEAI4 name addres s exDt res ohone no- Prima Structura I E l ectri cal Hechanica l name address cvnl rAq ohone no- Genera l Pl qmbi nq El ectri ca I PLUIIB I NG ELECTR I CAL MECHAN I CAL N0.FFF CHARGF NO FFF rHA PNF NO FFF CHARGF Each single fixture Residence of SQ. FT furnace/burner to BTU' s Reiocated building (new fix. additional)New circuits alts or extensions Floor furnace and vent S. F. P,esidence ( l bath)SERV I CES Recessed wal I Soacp heater and vpnt Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent s eDa rate l^later servi ce Change rps i dp in existing naF Stati onar.v evap cool er Sewer multifamily, conrn. or lndrrqtria l Vent fan with sinole duct Storm Sewer 0f Vent syster,n apart from heatino or A.C. c0Mr'1./IND. FEEDERS Mechanical exhaust hood and duct I ns ta I I /a I ter/ rel ocate dist-rih. feeders tJood stove/heater 0f amps. ISSIJANCE OF PFRI,IIT TOTAL CHARGES TOTAL CHARGES WHERE STATE t.{tl REQUIRES that tlre E'lectrical work be done by an Electrical Contractor, the e'lectrical portion of this perrnitshail not be vali'J until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apolication for oermit and correct, and I further certify that any and all work performed , and do hereby certify that all information hereon is true shall be done in accordance with the Ordinances of the Ci ty madeof Spriof any Board i ngfield and the Laws of the State of structure without the permission of Oreqon the Buil oertaining to the work described herein, and that NC 0CCUPANCY will be din g 0 Division. I further certify that my registration with the Builder'ss in full force and effect as required by ORS 7 1.055, that if exempt wi th OPS 701.055 wi l I the for exemption is noted hereon, and thatonly subcontractors and enrployees who are in como l i ance 0n l{AtlE(please print)IGNA Zone______-__Tyoe/Const, Un its So Ftt: Ftg Ftg l'lain x Value_ Fire Zone Bedrooms Occy Load Acces s x Val ue Flood Plain Stories 0cc.y Group Sq Other x Value_ TOTAL VALUATION BUILDING PERI'IIT Charges and Surc ha rges _3_"_-66,PIan Ck. Comm/Ind 657./B1do Per Fee Plan Ck. Res 30%/Bldq Per Fee K.FPLUI4BING PERMIT Charges and Surcha rges Fence D6mo ELECTRICAL PERI1IT Charges and Surcha rges Sidewal k Tota'l Comb. Permi t HECHANICAL PERHIT Charges and Surc ha rges Curb Cut TOTAL 3se& Owner Address Phone Construction Lender ACTORS TOTAL CHARGES A/C Paving COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference D-TTTR?. example- Lot 1. Block 3, 2nd Addition toSEifngfietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical ceilinq/or forced air oasZ, examp le- waterheater/electrical/or soTarE. Square footage or valuation;-etc.- i. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - if addition, check add, etc.F. Bui lding permi t informatjon:1. example - construct s.ingle family house with anattached garage ?. example - remodel existing garage into family room3. example - convert single family residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, BuitdingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electr.ical SchedulesA. Except where blink spaces ociur in the descript.ion--portion of the Mechanical and Electrical Scheduies,the appljcant need fill-.in only the No. Boxes adjaientto the appropriate .item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building D.ivision1. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefu l i schedu'tesC. BUILDING OIVISION 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 electrica.lsupervisor. The general contractor is not authorizedto sign the electrical labelIII. Applicant to sign and date lJhenever possib)e, the initiai applicat.ion wil.l be used asa-worksheet only. l^lhere possible, Building D.ivision Staffwill prepare a type written copy and return it to theapplicant 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 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 PER}4IT VALI DATION 01 ,ab \s U,\v o 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 s'l g nature date r\ s