HomeMy WebLinkAboutPermit Mechanical 1981-3-18
INSPECTION LINE
726-3769
-.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
.
INFORMATION LINE
726.03753
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Job Add.... ~115' MtJP-LeLA
legal Description I 1 () /. /
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Phone
ENERGY SOURCES: Sq. Ftg. Main
Heat~"'" Sq. Fig. Aecen.
Water Heater ~.R..."'" Sq. Ftg. Othe-"
Ronqe _New._Add_Alter_Rep.
I Value of Work: I ~~Fenee.__Demo_Change/Use
2., ~ 4-1') ~ _O,h.,
"I?'_.I"'~ ~ I BUlldi~g Per;:;'li.ln~ Descnbe Work (i.e., Build Single
~~:::::7 l='l]mllv p....,.l......... waf, Allnched Garaael
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1'1+11
Construction lender
Address
Phone
DESIGN TEAM
(name)
(oddren)
(lies. no.)
(expires)
(phone no.)
Primary
~
)
I
/;,1\\-_.
~~(
r~
Structural
Electrical
Mechonical
CONTRACTORS
(nom!!)
(addren)
(Iics. no.)
(expires) .
(ohone noJ
General
Plumbinq
Electrical
Mechanical
~fl."n'l c..
~ tJ?"
-Zc..l ~. zsnt
PLUMBING
ElECTRICAL
MECHANICAL
S+~.~1'fo
I
I FEE CHARGE I
\ .0.0 .J I
- /1
NO.1
FEE
I CHARGE I
I
I
I
Residence of
NO.
FEE
I CHARGE I NO.
.\
furnace/ burner to
QTU's
Appliance vent
separate
Each sinClle fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
so: ft.
New circuits, alterations
or extensions
SERVICES
Stationary evap.
cooler
Vent fan with
sinqle duct
Vent system apart from
hearinq or A.C.
Mechanical exhaust
hood and duct
I Wood stove/heater
I
I
Heat Pump
Air handler to
10.000 CFM
Duplex (I bath) eoch
Temporary Construction
Additional bath
Amps.
Water'lervice
Sewer
Storm Sewer
FEEDERS
Amps.
Air handler over
10,000 CFM
t
I TOTAL CHARGES
I WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrico portion of Ihis. permil shall not be valid until a
label has boen signed by an Electrical Contractor and ottached to the .I.etricol panel.
TOTAL CHARGES
I I
ISSUANCE OF PERMIT \ 9 .CfJ
TOT At CHARGES \ \ 0 0 .
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct. and I further
certify that any and all worlr. performed shall b. done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be mode of any strudure without the permission of the Building Division. I further
certlfy that my registration with the Builder's Boord is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted
h.,oo_ aod ,ha' ooly ,ub,oo"o"o.. a,d .mploym who 0'. ;0 ",mp!;ao", w;,h ORS 701.055 wm b. u,.d 00 '~'Oj.d'
Be,;, fo, Ru;ld.,', Bea,d .x.mption' , r l _IA
NAME(pl.o~p.;nl' ~-r~l~ L..Ho~t-J "GNATURE ~-fov...\a.lII' e"",^ oATE~/gI
FOR OFFICE USE ONLY
Zone -/J) ~
Fire Zone
Flood Plain
Type! Canst.
':!,edraam'
clori..
Units
"'ccy load
Occy Group
Sq. Ftg. Main
Sq. fig. Access
Sq. Ftg. Other
x
Value
Value
Value
x
TOTAL VALUATION
BUilDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/ Bldrj Per Fe",
Plan Ck. Res
30%/ Bld~ Per Fee
Systems Development
_ __C"-ar~,:" (1.5%'
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
--r~~ta:",..~ ~~.-P::it
,--_. -.-. ..
ELECTRICAL PERMIT
Chorges ond
Surcharges
Sidewalk
MECHANICAL PERMIT
Charges and
Surcharges
._\\0_ G'U__
,leU
I
\ \.0 . \QC\-
Ale Pnv;.....
Curb Cut
I TOTAL
III. Applicant to sign and date
Whenever possible, the initiol application will be used as ( 8'1'
worksheet only. Where possible, Building Division Staff v
prepare a typewritten copy and return it to the applicant
the time the actual permit is issued for his signature. \,'
Fees and Charges +-:- ~ _ _
Plan check fees are due and payable at the time of the application,
and no plans will be processed until tnese fees are paid. All
other fees and charges ore due and payable when the permit
is issued.
COMBINATION APPLlCATlON/PitIT
(CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example-tax lot 100, Lane County Map Refe"
2. example.Lot 1. Block 3. 2nd Addition to Spring'
Name. etc. of owner and construction lender
Energy Sources
1. example.heat/electrical ceiling/or forced air Ql
2. examole-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example.1250 sq. foot house, 500 sq. foat g'ara
2. example-if new project, check new-if addition, I
add, etc.
F. Building permit information:
1. example-construct single family house with an c
garage
2. exomple.remodel existing garage into family ro
3. example-convert single family residence inta
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H: DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Div
Staff must be able to contact appropriate persons re
design information or job site corrections, etc.
C.
Do.
II. Abbreviated Plumbing, Mechanical & Electrical ScheduJ.
A. Except where blank ~paces occur in the description F
of the Mechanical and Electrical Schedules, the appli
need fill-in.only the No. Boxes adjacent to the apprc
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 sehed"ul,
hove been abbreviated
2. If the item{s) to be installed are not covered on thl
ated scheduies you should consult the full schedul,
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
IV.
Y. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
name.1Z j} ~Jhr.?J:r/
.
PERMIT VALIDATION
~- .1
CiTY OF
SPRINGFIELD
f"
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B 56080("
Date ,~- IPs 198/ .'
Rec'd From Thp ,- (JhLl rJ (10 n fp AJ (
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Address3QQ 'j- n1fll7 (h-V1 ' .
, c:<{: J 1.0 -: J rL~te ')~
. -.ill 0 " l? J
Received For:'
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c.... . Amount Received
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Permit Clerk
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