HomeMy WebLinkAboutPermit Mechanical 1981-01-06INSPECTION TINE
72C3769 -aE CIIY OF SPRINGTIETD
COMBINAIION APPTICATIONI PERMII ^l!r INFORMAIION LtNE
72e3757
Owner
8z/Legol De:cription
Lof I
Euilding Permit lnfo: De:cribe Work (i.e., Build Single
l€8.o9
v/irh Alomrl
of Work:
Other
--Add -AIter-ReP'
-Fence.
--Demo-Chonge/ Us:
Woter Heoler
EN ERG
Heot ttg. Access.
Ftg. Moin
-other
sq.r_Js.
4N"-
Addresr PhonearSS
6 <,,)t)Co nstruclion L"^d* Qff
c\
Dc
N
Addres:Phone
(phone no.)(lics. no.DESIGN TEAM (nome)(ex
Ptinoty
Mechonical
(lics. no.) (expires) (phone no.t(odd ress)CONTRACTORS (nome)
Plumbing
Ele ctricol
Mechqnicol
MECHAN ICALETECTRICATPTUMBING
FEE i CHARGEaa=CHARGE NO. iNONO. I rEE I CHARGE
95.a /furnoce/burner lo
JOCtC9A srU,s L.eot-"Residence of
/'dAa ,o. tl
Appiionce vent
seporo te
New circuits, olterotions
or extensions
Relocoted buiiding
(new fix, odditionol)
Stotionary evop.
cooierSERVICES
S.F. Re:idence
(l both)crL\). 4
A Veni fon with
sinqle duct 3.q LeoTemoorory Conslruclion /n.QDuplex (l both) eoch
,I
Vent syslem oport from
heoting or A.C.Amps.
I
IAdditioool bqth
1,saIMechonicol exhqust
hood ond duclWoler:ervica
Wood slove/ heoteri'r/A),r Sewer
Heot PumpF EEDERSSlorm Sewer
Air hondler to
10,000 crMAmps.
Air hondler over
r0,000 cfM
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ISSUANCE OF PER}AIT /o,m
TOTAT CHARGES KaTOTAT CHARGES '55,O3
WHERE SIATE lAW REQUIRES thqr rhe Electricol work be done by the Electricol Conlroctor, tha clectricol portion of this pcrnit :holl not be valid unril c
lobel ho: bccn rigned by on Elactricol Conlrocror cnd ottochrd lo lhc clcaricol ponel.
IOTAL CHARGES
I HAVE CAREFULI,Y EXAMINED thc completed opplicotion for permit, ond do hereby cerlify lhot oll informotion hereon is irue ond correct, ond I further
certify thot ony ond oll .work performed sholl be done in occordonce with lhe Ordinoncer of the City cf Springfield ond the Lows of ihe Stqte of Oregon
pertoining to the work described herin, ond thor NO OCCUPANCY will be mode of ony rlruciure without the permirion of the Building Division. I further
.. certlfy thot my registroiion with fhe Builder's Boord is in full force ond e{fect os required
heron. ond thot only subconiroslors ond employees who ore in omplione with ORS 701
a--DAIE
by ORS 701.055, thot if exempt the bosis for exemption is noted
on lhis proiect.
Bosis for Builder's Boord exemption:
NAME (pleore prinr)
FOR OFfICE U5E OT{tY
lyp'i conrt. \F N unir,
Be drooms 16, - occy :?#;!;:H4#nI CIZD
ZZLSq. Ftg. Access
Flood Ploin Group
[ood
TOTAT VATUATION
Fire Zone-
Zone 5q. Ftg. Moin
Sq, Ftg. Ofher-x
-Yolue
Systemr Developmenl
Chorqe (1.59'")557,31BUILDING PERMIT
Chorger ond
Surchorges
Plon Ck. Comm/lnd
Per Fee
Per
Plon Ck. Res
3095 45:zC )-f,x I \31t-,.0
0o r 664n law Eta. /i#1.\au .Ao
Totol Comb. Permit
PI.UMBING PERATIT
Chorger ond
, Surchorges
2
--
- - -
u)
Demo
-v v - v-t
2b?,30
ETECTRICAT PERMII
Chorger ond
Surchorges
Sidewolk
/l8aMECHANICAT PERMIT
Chorges ond
Surchorger
Curb Cut
I
b TOTAI.3e6,t1f
Eoch le fixture
\
B t-P
/5/oo
/-,n4
Fence
/,uo
/, (/0
11oo
A/C Povino
9L..<n
U
COMBINAIION APPLIC,ATIO
l. Applicont-Jo furnish
A. Job Address
B. Legol Description
I. exompie-hect,,'r
2. tEmEE-woter
Nome, etc. of owner ond construction lender
Energy Sources
N/[-^,r,ur (cAP)
electricol ceili
t
l. exomple-tox lot 100, Lone County Mop Reference I2. exompie-Lot l. Block 3, 2nd Addition ro Springfieid I
PERMIT VATIDATION
OF SPRINGFIELD
Ciry Holl
Springfield. Oregon
Deportment of Public Works
OFFtCIAt RECEIPT
No. B
(fr
(C ITY
c
D
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oter ect col
or forced oir oos,.--------r-+'or solor 55620
E. Squore footoge o, ,oluorioi]lf,l-I. exomple-l=2lg rC. foor house, 500 sq. foot goroge2. exc.mple-if new proiecr, checki-ew-if oddition, cihecl,
oc,d. elc.
F. Building permit informotion:l. exompie-construct single fomily house with on ofiocigoroge
2. exomple-remodei existing goroge into fomily room3. @-conver, single fomily residence intoreslouron, (chcnge of use)
G. Volue of work os defined in Section 303 (o) of tireSi:.ucturol Speciolty Code
H. DESIGN TEAM,AND CCNTRACTORS
To cvoid design or construction cielcys, Building DivisioStoff must be oble to contoct oppropriote purro-n, r,ugo,design informotion or iob site correclions, etc.
Il. Abbrevioted Plumbing, Mechanicoi & Electricol SchedulesA. Except where blonk spoces occur in the description portof the Mechonicol ond Eiecrricol Schecjules, rnL "ppii*,neecj fill-in oniy rhe No. Boxes odiocent to the oppr"opiiitem(s) to be insrolled
B. Full Plumbing, Mechonicol, ond Electricr:l Schecjulesore ovoiloble ot the Building Division'I . To conserve spoce on the permit form the scheduleshove been obbrevioted2. lf the item(s) to be instolled ore not covered on the o' oted schecjules you should consult the full scheo,ulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANt
CHARGES ON THE SCHEDULES
lll. ,Applicont to sign ond dore
Whenever possible, the initiol opplicotion will be used os oworksheer only. Where possible, building Division Stoff wilprepore o lypewritten copy ond return it to the oppliconl othe time the octuol permit is issued for his signotuJe. - ' -+-
lV. Fees ond Chorges
A
Received For:c)
U)
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o,
u00o 3s.,r,
rlo {
hcro Sfr" =crfloob(
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Amounl Rece ived q1
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BY L1^.-
AUTHORIZEO SIGNATURE
sxELroN-TURNAU!L
'irNr€is €u6ENE OR graOl
Plon check fees ore due ond poyobre ot the time of the oppricotion,ond no plons will be processed until these fees ore poid. All -
other fees onC chorges ore due ond poyoble when the fermitis issued.
Y. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDTTIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
I
nome signolure dote
PLANS REVIEWED BY:
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