HomeMy WebLinkAboutPermit Mechanical 1986-10-14
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I IrISPECTlOII L1I1E
726-3769
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CITY OF SPRIIIGFIElO
COMBIrIATlON APPLlCATlON/PERMlT
Job Address
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E!lERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE of Hork:
INFORllATlON UNt
726-37S3
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A Her Rep.
-Fence Oemo ChangelUse
-Other- -
Address
Ul:.~lur{ a,ml
(name)
Phone
(address)
Builriina Permit Info: Describe Work{i.eo.
Familv nesidence With Attached Garaoe)
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Build Single
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legal De~cription
Owner~
Address ~~7~
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r(\a/U~ P~e7t/0
1<+(2..
Construction Lender
(1 ics. no. l
lexoiresl
(ohane no. ')
Primary
Mechanical
CONTRACTORS
(namel
(address'
(lies. no.)
;l.
~
~\
(pxoiresl ~ (ohonp nn.)
Structural
Electrical
Genera 1
Plumbina
Electrical
'Iechan;c'al~
. PlUllBIrIG
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OWYI.Q n.J
ElECTRICAl
MECHANICAl
-H.Q..:..I
FFF rHARr;F NO
I--E.E.L J:I!ARG.E. NO
aL..cJfARG.E.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
B:rU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
IS.F. Residence
II bath\
IDuPlex (1 bath) each
IAdditional bath
~Jater service
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
,
Temporary Construction
Change in existing
resinence
ImUl.t;-f.amily. COlllll. or
Innustrial
IOf amps.1
I COMI.1. /IND. FEEDERS I
IInstall/alter/relocate I
rlic::t.r'ih fppnprc::
IOf amps.[
I
[
I
Appliance vent
seOil ril tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.I":.
Mechanical exhaust
hood il:nd duc.t
Sewer
Storm Sewer
I
I
C'-i?CUI P, QI~ ~ I
if \ I
ij1~ I
Wood stove/heater
IS oD
(,'D
TOTAL CHARGES
WHERE STATE lAW REQUIRES
shall not be vali1 until the
TOTAl CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANC, OF PFRI1IT
TOTAl CHARGES
Is. C.;'O
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EX~lINED the completed apnlication for permit. and do herebY certify that all information hereon is true
and correct; and I further certify that any and all work Derformed shall be done' in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that NO OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration 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 employees who are in compliance with OP.S 701.055 will be used on this project.
rW.IE(please print)
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SIGIlATURE ,?V "'&..1/0-<..,." (::> d~k
V
DATEID -I tf --'&' h
Zone
Fire Zone
Flood Plain
FO~ OfFICE USE OiiLY
TyoelCons t. Units Sq. Ftg. fiain
Bedrooms Occy load Sq. Ftg. Access
Stories Occy Group Sq. Ftg. Other
x
x
x
Value
Value
ValuE'
TOTAL VAlUATION
BUIlDIIlG PERmT
Charges anc
Surcharges'
Plan Ck.
65%/Bldo
------------ Plan Ck.
30%lBldo
I Fence
10_
I Sidewalk
I AIC Paving
15 - 00 I Curb Cut
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Conm/lnd
Ppr Fpp
Res
Per Fee
Systems Development
Charqe (1.5~)
PLUliBING PERMIT
Cha rges an~
Surcharges.
ElECTRICAl PERI~IT
Charges an~
Surcha rges.
MECHANICAL PERMIT
Charges and
Surcharges
ITotal Comb. Permit
I
I TOTAl
/S.&d
.
COMBINATION APPLICATIONIPERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. exampl~- Tax Lot 100, lane County Map Reference
II OJ ,3
2. examole- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
1. example- heat/electrical ceilinQ/or forced air Qas
2. examDle- waterheater/electrlcal/or SOlar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B; Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item{s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible, Building Division Staff
wi.ll prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his.
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fe~s are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,
PERMIT VALIDATION
B & 7 z,t-(s
IO-ILf-rb
Permi t Cl erk C.L-/
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVI EWED BY:
name
signature
date