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Home My WebLink AboutPermit Mechanical 1984-12-177 CITY OF SPRINGFIELD COMBI NATI ON APPL ICATION/PERMIT 7?6 \o\ o Uo Yw,JL PtJob Address Legal Description O,,-bo YIo-L.t 4 Rang l,later Heater EIIERGY SOURCES Hea t q. Ftg. I'lain_ Sq. Ftg. Access.--- So. Ftq. 0ther_ l,ler^r Add A l ter Pep . _-Tence_Oerno Change/Use -other--Value of tlork:fl4s, o oowner 6, t)'au?r.0. n Z ..e., Build SingleBuildinq Pernrit Info: Describe l,lork( Farnily Residence liith Attached GaraqeAddressPhone 7y 7- Re'C*-r^"<ti1 .o 't ^t' taConstruction Lender vl $ 0--- uAddre s s Phone exDl res ohone no.addre s s I ics. nonameDESIGN TEAI{ Pri ma ry Structura I El ectri ca.l Mechani ca l I pxni res l (ohone no- )addres s lics. no.CONTRACTORS nafire Genera I P l umbi nq 7qz'&/6/T"kdtf Nechan i ca l MECHAN I CALELECTR I CALPLUIlBI NG NO FFF CHARGFFEFCHARGENNFFFCHARGENO furnace/burner to BTLI' 5 Residence of FTSQ Each single fixture New circuits alts or extensions Floor furnace and vent Relocated building (new fix. additional) Recessed wal I Snace heater and ventSERV I CESS. F. Residence(l bath) lD.0013 faz-qQDuplex (l bath) each Temporary Constructi on Apol iance vent seoa rateAdditional bath Stationary evap cool erl,Jater servi ce res i dence Change i n exi sti ng I ndu stri a I multifamily, comm. or Vent fan with sinole ductSewer 0f amps.Vent systern apart from heatinq or A.CStorm Sewer COMI.I./IND. FEEDERS Mechanical exhaust hood and duct l'Jood stove/heaterInstal I /al ter/rel ocatedistrib. feeders -ampi0f ,lrl0 l0.qo ISSUANCF OF PFRI1IT TOTAL CHARGES# /0,rloTOTAL CHARGESTOTAL CHARGES WHERE STATE LAtl REQUIRES that the Electrical work shall not be vali,l until the labe] has been signed by be done by an E1 an Electrical Su ectrical Contractor, the electrical portion of this permit pervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Oregon Dertaining to the work descnibed herein, and that N0 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and ernployees who are in comcliance with 0l?S 701.055 rvill be used on this oroject. l. -,.) -YrI GNATUREr,tAttE(please e"tnt) F4an\a[\ \J.Oc,.^orQL s D FFI E USE its Value al ue Val ue ToTAL VALUATI0N_-_- x xFtg0ther Load Sq. Group Zone Tyoe/Const.Ftq. l4ain Ftg. AcceFire Zone Bedrooms Flood Plain Stories Plan Ck. Comm/Ind 65%/81do Per Fee terns De ice- (iSvs Cha VE 5.E opmmtBUILDING PERI.IIT Charges and Su rcharges Plan Ck. Res 30%/Bldq Per Fee FencePLUi4BING PERMIT Charges and Surcha rges I * rc,// (. Sldewal kELECTRICAL PERIlIT Charges and Surcha rges ,.1 D oo A/C Paving Total Cornb. Permit Curb CutI,IECHAIIICAL PERMIT Charges and Surc harges TOTAL il / a,'/o ,l s Demo __Lq COMBI NATION APPL I CATION/PERMIT I. Applicant to furnishA. Job AddressB. Legal Description (cAP)PERMIT VALIDATION a D 1. g{g!E_lg.: Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot I. Block 3, 2nd Addition toSpringfield Estates Name, etc. of owner and construction Iender Energy Sources1. example- heat/electricai ceilino/ot. exampte- waterheater/electrical/or Square footage or valuation,-GTEI-- r forced qir gas E lqlcl- 1. examp-le- l?50 sq. foot house, !!9. sq. foot garagez. example-.if new project, checkl6w _ it aOOition,check add, etc.F. Building permit information:l. example - construct singie family house with anattached garage ?. examp_le - remodel existing garage .into family room3. example - convert single iamily-residence inio. restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Build.ingDivision Staff must be able to contatt appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate .item(s) to be installedB. Full Piumbing, Mechanical, and Electrical Schedulesare available at the Building Divis.ion1. To conserve space on the permit form the schedu.leshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF t^lILL FILL OUT ALL FEES AND CHARGES 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 iabelApplicant to sign and date Whenever possibie, the initial application will be used asa.worksheet oniy. Where possibie, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is .issued. FOR OFFICE USE ONLY o 1 II ,J 6G ,+0 ? ,r ) .{ pil III. IV, Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name Si gn ature date CITY OF SPRINGFIELD COHBI NATI ON APPL ICATION/PERMIT 726-37 Job Address Lesar Description l7 O Z9 6/q 2A 7op Ranqe tlater Heater EIIERGY SOURCES Hea t A Sq. Ftg. Access.