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HomeMy WebLinkAboutPermit Mechanical 1980-02-18L COMBI NATI APPL I CATIO ERI.lIT 726-37 53 z_sek-Job Address Lct EIlERGY SOURCES Hea t llater Heater Ranqe . Ftg I'la i n_Access._ 0ther Sq. Ftg So. Ftg l,lew Add Al ter Pep. Fence Demo Chan ge/ Use _ot her-B l-eqa1 Description 0wner Value of llork:OCD,OO Address 1l-a ru zf vno".ftf-fru.tI Descn ttached Ga e., Build Single Ft-o^)lnec. .d,rt^-tl Construction Lender -rc-t<r\+ 33&l Addres s Phone DES I GN TEAI,1 name address 1CS. nO.exD t res phone no Primary Structura I El ectri cal l'lechani cal CONTRACTORS name Lddress'I i cs. no.exDt res Genera I Pl umbi nq El ectri cal tlechani ca'l .O* \/sr\- PL UIIB I NG EL ECTR I CAL MECHAN I CAL FEE CHARGE NO FFF CHARGF NO FFF rHA ANF Each single fixture Res.idence 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,esidence(l bath)SERVICES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa ra te l,later servi ce Chanqe in existing res i dence Stati onar.v evap cool er Sewer multifamily, comm. or I ndus tr.i a I Vent fan with sinole duct Storm Sewer 0f Vent systern heatinq or A apart from .c. COI4I.,!. / IND. FEEDERS l"lechanical exhaust hood and duct Instal I /al ter/rel ocate di stri b. feeders \['Jood stove/heater Ef0 0f s. ISSUANCF OF PFRI1IT lb 90 TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAtl REQUIRES that the Electrical rvork be done by an Electrical Contractor, the electrical portion of this permit shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI{INED the completed apnlication for oermit, and do hereb.y certify that all inforrnation hereon is true and correct, and I further certify 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 0reoon oertaining to the work described herein, and that NC 0CCUPAI,ICY will be made of any structure without the permission of the Building Divis.ion. I further certify that my registration vrith the Builder's Board is in full force and effect as required by ORS 701.055, that if exemot the basis for exemption is noted hereon, and that only subcontractors and ernployees who are in comcliance with 0l?S 70i.055 r,rill be used on this Droject. t'lAl.'lE ( p1 ease pri nt )S I GIIA oarc z- lf,-& FOIl r)FFI Zone oelConst. Uni ts So Ftt: Ftg Ftg l'la i n x Value Fi re Zone Bedrooms Load Access 0ther al Fl ood Pl a'i n Stori es 0c c.y Group Sq X Val ue TOTAL VALUATION BUILDING PERI.IIT Charges and Su rc ha rges Plan Ck. Comm/lnd 65%/B1d'o Per Fee Svs Cha tems Deve rqe (1.51 opment Plan Ck. Res 30%/B1dq Per Fee PLUI^4B ING PERMI T Charges and Su rcha rges Fence Dgrno ELEC;hICAL PERIIIT Chay'ges and ^'rrcha rges Sidewalk A/C Pavi ng Curb Cut Total Comb. Permit MECHANICAL PERMIT Charges and Su rc ha rge s -(4 TOTAL l5@ ul ----'= COMBINATION APPLICATION/PERMIT (CAP) i. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION i. exanple- heat/electrical ceilino/2. exa,:rT-e- water[eETerZelEEtrlE]-/ot. square f0otage or valuation, etc. or forced air Srsoar II. 1. examp_le- 1?50 sq. foot house, 500 sq. foot garageZ. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single fami)y house with an attached garage ?. example - remodel existing garage .into family room3. example - convert single famiiy residence into- restaurant (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, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrecti ons , etc. Abbreviateci Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Build.ing 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 theful I schedulesC. BUILDING DIVISION STAFF t,/ILL 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 electricalsupervisor. The general contractor is not authorizedto sign the electrical iabel.Appiicant to sign and date Whenever possibie, the initial application w.il'l be used asa.worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no ptans wil l be processed until thesefees are paid. All other fees and charges are due andpayable vihen the permit is issued. FOR OFFICE UsE ONLY I1I. IV Permit Clerk PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name Si gna tu re \ date I IIS PE 725-3 oilL It COIIBI iiATI ON APPLI CATICN/PERI.IIT FORIlA 726-37 Job Address Qzo L EIIERGY SOURCES Hea t So. Ftq. l.lain_ Sq. Ftg. Access._ Sq. Ftq. 0ther_ _l,lew-Addll ter_Pep. l,later Heater Ranoe F _0 'ence_Demo Change/Use therVal ue of l.lork nq Re t In Descri be t tached lJork .e., Build Singie Farni I sidence 1,.i th n Ga ra t <(uD Legal Description Owner Address Phone Constructi on Lender -\-C-rF,(r* 33&l Phone I]E5IGN TEAI.,I name addres s lics. no exo'i res ohone no. Pri mary Structura l Electrical llechanicaI CONTRACTORS name addres s (lics. no.exDl res ohone no. ) Genera l P l