HomeMy WebLinkAboutPermit Mechanical 1981-03-25Description
Phone Anoched
Ilob
I
5t4
60
Ro!R3CD' 11033 Woter Heoter
Volue of riy'ork:
5q. Ftg. Acce;1.
Sq. Frg. Olhet
Owner
Addre sr
INSPECIION TINE
72C3769
CIIY OF SPRINGTIETD
COMEINAIION APPTICAIIONi PERMIT
INFOR'iAIION TINE
,2U1753
Building Permit lnfo: Describe Work (i.e., Euild Single
ENERGY SOURCES:
Heot
-
--Orher
-
Sq. Ftg. Moin
-
New,-Add--Alter--ReP'
, - -Fence-,-Demo-Chonge/ U:e
ur-fcnAt-\nrlE )Conrrruction lender
acve
PhoneAddress
(nomc)(oddre:s)(lics. no.)(ex pi re r)(phone no.)DESIGN TEAM
Primory
Str u cturo I
Mechonicol
RS
I
Plumbi
Elecrricol
Machonicol
MECHANICALETECTRICATPTUMBING
NO.FEE I CHARGECHARGENOFEECHARGENo. i i FEE
Residence of
--rq.
ft
furnoce/burner lo
-BTU'T
I
I Eoch ringlc fixtura
Appiionce vent
se pq ro te
New circuits, olterotions
or exiensions
Relocoted building
(new fix. odditionol)
Stotionory evop.
coo IerSERVICES
S.F. Reridence
(l bqth)
Vent fon with
sinqle ductTemporory ConrlruclionDuolex (l boih) eoch
Vent syslem oport from
heotinq or A.C.,Amps.Additionol both
Mechonicol exhoust
hood ond ductWoler:ervice
Wood slove/ heolerSewerI
I
Heot PumpSlorm Sewer FEEDERS
Air hondler to
r0,000 cFMAmpr.
Air hqndler over
't0,000 cFM
ISSUANCE OF PERMIT
WHERE SIArE LAW REOUIRES fhor the Electrical work be done by the Eleclricol Conltdclo., the clectricol porlion of this permir shall not be valid unril o
lobal hsr bon rigncd by on Elaclricol Conlroctor ond ottachad to the electricol ponel.
I HAVE CAREFULLY EXAMINED the completed opplicotion for permit, ond do hereby certify thot oll informotion hereon is irua ond correcl, ond I {urrhcr
certif), rhor ony ond oll work performed sholl bo done in occordonce with fhe orCinqnces of rhe City of Springfield ond lhe Lows of the Stote of Oregon
perroi.ing to tire work dercribed herin, ond lhol NO OCCUPANCY will be mode of on), siructure without the permission of the Building Division. I furlher
certlfy th-or my registrotion with the Builder's Boord is in full Iore ond effect os required by ORS 701.055, thol if exempt fhe bosis for exemption is'notcd
heron, ond rhot mly rubcontroctorl ond employeer who ore in complione wirh ORS 701,055 will be used on lhis proiect'
DATESIGNAV/t, -,,.
TOTAT CHARGES TOTAI CHARGES TOTAI" CHARGES
Bo:is for Builder'r Boord exemption:
NAME (pleose prinr)akehre- A
FOR OITICE UsE ONTY
Zone
-Type/Const.-Units
-_.---Sq.
Flg. }{oin x Volue
x Vo luc
x
-Volue
TOTAL VALUATION
Fire Zone-Eedrooms occy Lood Sq. Ftg. Acce:s
Flood Ploin Srorier-Occy Group-Sq. Ftg. Other-
Syslemr Developmenl
Choroe (.I.5?6)
Plon Ck. Comm/lnd
659;l
Plon Ck. Rer
Per Fee
BUITDING PERMIT
Chorges ond
Surchorge:
Fence
Totol Comb. PermitDemo
PtUtrlElNG PERlvllT
Chorges ond
Surchorges
Sidewolk
A/C Povinq
ELECIRICAT PERMIT
Chorger ond
Svrchorger
Curb Cut
IOTAT /5bo
MECHANICAT PERMIT
Chorger onl
Surchorger
tr_F,C) + .<3R\
Flettrico I
/5, ao
ho
coMBINAT|ON AppLtcATtON,, pE^_.T (CAp)
l. Appliconr to furnish
A. Job Address
B. Legol Description
l. exomple-tox lot 100, Lone County
2. er,fi;le--Lot l. Block 3, 2nd Addiii
C. N".r*, .I. of owner ond construction
D. Energy Sources
I. exomple-heot,'electricol ceilinqr'or
2.exo;;G-,nroterJ-.'-6oter.-ElEiii:col,,'o
E. Sq"".e fo"roge or rolrotioi]!I]-
Mop Referenc,
on to Springfiei
lender
forced oir gos
r solo r
PERI\,IIT VALIDATION
l. exomple-1250 sq. foot house,500 sq. foot goroge2. e-f-mElE-iFiiw proiecr, checkiGi-ii oddition, Jh,
odd, etc.
F. Building permif informotion:l. exomple-construct single fomily house wiih on ollgoroge
2. exomple-remodel existing goioge into fomily roor3. eG;;l-e-converr single fomily residence into
GlJEG6nr (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of rhe
Structurol Soeciolty Code
H. DESIGN TEAIA AND CONTRACTORS
To o_void design or ccnsrruction deloys, Building Divi:Stoff mus, be oble to contoct oppropriote p..rJn, ..5design informction or [ob site corrections, etc.
ll. Abbreviored Plumbing, Mechonicol & Electricol Schedule
A. Except where blonk spoces occur in fhe description prof the Mechonicol ond Electricol Schedules, rhe oppiir
need fill-in oniy rhe No. Boxes odiocent to the opprol
item(s) to be instolled
8. Fuil Plurabing, Mechonicoi, ond Electricol Schecjules
ore ovoiloble or rhe Building Division
I. To conserve spoce on the permit form the schedult
hove been cbbrevioted
2. lf the item(s) to be instolled ore not covered on th(. oted scheduies vou should consult the fuil schedul,
C. SUILDING DIVISiON STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
lll. Agplicont fo sign ond dote
Whenever possible, the initioi opplicotion will be used o:worksheet only. Where possible, Builciing Division Stoff r
prepore o iypewritten copy ond return it to the oppliconr
the rime the oouol permit is issued for his signotuie.
CITY OF SPRINGFIELD
City Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAT RECEIPT
No. B 561-53
r9
d
dress
Received For
Amount Received
AY
AUTHORIZEO SIGNATUFE
SHEIION.TURNAUI! PFiTIEFS EUGETE OR 97'OI
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lV. Fees ond Chorges l-
Plon check fees ore due ond poyoble ot the time of the oppricotion,ond no plons will be processed until these fees qre poi<i. Allother fees ond chorges ore due ond poyoble when ihe permit
is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Pro[ect lnformofion:
nome signqture dote
PLANS REVIEWED BY:
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