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Home My WebLink AboutPermit Mechanical 1980-11-05I llL f- coMBI APPL I CATI2669 Job Address S l-ega1 Description bo EIIERGY SOURCES Hea t !.later Heater Range Sq. Ftg. Main_ Sq. Fts. Accelil- Sq. Ftq. 0ther__ _l{ ew_Ad d__1A 1 te r_Re p . _Fence_Demo Change/Use 0ther -Us tJJ tt\)55I")D, Vaiue of U,o"Or/rfuO ?owner f-ero-ld Lrtck-lea-f Address (nJ t D. qi)Frr (+^ Phonerltl?-n scr 'e., Build Single gt32 Construction Lender lLt-#tLl82- Addre s s Phone DESIGN TEAI1 name address 1CS. nO.exoi res ohone no. Primary Structura I El ectri ca I l'lec ha n i ca I CONTRACTORS n ame addres s I i cs. no.exoi res ohone no. Genera I Plumbinq El ectri cal l'echani cal PLUIlB I IIG ELECTR I CAL MECHAN I CAL I FFF CHARGF NN FFF CHARG F il0 FFF CHARGF Each sing1e fixture Residence of SQ. FT furnace/burner to BTU' S Relocated buildinq (new fix. additional) New ci rcu i ts al ts or extensions Fl oor furnace and vent S. F. [?es i dence ( i bath)SERV I C ES Recessed wal l Soace heater and vent Duplex (l bath) each Additional bath Temporary Construct ion Apoi iance vent s epa ra te l^later serv ice Chan res i ge in existing dence Stati onar.v evap cool er Sewer multifami1y,comm. or Tndustrial Vent fan with sinole duct Storm Sewer 0f amp s.Vent system apart from heatinq or A.C. c0r.$1./rND. FEEDERS Mechani cal exhaust hood and duct I n sta I i /a I ter/ rel ocate di ctri h- feedprs tJood stove/heater 0f amps" ISSUANCF OF PFRI{IT TOTAL CHARGES TOTAL CHARGES IOTAL CHARGES TJHERE STATE LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valil until the label has been signed by an Eiectrical Supervisor and returned to the Bui1ding Division tionforoermit,anddohereb'ycertifythatallinformationhereonistrue and correct, and I further certif_v that any and all r.rork performed shall be done in accordance with the 0rdinances of the City of Soringfield and the Laws of the State of Oregon oertaining to the work descr.ibed herein, and that NC 0CCUPANCY will be made of any siructure without the permission of the Building Division. I further certify that my registration vtith the Builder's Board is in full force and effect as required by 0R5 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and emnloyees r.rho are in comcliance with 0l?S 701.055 r.lill be used on this rrro.ject. t'lAl'IE ( p1 ease prl nt )E tr*lol ,. La Vle. -S IGIIATURE FOI1 OFFI( Zone oel Con s t its Ftg Ftg Ftg l4ain x a lue Fire Zone Bedrooms Flood Plain Stories Load 5q Acces s 0the r x Val ue 0c c.y Group Sq.x Val ue TOTAL VALUATI BUILDING PERI.IIT Charges anC Surcharges Plan Ck. Comn/Ind 6\/"/Bldo Ppr Fpe Svstems Develogment Charqe (1.5q) Plan Ck. Re 30illBl dq Pe srF ee PLUI4BING PERMIT Charges and Surc ha rges Fence Derno ELECTRICAL PERIlIT Charges and Surcharges Sidewal k A/C Paving Total Comb. Permit I4ECHAI\ICAL PERMIT Charges and Surcharge s /500_Curb Cut TOTAL t5. bo re Work ( Ga raoe I t COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County l'1ap Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. example- heat/2. examplE waterE. squaiFT6oTage or air qas 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if-i'ew project, check-new - if additio;,Elec[-add, etc.F. Building permit information: exampl e a tta c hed - construct single family house with an qarage u 2. example - remodel existing garage into family room3, example - convert single family residence intorestaurant (change of use) Value of work as defined in Section 303 (a) of the u Structural Specia lty Code DESiGN TEAI4 AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except r,rhere blank spaces occur .in the descriptionpcrtion of the I'lechanical and Electrical Schedu'les,the applicant need fili-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumb.ing, Mechanical, and Electrical 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 theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO C}IARGES 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.III. Appiicant to sign and date Whenever possible, the initial application will be used asa worksheet only. Where possible, Bu.ilding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gnature. IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: Permit app'licant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEl^lED BY name SI gnature da te ltL COMBI ON APPLICATI IT 725-3 Job Address EIIERGY SOURCES Hea t l.later Heater Ranqe Sq. Fto. I'lain_ !q. Ftg. Rccess] So. Ftg. Other--_ l.lew_AddJl ter_Pep. _Fence_Demo Change,/Use 0ther l-egal Descri ption Va.l ue of l.lork Owner Addre s s Phone Builr;inq Pernlit Info: Describe l,lork(i Fanily llesidence l',ith lttached Galaqq) e., Build Single Constructi on Lender Addre s s Phone DESIGIi TEAI,!address ICS- nO-exD l res ohone no. Pri ma Structura I El ectri ca l ilechanr ca I --.ii(HLI,-^)i name address {lics. no. ) (expires ohcne no^ ) Genera i Pluroino il ectri ca I ":c-:ri ca I PLUIlB i iIG ELECTR I CAL }lECHAN I CAL .I]ARGF ; i,IN I FiE I CHARGE t,n FF T I '!]ACGF Iach singie rixture I I I