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Home My WebLink AboutPermit Mechanical 1981-01-15CC co (/ Struciuisl Eiectritoi jvlechonicol Plumbi Electricol hcne INSPECIION UNE 72(..3759 INFORMATION TINE 72(F3753 CIIY OF SPRINGTIELD COA.TSINAIION APPTICAIION / PERMII tesolpelqipr-\ / 7-O.3 - )./^-21 'l-/ 4/^Of) Addres: -,?ENERGY SOURCES: Heof v\ /a Wqler Hesler Rqnge --New-Add--Alter-ReP'Fence-Demo-Chonge / Use y'torh., - Sq. Frg. Ir{oin Sq. Ftg. Accesr. 5q. Ftg. Other (l*^- Lliltt o4o{-Owner Vqlue of Work: 550.op ?honc 741-lq5t)Addre:s da'dia-n-tDU/ Fomi Residence Wilh A Building Permit lnfo: Describe Work (i.e., Build Single Wo,L A,66-qq/3 Phone Construction Le Addre ss (nome)(lics. no.)(expires)(phoneDESIGN TEAM Prim o ry NO.FEE CHARGE NO.rEE CHARGE furnoce/ burner lo s I i Eoch:inqle fixture Residence of fi Relocoted building (new fix. odditionol) New circuils, olterotions or extensions ,Applionce vent seporole Sloiionory er.op. coo le r S.F. Residene (l both)SERVICES Duplex (l both) eoch Temporory Construction Vent fon with single duct Ampr. Vent system oport froi'n heoting or A.C.Addiiionql both Mechonicol exhqust hood ond ductWoler rervice Wood rtove/ heoter .< Oa )?--,.o9Sewer FEEDERS Heot PumpSlorm Sewer Amps. Air hondler lo I0,000 cFM Air honciler over 10,000 CFI'I ,9ISSUANCE OF PERMIT o/o. WHERE STATE tAW REQUIRES rhor thc Electricol work be done by ths Eledrieol Conhoctor, the slcclricol portion of this permit sholl not ba valid until o label hos been signed by on Elactricol Controctor snd ottoched to the electricol pcnel. I HAVE CAREFULTY EXAMINED the ompleted opplicotion for permit, ond do hereby cerlify thot oll informotion hereon is lrue. ond correci, ond I further certify thot ony ond oll work performed sholl be done in ocordonce with the Ordinonces of lhe City of Springfield ond the.Lows of the Stote of Oregon pertoining to the work described herin, ond thot NO OCCUPANCY will be mode of ony slructure wilhout the permission of the Building Division. I further ertl{y thot my ,egistroiion with tle Builder's Boord is in full force ond effecl os required by ORS 701.055, thot if exempt the bosis for'exemption is noted heron, onci thot only iubcontroctors ond employee: who ore in omplionce wilh ORS 7Ol.O55 will be used on lhis prolett. TOTAT CHARGESTOTAT CHARGES SIGNATURE , TOTAI CHARGES Bosis for Builder'r Eoord exemption: NAME (pleose prinl) FOR OFFICE USE Type/Consr.Zone Flood Ploin - Sto Fire Zone TOTAI. YATUATION nits --Sq. Ftg. Mdin x Volue x -Voluo Group-Sq. Ftg. Other-x -Yol Syslems Development Chorqe (1.5%) BUILDING PERMIT Chorges ond Surchorges Plon Ck. Comm/lndO-Per Fee65% Plon Ck. Res Per Fee Fence /5,6eToiql Comb. PermitDemo PI.UMBING PERMIT Chorges ond Surchorges Sidewolk ETECTRIC.AT PERMIT Chorges ond Surchorge: O A/C Povinq Curb Cutoa 6o TOTAI.# r< Lo'/-)t - MECHANICAI. PERMIT Chorges ond S urchorge s Mechonicol NO. PTUMBING EtECl'RICAt /TIECHANlCAL FEE CHARGI: o- o^ft t f trf6.d QI Oarv -o- COMBINATION APPLTCATION/FE(MIT (CAP) l. Applicont tp furnish A. Job Address B. legol Descriptionl. exomple-tox lot 100, Lone County Mop Reference l7 03 432. exomple-Lot l. Block 3, 2nd Addition to Springfield Esrotes C. Nome, etc. of owner ond construclion lender D. Energy Sources lectricol ceili .,'or forced oir gos 2.eoter ectr l,'or- solE?