-- Sq. Ftg. 0ther_ llew Add A1 ter P.ep. ther Demo Cha nge/Use . Ftg.n_ Value of tlork 0wner n t n sc e e'I l,^lo Ga ng eAddre 0 4 77 7g ) ,). -0.-./.).r--. -,t_ u_wcfnstrucio({ Lender / | I \hl a$. a v Oa tcs. no.exDt res ohone no.name lr)addressDEsIGT EAI'{ Pri mary Structura I Ei ectni cal Mechani cal addres s I i cs. no.exDt res ohone no.name Genera I Pl umbi no El ectrr'cal , ELECTRI CAL J MECHAN I CALPLUMB I NG FFF CHARGF NO FFF CHARG F NO FFE CHARGFN0. Residence of FTSQ furnace/burner to BTU' sEach single fixture Relocated bui lding (new fix. additional) New circuits alts or extensions Floor furnace and vent SERV I CES Recessed wal l Soace heat-er and vent( l bath) S. F. Residence Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sepa rate hlater service ge in existing dence Chan res i Stati onar.v evap. coo I er mul t'i f ami l y, Tndrrctrial comm. or Vent fan with si nol e ductSewer Vent system apart from heatino or A-C.Storm Sewer ,amps.0f Mechanical exhaust hnod and drrctc0Mr'1./IND. FEEDERS Instal I /a1 ter/re1 ocate distrih- fecders I,lood stove/heater 0f s.I An At \lo"rflg.f I d',r* ,rtl t ,U - ISSUANCE oF PFRI'IIT )O-t' TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES WHERE STATE LAll REQUIRES that the Electrical work shall not be valiC until the label has been signed by be done by an Electrical Contractor, the electrical portion of this permit an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that N0 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my reqistration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and empioyees who are in compliance with oRS 701.055 will be used on this Droject. llAt'lE(please print)I GNATURE\,DATE ]\'re-trq Flood Plain Stories Occ.y Group Sq Ftg Ftg Ftg Tonc Load Val u P I Const. Uni ts Scl Fire Zone Bedrooms TOTAL VALUATION l4ain x 0ther x . Access x Value_ PIan Ck. Comm/Ind 65%/B1do Per Fee Svstems Deve' Charqe (1.57'opmmtBUILDING PERMIT Charges and Surcha rges Plan Ck. Res 30%/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Demo Sidewal kELECTRICAL PERIIIT Charges and Surcharges Tota'l Comb. PermitA/C Paving Curb Cut14ECHANICAL PERMIT Charges and Surcharges /o-9_0_ ,40 lotL /09 16(! 1,n --a.e lt l-L (J( tt t/o ?of COMBINATION APPLICATION/PERMIT (CAP) L Applicant to furnishA. Job AddressB. Legal Descriptionl. glaTplg: Tax Lot 100, Lane County Map Reference17 03 432. exampie- Lot l. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. example - construct single family house with anattached garage ?. examp]e - remodel existing garage into family room3. example - convert single family-residence inlo . restaurant (change of use)G. Vaiue of work ai defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construct.ion delays, Building0ivision Staff must be able to contait appropriitepersons regarding design information or job sitecorrections, etc. are available at the Building Divisionl. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF hIILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The generai contractor ii not authorized lrJhenever possible, the in.i t.ial application w.i l l be used asa.worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actual perm.it is issued for his s i gnature. Fees and Charges P'lan check fees are due and payable at the t.ime of theapplication, and no pians will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY II III IV. V heat/electrical cei I inq/ wa te rhEa teiT e fEcT rJ c a 17o ge or valuatioE=tcl example- 1250 sq exampie- if new ElecFadd, etc. 1 F or forced air gasr soTar 1. examol e-2, exampl e-E. Square foota foot house, 500 sq. foot garageproject, check-iew2.if addition, Bui lding permit information : to sign the electrical label Appl icant to sign and date Abbreviated P1 umbing, MechaniA. Except where blank spacesportion of the Mechan.ical the applicant need fill-ito the appropriate .item(s B. Full Plumbing, Mechanical cal, & Electrical Schedules occur in the description and Electrical Schedules, n only the No. Boxes adjacent ) to be instaI led , and Electrical Schedules P# G3?&7 C! | e//a/*r PERMIT VALIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Project Information : PLANS REViEWED BY: datenames'l gnature