I Residence of s0 trT furnace/burner to BTLI' s ?elocaEeo building (neur tix. additjona i ) Nei.r c ircui ts al ts or extensi ons Floor furnace and vent iS.F lrr . Fles i dence bath)SERV I C ES Recessed wal I Soacp heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apoi iance vent seDa ra te l,later service C han res i ge in existing dence Stationary evap. cool er Sewer multifamily, comm. or I ncius tri a .l Vent fan with si nol e duct Storm Sewer 0f s. Venl system apart from heatino or A.C. COI.1I.1. / IND. FEEDERS Mechanicai exhaust hood and duct Instal I /a l ter/re1 ocate di ctri h. feeders llood stove/heater 0f amps. ISSUAIICF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES sha I I^IHERE STATE LlN REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this p-ermit I not be valil untii the label has been siqned by an Electrical Sunervisor and returned to the Building Division CAR EF UL I Y L I lt ED t he comp I e a0 l-)c t 0 for oermit k oerformed an d do he re b rt i fv tha t a 1 i n forrna t i o n hereo n is truef the City 1 I be made ui I der' s, and that a nd co rr EC L a nd I U rth er e rt i fy t ha L any and a I 'l tior ha I l be don 'I n ac cordan L h the 0 rd ,l n an ces 0 of Soringfield and the LavIS of the State of Oreqon oertaining to the r*ork descrjbed herein, and that t'l0 of any structure without the permission of the Building Division. i further certify that m.y registratio Board.is in full force and effect as required by ORS 701.055, that if exempt the basis for exemotion is oni_y subcontractors and emnloyees rvho are in comcliance with Oi?S 7n1.055 viill be used on this Dro.iect. OCCUP ,AI,ICY lvi n !Jl th t he no ted h e reon l.lAt'lE( pl ease pri nt)0rr*l"t ,. Lo Vlr. v SIGi{ATURE fu)t t. L DATE Y Zone T_yDe/Const. Un its So Ftu Ftg Ftg l'la i n x val ue-."--' VaiueFire Zone Bedrooms Flood Plain Stories 0cc y Load S q Acces s 0ther x 0cc.y Group q X Value TOTAL VALUATION BUILDING PERI.iIT Charges anC Su rcharges Plan Ck. Comm/ind 6\"/,/B1do Ppr Fee o pmen t 1. 5Z Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICI,L PERIiIT Charges and Su rcha rges Sidewalk A/C Pavi nq Total Comb. Permit 14ECHANICAL PEP.IlIT Char-oes and Surc harge s Curb Cut TOTAL COiqBINATION APPLICATION/PER,I.IIT (CAP) i . App l i cant to furn i shA. Job AddressB. Legai Descriptionl. examDle- Tax Lot 100, Lane County Map Refere17-0f-432. examole- Lot 1. Block 3, Znd Addition toSprrnqfield Estatesq. ilame, etc. of owner and construction IenderD. Energy Sources PERMIT VALIDATION CITY OF SPRINGFIELD Ciry Holl Springfield, Oregon Deporfmenl of Public Works OFFICIAT RECEIPT No. B 55095 r9 Rec'd F Address 02 t /-t.?'/A ll) :7-(' Recer ved For L /3, C0 42,(,o, (i'Amount Received examcle- hea t,/el ectrica ceilin or forced a?. ex-amfl e-- wa e 0r s0 arE. Squa re Iootage or valuation,etc examo i e- ( ( ( ( Ey$ilEr EIEET-aod 1250 s if-new , etc q. foot house, 500 sq. footproject, check-iew if add 9 i I F. Buildinq permit inforrnation:i. exanpie - construct single family house withdttacned qaraqe ?. e.ranole --remoael existing garage.into famil3. qerlr1tr - convert single iaiiiy'.es.iaence inFEiiJuFant (change of-use)q. {atue 0t worK as defined in Section 303 (a) of tStructural Specialty CodeH. !:Sicii TEAi.,i AND COIITRACTORS To avoid design or construction delays, Bui)ding0ivision Staff must be ab'le to contait appropriipersons reoarciing des.ign information or job s.itecorrections, etc. Abbrevrare,l Plunbing, ilechanical, & Electrical Schei:A. ixceor i,;nere blink spaces Jcir. in-in. descript.iracrgion cf:he ilechanical and Electr.ical ScheCu.l,Ehe appiicanr need fili-in only the No. Boxes ad. - to the aoproDriate.i tern(s) to be.installedB. Full Piuncing, |techanical, and Eleiirical Schecjuare available at rhe Building Division1. To conserve soace on the permit form the schrhave been abbreviated2. If the irem(s) to be installed are not cover(the abbreviated schedules you shou.ld consultfu I I schedu.iesC. BUILDI|IG DIVISIOII STAFF WILL FILL OUT ALL FEES AI CI1ARGES Oi{ THE SCHIDULES0. As noced on the CAp, the label must be deliveredeiectrical contractor for signdture by his electrsupervisor. The general con[ractor ii not author - to sign the electricai labelApplicant to sign and date !'lhenever possible, the initial apptication will be usa.worksneet only. l,jhere possiblL, Building Divisionwill.prepare a type written copy ind ."ar"n it to th€apptrcanr at the t,rme the actual permit is issued for s i gna ture. Fees and Charges Plan cneck fees are due and payable at the time of thtsapplication, and no plans wiil-be procesiJd until theserees are paid. All other fees and charges are due andPayable when the permit is issued. FoR oFilCE USr OilLY ( ( III ( ( ( (a AY //i ( L-/ AUTHORIZEO SIGNATURE 5HELION'TUhRIULL PNIITEIS EUCENE OR 97401 Permit Clerk IV V PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: rmit applicant exempt from registration with the Builder's Board because:Pe Additional Project Information: PLANS REVIElllED BY: name signature date I /,, h// d-