HomeMy WebLinkAboutPermit Mechanical 1981-03-23INFORMAIION TINE
72U3753
CITY OF SPRINGTIETD
COMBINATION APPI,ICATION I PERIAIT
INSPECTION LINE
72(}3769
Ro
EN ERGY
Heo t
Wolet Heolet
legol
Sq. Ftg. Moin
5q. Frg. Orhe'
-
New,-Add--Alter-ReP,
- -Fence--Demo-Chonge/ Use
5q. Flg. Accers.
Volue of Work:
C)o
Addre rr Phone
Buildinq Permit I
Fomi
:cribe Work (i.e., Build Single
tto ched
t
9c
c
Addresr Phone
OESIGN TEAM (nome)(lics. no.)no.)
Strucfurol
Mechonicol
CONTRACIORS - ^ (nome)(oddrers)(lics. no.)(expire r)(phone no.)
Plumbi
Electricol
Mechonicol
PLUA^BING ETECTRICAT MECHANICAL
No. i i FEE CHARGE NO.I FEE CHARGE _NO.FEE CHARGE
I
I Eoch single fixturc
Residenca of
-rq.
ft.
furnoce/burner to
TU'S
Relocoted building
(new {ix. odditionol)
New circuits, olterolions
or exlensiont
Applionce vent
sepo role
S.F. Re:idence
(l both)SERVICES
Stolionory evop.
cooler
Duolex (l both) eoch Temporory Conslruction
Vent fon with
single duct
Additionol both Amps.
Vent system oport from
heotinq or A.C.
Woler rervice
Mechonicol exhousi
hood ond duct
Sewer Wood slove/ heoter ho )
Slorm Sewer rEEDA Heot Pump
/,,.Air hsndler to
t0,000 cFM
Air hondler over
r0,000 cFM
rssuANcE or PERMTT \o p D
TOTAL CHARGES TOTAT CHARGES
WHERE STAIE IAW REQUIRES thql the Electricol work be donc by lhe Eleclricol Controclor, the alectricol portion of this permit rholl not bc volid unril q
lqbel hos baen :igned by on Elcctricol Controdor ond ottoched to lhe electricol ponel.
IOTAT CHARGES oo
I HAVE CAREFUTLY EXAMINED rhe completed opplicqtion for permil, ond do hereby certify thot oll informoiion hereon is true ond correct, ond I further
certify thot ony ond oll work performed sholl be done in occordonce with ihe OrCinonces of the City of Springfield ond fhe Lows of the Stote of Oregon
perfoining to the work described herin. ond lhot NO OCCUPANCY will be mode of ony structure withoul the permission of the Building Division. t further
cerllfy thot my regi:trorion with the Builder's Eoord is in full fore ond effect os required by ORS 701.055, thot if exempt the bosi: for exemption is'noted
heron. ond rhol only rubcont.oclor5 ond employees who sre in complione wiih ORS 70I.055 will be used on thir prolect.
D^r3a3J/:NA-&IE (pleose print)
Bqris for Builder's Boord exemption:
FOR OffrCE UsE OilrY
Zone
-fype/Conrt.-Units -Sq,
ftg. Muin
Fire Zone--Bedroomr ccy Lood 5q. Ftg. Access
FloodPloinslorie3-occyGroup-Sq,Frg.other-x-Vo|ue
TOTAI YAI,UATION
x -----Yo lue
x Volus
Syslems Development
Choroe (1.5?i)
BUILDING PERMIT
659',"1 Per Fee
3Oo,Llg Per Fee
Plon Ck. Comm/lnd
Plon Ck. Res
Chorges ond
Surchorges
Totol Comb, Permit
PI.UMBING PER/$IT
Chorge: ond
Surchorges
tence
Demo
ETECTRICAI PERMIT
SidewqlkChorges ond
Surchorges
MECHANICAT PERMIT
Chorges ond
Surchorge:_t Curb Cut
TOTAI 15r"
tl
(u n fr L*{.- *\\r-( \pN ,
\\ on\ .
(oddress)(ex pi rer)
Primory
a/a Pd.i^.
DO
6OMBINATIqN AppLlCATlON,/PE'^'T (CAP)
l. Appliconr. to furnish
A. Job Address
B. Legol Description. I. exomple-tox lot 100, Lone County Mop Reference l7 03 43
2. exomple-Lot l. Block 3, 2nd Addition ro Springfield Esrotes
C. Nome, etc. of owner ond construction lender
D. Energy Sources
exompie -heot,ielectricol ceilin .z'or forced oir gos
col or solEieo ter
E. Squore footoge or voluotion, elc.l. u"gqp!g-!:19 rq. foot house. 500 sq. foor goroge
2. e-IE -ilE- if-n ew p ro i e c r, c h e c k -n e w - i i o d d ; tio n, ih ec k
odd, etc.
F. Building permit informotion:
l. exomple-construct single fomily house with on ottochedgoroge
2. exomple-remodel existing goroge inlo fomily room3. @-converr single fomily residence into
restouront (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of the
Structurol Speciolty Code
H. DESIGN IEAM AND CONTRACTORS
To ovoid design or construciion deloys, Building Division
Stoff must be oble to contoct oppropriote p.rron, regording
design informotion or iob site corrections, etc.
ll- Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description portion
of the Mechonicol ond Electricol Schedules, the oppiicont
need fill-in only the No. Boxes odiocent to the oppropriole
item(s) to be instolled
B. Full Plumbing, Mechonicoi, ond Elecrricol Scheciules
ore ovoiloble ot the Building Division
l. To conserve spcce on the permit form the schedules :
hove been obbrevioted
2. lf the item(s) ro be instolleo' ore not covered on fhe obbrevi-. oted schedules you should consult rhe fuil schedules
C. BUILDING DIVISION STAFF WILL FILL OUT.ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible, the initiol onplicorion will be used os o
worksheet oniy. Where possible, Builciinq Division Stoff will
prepore o typewriilen copy ond return it to the opplicont ot
the rime the octuol permit is issued {or his signotuie.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicotion,
ond no plons will be processed until these fees ore poid. ail
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
2 -worer
PERMIT VALIDATION
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
nome signoturea
dote
PLANS REVIEWED BY: