HomeMy WebLinkAboutPermit Mechanical 1981-03-02INSPECTION I.tNE
7263769
CIIY OF sPRINGFIEID
COMBINAIION APPI.ICATION / PERMII
INFORMATION tINE
72e3753
4 &.,ob Address
oLegol De:cription
ENERGY SOURCES:Sq. Ftg. Moin
Sq. Ftg. Acces!
5q. Ftg. Other
Heot
Woler Heoler
R
-.New-,-Add-,Alter -ReP.. Fence- Demo- ChoPge/Use
Ylo*,", (' )o'zr)A*Zf)Ao{ Work:
flo,a9
Building Permit lnfo: Describe Work (i'e', Build Single
Fomi With Attoched
q\
a
-N
Owner
Address Phone
Conclruclion Lender #
Addre ss Phone --l 4
DESIGN TEAM (nome)(oddre:s)(lics. no.)(expires)(phone no.)
Primo ry
Structurol
Electrico I
Mechonicol
CONTRACTORS (nomei (oddress)(lics. no.)s)(phone no.)
Plumbi
Eleqirico I
Mechonicol
PTUMBING ETECTRICAL fiECH.ANICAL
NO.FEE CHARGE NO,FEE CHARGE NO FEE CHARGE
Eoch sincle fixture
Residence of
-sq.
ft.
furnoce/burner 1o
Relocoted building
(new {ix. odditionol)
New circuits. olteroiions
or exlensions
Applionce veni
se po ro te
S.F. Residence
(l both)SERVICES
Stotionory evop,
coo ler
Duplex (I both) eoch Temporory Consiruclion
Vent fon with
single riuct
Additionql both Amps.
Vent syslem oport from
heoting or A.C.
Woler:ervice
Mechonicol exhourl
hood qnd duct
Sewer Wood siove/ heoter
.<oo).-zco
Storm Sewer FEEDERS Heot Pump
Amp:.
Air hondler to
t0,000 cFM
Air hqndler over
10,000 cFM
tssuANcE oF PERM|T /d,"9
TOTAT CHARGES c-TOTAT CHARGES --o-TOTAT CHARGES
WHERE STATE tAW REQUIRES thor lhe Electricol work be done by the Electritol Conlrcclot, the elcctricol portion of lhis permit shsll not be volid until o
lobel hos b*n signed by on Elactricol Coniroctor ond qttoched to the clectricol ponel.
I HAVE CAREFUTLY EXAMINED rhe completed opplicotion for permif, ond do hereby certify thof oll informotion hereon is lrue ond correct, ond I further
certify thot ony ond oll work performed sholl be done in qccordonce with lhe Ordinonces of the Ciry of Springfield ond lhe Lows of the Stqte of Oregon
pertoining to lhe work described herin, ond thor NO OCCUPANCY will be mode of ony structure without the permission of the Building Division. I further
ertlfy thot my registrotion with the Builder's Boord is in full fore ond effect os required by ORS 7Ol .055, thot if exempt the bosis for exemption is noted
heron, ond thot only subcontroctors ond employees who ore in complione with ORS 701.055 will be ued on this
Bosis for Builder's Boord exemption:
NAME (pleose print)D^rE&E-&
FOR. OFFICE UsE ONLY
zon" F= \ Type/Consr. - Units -sd Ftg. Moin x Vo lue
x Yolue
a
-Volug
TOTAT YATUATION
Fire Zone-Bedrooms Iood Ftg. Access
FloodPloinStoriel-OccyGroup-Sq.Ftg.other-
-&4'oZ
BUITDING PERMIT
Chorges ond
Surchorges -L)
Plon Ck. Comm/lnd
65%/Blclg Per Fee
Systems Development
Chorqe ( I .5",/o)
Plon Ck. Res
30%/Bldg Per Fee
PIUMBING PERMIT
Chorges ond
Surchorges
.-o Fence
Demo Totol Comb. Permit
ETECTRICAT PERMII
Chorges ond
Surchorges
,_O Sidewqlk
A/C Povino
MECHANICAT PERMIT
Chorges ond
Surchorges $o
Curb Cut
TOTAT /< 66t-J>-
-BTU'S
COMBINATION AppLTCATtON/FcRMtr (CAp)
l. Aoplicont to furnish
A. Job Address
PERMIT VAI.IDATION
B.