umbi nq E l ectrical l.lechanical O* v<.r\- PLUIlB I NG ELECTR I CAL MEC HAN I CAL N0.FFF CHA RG F NN FFF CHARG F NO FFF CHARGF Each single fixture Res i dence 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. Residence(t bath)SERV I C ES Recessed wal l Soacp heaipr and vpnt Duplex () bath) each Additional bath Temporary Constructi on Apol iance vent s eoa ra te l/ater servi ce Change in existing rcs'idencp Stationary evap cool er Sewer multifamjiy, comm. or Industrial Vent fan with sinole duct Storm Sewer 0f .amp s.Vent systen apart from heatino or A.C. c0t4H./tND. FEEDERS Mechanica l exhaust hood and duct Instal I /al ter/re l ocate dist-rib. feeders \llood stove/heater 500 0f amp s. ISSUANCF OF PFRI1IT lb 00 TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE Lll.l REQUIRES that the E.Iecshall not be valil until the label has bee tricai r'rork be done by an Electricai Contractor, the electrical portion of this perriit n signed by an Electricai Supervisor and returned to the Building Division E XAIl INE D t he comp I eted apnl ic any and ai e of 0rec_ron a 0n r DC rm'l L an d do her b.y ce rt 1 fy th a L a I I I n fo rrna t o n he reo n 'I s true a nd rrec t a n d I fu r the r c er t 'I fy t h a t 'I t^/0 r k Der fo rmed s ha I I be do ne ,i n a cc rda nce t/ l th t he 0rd 1 nan ces f the C 'I ty o f S 0r 'I ng f ,]e I d a nd th e La ws of t he Sta t 0e rt a i n I ng to t he \^/O r k d e S C r 'I bed here i n an d t ha t ilc OC CUPAiI CY wt I I be madeof any structure wi thout the permission of the Build g Di i s 'l on I cert I fy th at my req 'I s t ra t 'I 0n v/l t h the Bu .l I der sBoard'i s ,l n fu I I fo rce and f fec t a s recl u 'i r ed by 0R5 7 0 05 5 tha f exemo t L he ba s I s fo r exemr)t I 0n 'I s n oted hereo n a nd th atIbc0nvsuontrac t0rs an d emD I oyee S wh a re I n c0mc 'I 'I a nce rvl t h 0i?s 707 0 55 i I I be u S ed o n th ,]s DT o.j ec t I'iAl,1E (pl ease pri nt)S IGIIA DAT e Z-lf-& Zone e/ Con s t.Uni ts Ftg Ftg Ftg lla i n x Val ue. Fire Zone Bed rooms Load Sq Acces 0ther Val ue Flood Plain Stori es 0 cc.y Group Val ue ToTAL VALUATI0N_---- Sq BUILDING PERMIT Charges and Su rcha rges Plan Ck. Comm/lnd 65i-llBl dq Per Fee S vs tems Cha roe Deve(1.sz 0pment Plan Ck. Res 30:i/Bldq Per Fee PLUI4BING PERMIT Charges and Su rcha rges Fence Dgrno ELECTi'{ICAL PERIlIT Charges and Sl -cha rges Sidewalk A/C Paving Total Comb. Permit IlECHANICAL PERMIT Charges and Su rc ha rges _u) Curb Cut TOTAL 15@ Add res s furt he r COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County l,lap Reference Iz--03-T:2.' example- Lot 1. Block 3, ?nd Addition to SpiTn!-f,ield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. exanole- heat/electrical ceiling/o2. exanole- waterhetter/electrical/orE. SquaiE-?6otage or valuation, etc. r forced air s SO ar l. example- 1250 sq. foot house, 500 sq. foot garage2. "*mpjF Tffiew project, check-new - if additio;, EIEEx-I-dd, etc.F. Building pernrit information:1. exanple - construct single family house with an ;TTacFA garage 2. exancle - remodel existing garage into family room3. examcle - convert single famiiy residence into- restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty Code; J. OESIG|{ TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appro.prlate persons regarding design'information or job site corrections, etc.II. Abbreviated Plumbing, Mechanicai, & Electrical SchedulesA. Except r.rhere blank spaces occur in the descriptionportion of the Mechanical and Electrica'l Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Fuli Plumbing, Mechanical, and Electrical Schedules are avai lable at the Building Division' I. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instailed are not covered on the abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESr r t di,t?:?:.?'Jli"fii;!l*,'I[].ui#H;l':i::l.ll;in' supervisor. The general contractor is not authorizedto sign the electrical label. I II. Appl icant to sign and date l,lhenever possible, the initia) application wil l be used as . a worksheet only. t.Ihere possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual oermit is issued for his: -rt. .t, 30. slghaEure.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wiil be processed until these fees are paiC. Ail other fees and charges are due and payable vihen the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BIFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVI EI^IED BY : name s'ignature da te PERMIT VALIDATION 3ITY OF SPRINGFIELD CitY Holl Springfield, Oregon Deporlmenl of Public Works OFFICIAT RECEIPT l{0. B 52823, F lress eived For: d* . !!i;' nounl Received (UTHOaTZEO Sr RE sHELTON IUaEEUL! PirRtERS - EU6€NE Oi tTaol 3!!!l-a Permi t Cl erk ,