- E. Squore footoge or voluotion, etc. 1. exomple-l 250 sq. foot house, 500 sq. foot goroge 2. exEmFlE-iT ne; proiect, checkieii-if oddition, check odd, etc. F. Building permit informolion:l. exomple-conslruct single fomilv house with on oltoched goroge 2. exomple-remodel existing goroge inlo fomily room 3. glgl@-converl single fomily residence inro rEsiouiont (chonge of use) G. Volue of work os Cefined in Section 303 (o) of the Structurol Specio lty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construclion deloys, Building Division Stoff must be oble lo contoct oppropriote persons regording design informotion or iob site correclions, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the description portion of the Mechonicol ond Electricol Schedules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriote item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building DivisionI. To conserve spoce on fhe permil form the schedules hove been obbrevioied 2. lf the item(s) to be instolled ore nol covered on the obbrevi-' oted schedules you should consult rhe full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Building Division Stoff will prepore o typewritten copy ond return it to the opplicont ot tLe time the octuol permit is issued for his signoture. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicotion, ond no plons will be processed until these fees ore poid. All other fees ond chorges ore due ond poyoble when the permif is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION I Permit Clerk PROJECT CONDIIIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: PLANS REVIEWED BY: nome signolure dote INSPECTIUN TINE 72&.769 CTIY OI SPR,INGFIETO COME]NATION APPITCATION/PERMIT INFORMAIION I.INE 72U3753 Uo (/ 77- on Addres; Legol Descri ENERGY SOURCES: Heo t Woter Heoter Ronge -New-Add- --Alter-ReP. -Fence-Demo-Chonge/ Use doth"r- sq. Ftg. Moin Sq. Ftg- Access. Sq. Frg. Olher Volue of \York: 550.o9 Addrers o Phone Fomi Reridence With Building Permit lnfo: Describe WorL (i.e., Build Single t&b,L 666-qq /5 Construclion Lender Addresr Phone (nome)(oddres:)(licr. no.)(ex pires)(phone no.)DESIGN TEAM ?rimory Structurql ico I CONTRACTORS (ncme)(oddress)(lics. no.)(expires)(phone no.) Generol Plumbing El e clri co I NO.FEE ETECTRICAI. CHARGE PTUMBING MECHANICAL CHARGE Mechonicol FEE NO. I I Eoch rinqle fixture Residence of -sq. ft. furnoce/ burner to --BTU'SRelocoted building (new fix. odditionol) New circuils, olterotions or extension3 Applionce vent se pq ro le S.F. Residence (l both)SERVICES Stolionory evop. cooler Duplex (I bqth) eoch Temporory Consiruction Vent fon with single duct Additionol both Amps. Vent sy5lem oport from heotinq or A.C. Woter lervice Mechonicql exhousl hood ond duct Sewer Wood sfove/heoter .< oo )?-*,.o9 Storm Sewer FEEDERS Heqt Pump Amor. Air hondler to I0,000 cFM Air honciler over 10,000 cfM ISSUANCE OF PER}AIT /O."9 TOTAT CHARGES C^TOTAT CHARGES O- WHERE STATE tAW REQUIRES thot the Eleclricsl work be done by rhe Eleclricql ControGtor. lhe alcctrirol portion of rhis permit sholl not be vqlid unrit o lcbel hqr been signed by on Elcctricol Cont:sctor ond ottarhed to the alectricol ponel. TOTAT CHARGES I HAYE CAREFULLY EXAMINED the ompleteci opplicotion for permit, ond do hereby certify thot oll informotion hereon is true. ond correct, ond I further certify thot ony ond oll work performed sholl be done in qccordqnce with the Ordinonces of the City of Springfield ond the.Lows of ihe Stote of Oregon Pertoining lo the work described herin, ond lhol NO OCCUPANCY will be mode of ony sttucture wilhout lhe permission of the Building.Division. I furrher . €rllfy thot my regi:totion with lhe Builder's Boord is in full force ond effect os rcquired by ORS 701.055, thot if exempt the bosis for.exemplion is noted heron, onci fhot only :ubconlrsstors ond employeer who ore in omplione with ORS 701.055 will be u*d on this proiect. SIGNATURE7-,o,, !J-{-Gd!