D.
tr
Legol DescriptionI. exomple-tox lot I00, Lone County Mop Reference l7 03 432. exomple-Lor l. Block 3, 2nd Addiiion ro Springfield Estotes
Nome, etc. of owner ond construction lender
Energy Sources
2.
lectricol ceili /or forced oir gos
eoter ect or solorcol
Squore footoge or voluoti on, etc.
foot goroge
oddition, check
F
'I . exomple-i250 sq. foot house.500 so2. exompE-iT nEw project, .ie.[ ".*-iiocid, etc.
Building permit informotion:
I. exomple-construct single fomily house with on oltoched
gorsge
2. exompie-remodel existing goroge into fomily room3. @-convert s;ngle fomily residence into
restouront (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of the
Structu rol Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To o_void design or construction deloys, Building Division
Stoff must be qbie to contoct oppropriote p.rron. regordingdesigninformotionoriobsitecorrections,etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
,A,. Except where blonk spoces occur in the description portion
of the Mechanicol ond Electricql Schedules, rhe oppiicont
need fill-in only the No. Boxes odiocent to the oppropriote
irem(s) to be insto!led
B. Full Plumbing, Mechonicol, ond Electricol Schedulesqre ovoiloble ot the Building Division
l. To conserve spoce on the permit form the schedules .:
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the obbrevi-. oted scheduies you shouid consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dore
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 oppliconl ot
the time fhe octuol permit is issued for his signolure.
lV. Fees ond Chorges
PIon check fees ore due ond poyoble ot the time of the opplicolion,
ond no plons will be processed until these f,ees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO SE SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
PLANS REVIEWED BY.
nome signoture dote
INSPECIION tINE
726..3769
CITY OF SPRINGTIETD
COIABINAIION APPTICATION / PERTIII
INFORMAIION [INE
72U3753
Jsc 8 Lt-o9 5(,job Address
Legol Dercription r r-o< - 15-Rc nV 3/og Rcn
ENERGY SOURCES:
Wqler Heqler
Heot
Sq. Frg' Moin
Sq. ftg. Accesr.
5q. Flg. Other
-
N ew --Add-Alter--R e P.
Fence -Demo - ChoPge/ Use
{o,h,, U)ndA.lzLA-of Work:
fl139Owner (i.e., Build SingleBui
Gonce
Permil lnfo: Describe
Address -j)3 Pho"" 747-s{
#
Q\
-a
+
'4
PhoneAddrers
(oddress)(lics. no.)DESIGN TEAIA (nome)
Structuro I
€ le <iri co I
Mechonicol
MECHANICALETECTRICALPIUMBING
iEE CHARGEFEECHARGENOFEECHAR,GE NO
furnqce/burner to
.=-*-BTU'S
Residence of
ft.Eoch single fixture
Applionce vent
seporq le
New circuits, olterotions
or exlension:
Relocqted building
(new fix. odditionol)
Stotionory evop.
cooierSERVICES
S.F. Residence
(l both)
Yent fon with
single <iuttTempororv ConsiruclionDuplex (l both) eoch
Vent syslem oporf from
heoting or A.C.Amps.Additionol both
Mechonicol exhousl
hooci ond ductWoler !ervice
.<OO
.).2 5"Y'Wood stove/ heoterSewer
Heot PumoTEEDERSSlorm Sewer
Air hondler to
r0,000 cFMAmpr.
Air hqndler over
r0,000 crM
ISSUANCE OF PERMIT /d Ou
TOTAL CHARGES*\)-TOTAT CHARGESIOTAL CHARGES -l)
WHERE SfATE tAV, REOUIR.ES thor the Electricol work be done by the Eleclri<al Conttoctor, the electricol portion of this permit shall not bo valid until a
lobel hor bmn signed by on Eleciricol Conitoctor ond qtloched lo the elactricol ponel.
