HomeMy WebLinkAboutPermit Mechanical 1980-11-21INSPECTION LINE
726-37 69
CITY ()F SPRINGFIELD
CO}1BI iIATI OI'I APPL I CATION/PERMIT 726
Job Address EIIERGY
Hea t
lJater Heater
e
tg. l'la n_
:q. Ftg. Access._
Sq. Ftq. 0 ther
I tE[flep. -
Cha nge/ Use
oa?
_c
U
Legal Description
value or ""I'rlqarcJreC{O{L\
Address r\Phone BuiIcii
Fami I y
ng
Re
Pernri t I nfo: Descri be l,lork ('
sidence l,lith /l.ttached Garage
.e., Build Singie
19b^Ulltl
Construction Lender -n
Addre s s Phone
DES I GN TEAI.I name addre s s (lics. no.exD t res phone no.
Pri ma ry
Structura l
E I ectri ca I
i''!echanica l
nane addres s 'Iics. no. )exDl res (ohone no. )
Genera I
IPl umbi nq
E I ectri ca I
tlechan'i ca'l
PLUI1B I IIG ELECTR i CAL 14ECHAN ICAL
CHARGE NO FFF rHA RGF li0 FFF CHARGF
Each sinqle fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated bui 1 ding
(new fix. additional)
New ci rcui ts al ts
or extensions
Fl oor furnace
and vent
S . F. Res i dence(t bath)SERV I CES
Recessed wal I
Snaap heatPr and vpnt
Duplex (l bath) each
Additional bath Temporary Construction Apol iance vent
seDa rate
Llater servi ce Change in existing
resi dence
Stati onary evap
cool er
Sewer muitifamily, comn. or
Industrial
Vent fan with
sinole duct
Storm Sewer 0f amps.
Vent systern apart from
heatinq or A.C.
C(]I4N./IND. FEEDERS
Mechan i ca I
hood and d
exhau
uct
st
Instal I /al ter/rel ocate
distrib. feeders l'lood stove/heater
0f amp s.
ISSUANCE OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAl.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall 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 apn'lication for oermit, and do hereb-v certify that all information hereon is true
and correct, and I further certif-v that any and all work performed shall be done in accordance with the Ordinances of the Cityof Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC OCCUPAI,ICY will be madeof any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 70i.055, that if exemot the basis for exemption is noted hereon, and that
only subcontractors and ernployees who are in comcliance with 0l?S 701.055 will be used on this pro,ject.
L* ^^ 6rar....,-.^DA.IE I / -l{Al'lE ( pl ease pri nt)S I6NATU
l-,FOI1 OFFICE USE Oi,{LY U\
Zone Tyoe/ Cons t Uni ts Sct Fto. l'lain x Val
Fire Zone Bedrooms Occy Load Sq
Flood Plain Stories 0cc.y Group Sq
Ftg. Access
Ftg.0ther_
X Val ue
l
TOTAL VALUATI
BUILDING PERMIT
Charges anC
Surcharges
Plan Ck. Comm/Ind
65%/91do Ppr Fpc
S vs tems
Cha rqe
Deve
(1.5X
opment
Plan Ck. Res
30%/81dq Per Fee
PLUi4BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERTIIT
Char ges and
Su rcha rges
Si dewa I k
A/C Paving
Curb Cut
Total Comb. Permit
I,IECHANICAL PERI,lIT
Charges and
Surcharges c iLII},L /5r,o
Owner
CONl ATTOR\
FFF
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County l4ap Reference
17-T3-43?. example- Lot 1. Block 3, Znd Addition toSFrlnlFietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. example- heat/electrical ceilino/Z. examp le- waterheater/electrical/oE. SquarE f66Tage or valuation,=Tc.-
or forced air gas q-61)q x
r soTar
Ii
1. example- !2lQ sq. foot house, 500 sq. foot garage?. exarpig: JT-new project, cheikl-ew - if aodition,
check add, etc.F. Building permit informat.ion:1. exampie - construct s'ingle family house with an
eTE aled garase2. example - remodel existing garage into family room3. examole - convert single family residence intoiElTiiFant (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, Building
Division Staff must be able to contact appropr.iate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the l4echanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the aopropriate item(s) to be installedB. Ful l PIumbing, Mechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the perm.it form the scheduies
have been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefui.l schedulesC. BUILDING DIYISION STAFF hIILL 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 eiectrical label.
Applicant to sign and date
Hhenever possibie, the initial application will be. used asa worksheet only. Where possible, Building Division Staffwill prepare a type rvritten copy and return it to theappiicant at the time the actual permit is issued for hissignature.
Fees and Charges
PIan check fees are due and payable at the time of theapplication, and no plans rvill be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III.
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Add'itional Project Information :
PLANS REVIEWED BY:
name s'i gnature date