- Bosir for Builder's Boord exemption: NA.lilE (pleose print) FOR OFFICE USE FloodPloin-5tories-OccyGroup-Sq.Ftg.olher- Ocrv Zone fypc/Const ^ Unirs Fire Zone * Bcdroomr Ftg. Moin TOTAT VATUATION x -Yol p\ Lood -Sq. Ftg. Accerr x Yolua I -VolucEUILDING PERMIT Plon Ck. Comm/lnd mr DevelopmentO^Per Fee650l, Plon Ck. Res Per Fee Chorges ond Surchorge: PI.UMBING PERMIT Chorges ond Surchorges Demo -C) - Totol Comb. Permit /.5,ce Chorges ond Surcho rger ICAI PERMIT SidewolkO c MECHANICAT PERMIT Chorges ond Surchorges Curb Cut TOTAL # 75,L-o s0 bo '*'//a-sis.: tt (1.50/^\ Fence @ coMBINATTON AppLtc.ATtON/Fr,tMtT (CAp) I. Appliconr lo furnish A. Job Address B. legol Descriptionl. exomple-tox lot 100, Lone County Mop Referen2. exompie-Lot I. Block 3, 2nd Addition ro Springfi, C. Nome, etc. of owner ond construction lender or forced oir os ,'or so E. Squore footoge 6r voluotion, etc.l. exomple-l 250 sq. foot house, 500 sq. foot gorog 2. eIEmFie-iT;ew proiect, che.kEei-ii oddition, c-1" ;ea;;rc. F. Building permit informotion: l- exomple-construct single fomilv house wirh on ol goroge 2. exomple-remodel exisling goroge into fomily roo 3. exomp-lE-convert single fomily residence inio Eli6'i?Ent (chonge of use) G. Volue of work os Cefined in Section 303 (o) of the Strucrurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Divis Stoff must be oble to contdct oppropriote persons reg design informotion or iob site correclions, etc. l'1. Abbrevioted Plumbing, Mechonicol & Electricol Scheduler ,d. Except where blonk spoces occur in the description pc of the Mechonicol ond Electricol Schedules, the opplic need fill-in only the No. Boxes odiocent to the opprop item(s) lo be instollecj B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division l. To conserve spoce on the permil form the schedule: hove been obbrevioted 2. lf rhe item(s) to be instolled ore not covered on the' qted schedules you should consult rhe full scheduie: C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN CHARGES ON THE SCHEDULES CirY Holl Springfield, Oregon o"pJ."it of Public works ( OFFICIAT RECEIPT No. B 55589r I CITY -O F SPRINGFIELD (1 7 D. Energy Sources I. exomple-heotz'slgs1716ol ceilino'l. exompte-woter heoter.. electricol O9 d <t Rece ived For: o{a9 4 /\,6:, ( ( (r tir ( { (r b9 Amounl Received lll. Applicorrt to sign ond dote Whenever possible, the initiol opplicoiion will be used os < workshee, only. Where possible, Building Division Stoff wig prepore o typewritten copy ond return it to the opplicont ot tlre time the octuol permit is issued for his signoture. lV. Fees ond Chorges Plqn check fees ore due ond poyoble ot the time of the opplicotion, ond no plons will be processed until lhese fees ore poid. All other fees ond chorges ore due ond poyoble when the permif is issued. V. FOR OFFICE USE ONLY AUTHORIZED SIGNATURE lHELtox.luixlulL titNiEis ' '!6'NE OR 97'Ol l65r r.6 Permit Clerk {t( ! PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: PLANS REVIEWED BY: nome signolure dote I I I ( '| q -(