SIGNATURE DAIE
' ony
to thc of ony
req uired
true ondollthqthereoninformotiont5ondcorrecl,furthertorlicotiononddoYCAREFUTT'NEXAMI ,heED hereby certifyVEOPPpermit,completedIHA
theof lheond ofLows Stotethe ofrhwiihOrdinoncesofbesho ll nedo occordonce City n9f ieldSprilnoIworkondthoperformedcerlify Oregon
furtherstruclurethethoutollheDiStonBuildingOCCUPANCYNObewilldemopermissiondescribedihotondherin,pertoining
rhe701oRsthofIt bosis for ts notedndoby.055,exempt exemptioBoordBuilde/s tnrs {orcef ull o effectthotwiththeerrlfymyregi strotion
wil.055 beI rhisInnerh701onusadRSondorewhoondthotsubcontroctorsemployeesrcmplioonlyheron,
Eoris for Builder's Boord exemption:
NAME (pleqse pri
FOR, OFFICE USE ONtY
zoru F= \ Type/Const. - Units - 5q' Ftg' Main x Yolue
1-Volue
1-Volue
Fire Zone-Bedrooms Occy Lood Sq. Ftg. Access
-fll -o-oIOTAT VATUATION
Ftg. Olher
-
Flood Plqin Stories-OccY GrouP
Sy:tems Developmeni
Chorgg (1.59/q[_---Plon Ck. Comm/lnd
6596lBldg Per Fee
Plon Ck. Re:
309./0/ Bldg Per Fee
BUILDING PERMIT -:oChorges ond
Surchorge:
Fence
Totol Comb. PermitDemo
PIUMBING PERMIT
Chorges ond
Surchorges
.-o
Sidewqlk
A/C Povinc
Chorger ond
Surchorges
ICAI PERMIT .-c
Curb Cut
MECHANICAT PERMIT
Chorger ond
Surchorger
oc)
$o
/5.
TOTAI./5,-e
0- ")rt ^lluv n J7E 73
Construciion Lender
Nr)
A.dditionol Proiec lnformotion:
nome signoture dote
PLANS REVIEWED BY:
F. Building permit informorion:l. exomple-construct single fomily house with on ottoch
Eoroge2. exompie-remodel existing goroge into fomily room3. 6fomile-convert single fomily risidence into
Ei6u?Ent (chonge o1 use)
G. Volue of work os defined in Section 303 (a) of theStructurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delovs, Building DivisicStoff must be oble to contoct oppropriote persons regodesign informction or iob site corrections, etc.
CITY OF SPRINGFIETD
Ciry Holt
,.r^- -tlt'ntfield, oregon
""L';H?,'^T I,.H,X;*.
PERMIT VALIDATION
No. B
t9
Co
. 6<;
I
(
(
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t),.55948
{
(l
,d
r\,l
ll. Abbrevioteci Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description porof the Mechonicol ond Electricol Schedules, rhe oppiicc
need. fill-in only the No. Boxes odiocent to the oppropr
item(s) to be instolled
B. Full Plumbing, Mechoniccl, ond Electricol Schedulesqre ovoiloble ot lhe Building DivisionI. To conserve spoce on the permii form the schedule
hove been obbrevioted
2. lf the item(s) to be insrolled ore not covered on the
oted schedules you shouicj consult the full schedulr
C. BUILDING DIVISION STAFF WILL FILL OUT AtL FEES A
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dore
Whenever possible, the initiol opplicotion will be used o
workshee, oniy. Where possible, Building Division Stoff
prepore o typewritten copy ond return it to the opplicor
the time the octuol permit is issued for his signotuie.
lV. Fees ond Chorges
PIon check fees ore due ond poyoble ot the time of the
ond no plons will be processed until these fees ore poi<
other fees ond chorges ore due ond poyoble when ihe
is issued.
V. FOR OFFICE USE ONLY
JO,
tt
EY
(
(
-4mo unl Recei ved
ELTON.TURIBU!L
bct
AUIH oRtzEO SIGiATU
t5,
tRE-r
PROJECT CONDITIONS TO BE SATISF|ED BEFORE OCCLirn,r-,. \(.
coMBINATION AppLtcATtoN/pERMlr (CAp)
l. Appliconf. to furnish
A. Job Address
B. Legol Descriprionl. exomple-lox-lot.lOp,^Lole.Counry Mop Reference I7 03 43
- 2. exomple-Lor l. Block 3, 2nd Addirion ro Springfield EstoresC. Nome, etc. of owner ond construction lenderD. Energy SourcesI. exomple-heot/'electricol ceiling,ror forced oir gos2.exomEle-woterTeo-IEiTEIErric-icot,ro6 jff
E. Squore footoge o. rolrotioi-lt.-l. exomple-l 250 sq. foot house, 500 sq. foor goroge2. #-iTIEw projecr, .i.,".[ n.*-ii "Jairi".,
j.,..t iodd, elc.
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