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HomeMy WebLinkAboutPermit Mechanical 1981-10-5 INSPECTION LINE 726-3769 .. CITY OF ~kl"'Gfl&;:D COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 Job Address ~?mL f\'C\ . in, ENERGY SOURCES: Hea" Water Heater Ran~e Value of Work: Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _New_Add_Alter_Rep. ~l"n(e~Demo_Change/ Us~ ( .....'C: Other i") Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached GaraCle) Legal Description O~' 0. JlOA\"\ Nf\\f\O'L"~ IHs\\OX '-- h ni"J\ - - ~ Ad~'h_n ~ ~-.~ '1<DniD . 3 J,J'l_'c) \ \ Con1trudian lender V DESIGN TEAM (name) (address) ~\)\t'10() _ (~u('t-ll:hXl . ,." . 0 )){'If\tinOl '~r\. f\, - J (PhOn~) (liu. no.) (~'ds) Address Phane- Primary Structural Electrical Mechanical CONTRACTORS (name) {address} (lies. no.) (expires) (phone naJ General PlumbinR Electrical ( 'O~f\.\~ ~ f""I LJ PLUMBING \.) ~ - --- ~ r..Ij/f::J-(jII) I ~ S" l "J \ Qt=:#- 41 DO tt:I~f{z... ELECTRICAL MECHANICAL Mechanical I SQ. ft. New circuits, alterations or extensions I(JXJ furnace/ burner to D,TU's Appliance vent separate Stationary nap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct fEE 'C~E lo.('Y Residence of FEE CHARGE NO. .1 NO. fEE CHARGE NO. _!ach sinq.le fixture Relocated building (new fix. additional) S.F. Residence (1 both) SERVICES Duplex {I bath} each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/h..ater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10,000 CFM Amps. TOTAL CHARGES TOTAL CHARGES L lo.m TOTAL CHARGES ISSUANCE Of PERMIT I {),vU ! (O.ClO WHERE STATE LAW REQUIRES that the Eledrical work be done by tb. Electrical Contrador, the electrical portion of this permit sholl not be valid until a label has bun signed by a~ Electrical Contrador and attached to the eledrieal panel. I HAVE CAREFUllY EXAMINED the completed application for permit. and do heteby certify that. all information hereon is trult and correct, and I further certify that any and all work perforrTl4!d sholl 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 herin. and that NO OCCUPANCY will b. made of any structure without the permission of the Building ~ivision. I further c:ertrfy that my registration with the Builder's Board is in full force and effect 0 s required by ORS 701.055. that if exempt the basis for exemption is noted hetan, and that only subcontractors and employees who ore in compliance with ORW01.055 will be used on this project. Basis for Builder's Board-exemption: NAME (please print) D?'Jl/,j N. l-IaJ'!",Md SIGNATUREi~~,,-'}?J iLM..ocQ DAT1}f5pl FOR OFFICEAfE ONLY Zone Typo/ Canst '1nits Sq. Ftg. Main fir. Zone ~droom' nccy Load c:.q. Fig. Acclll' Flood Plain "torie- --;>ccy Group Sq. Ftg. Other BUILDING PERMIT Plan Ck. Camm/lnd Charges and 6S%/Bldq Per Fee Surcharges Plan Ck. Res 30%/ Bldq Per fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Ir ?+~ Charges and Sidewalk. Surcharges A I C Pavine> MECHANICAL PERMIT .llO-,- ex)_ Charges and Curb Cut Surcharges .{ oLl x Value x Value Value TOTAL VALUATION Systems Cevelopment Chorae (, .5%) Total Comb. Permit TOTAL , .' \ \ . J" ..-'.- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100. Lane Caunty Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates. C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air qas ( 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. foot house, 500 sq. foat 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 ottached garage 2. example-remodel existing garage into family room d " 3. example-convert single family resi ence into , restaurant (change of use) G. Value of wo,k as defined in Section 303 (a) af the Structural Specialty Code ( H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regardir'l ..-. 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 Elect,;cal Schedules, the applicant need fill-in only the No. Boxes adiacentta the approp,;ate 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 abb ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF wiLL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where pcssible. Building Division Staff will prepare a typewritten 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 applic and no plans will be processed until these fees 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: Additional Project Information: PLANS REVIEWED BY: , nom"" e.ignatur"" .' 'PERMIT VALIDATION CITY OF SPRINGFIELD City Hall Springfiold, Oregon Department of Public Works OFFICIAL RECEIPT If\. .L c::: . No. B 5 7.4 0 5 Dote \\j'r/. ::::::> 1~~ \ Rec'd F=~~t- .d{0fr) Address~S-~ ~ tstJ / Received For: ..- - - i '. , \ \~)~ \t\ /\r77, t /j, \loPO {oU ( ( \ Q \lO~. (f) .(J.-J .,\' h L\{ ) ( ( Amount ( BY -C' -, , , Received ~il 04 ~1[):j "H.LTO".TU~"'UU ....'..T.... ' lUG."., 0.. '~"G' .,,,,,., Permit Clerk dale u/ ..... ( I INSPECTION LINE 726-3769 I Job Address -. CITY OF SPIi1NGFIE!~~. COMBINATION APPU-CATlON'PERMIT . INFORMATION LINE 726-3753 JJ ~'.::C'Q. l f'\'{\ i I\ , I ENERGY SOURCES: Heat I Water Heater RanRe Value of Work: Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other -- _New_Add_Alter_Rep. 0 _, F",..,(e_Demo_Change/Use ~ .....C 'Other ............ ~ - /J (B". no.) i.,.(;;' ,) iPhOn~) Legal Description I odCl1Qf) "\ Nl \. V)9'L (" ~:pl \ U i.o X I A~::::-~3n I lJl1\ fl.r'~ \~:*~~. I {\ n 0 I (.) f:\ . Ul ~ (\ D1U ~. I .~ ~n\.'c). Construction lender I Address I DESIGN TEAM I Primary I Structural I Electrical I Mechanical I CONTRACTORS Phone (name) (address) ~ fJr~ (name) (address) (Iics. no.) (expires) (phone no.\ G""",,ol Plumbino Electrical , t'~.l~~(""'lLJ PLUMBING \) - -- ~ r..Ij/f::J-ij/l) 1 8ss1 .,:)\Qt*41~/X'z... ELECTRICAL MECHANICAL Mechanical No.1 FEE I CHARGE NO. I FEE CHARGE NO. ./ furnace/burner to ~TU's Appliance vent separate Stationary evap. cooler Vent fan with sinRle duct Vent system aport from heatinq or A.C. Mechanicol exhaust hood and duct FEE ,t~~E I 0.1;J-J Residence of Each sinRle fixture Relocated building (new fix. additional) S.F. Residence (1 bath) I s~. ft. New circuits, alterations or extensions / rYr1 /".h~ SERVICES Duplex (l bath) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over ID.ODD CFM Amps. TOTAL CHARGES TOTAL CHARGES In.m TOTAL CHARGES ISSUANCE Of PERMIT //) ,DO /(0.00 WHERE STATE LAW REQUIRES that tho Electrical work be done by tho Eledricol Contrador, tho electrical portion of this permit shall not be yolid until 0 label has bHn signed by a~ Electrical Contractor and attached to the .Iedricol panel. Basis for Builder's Boarc>>exemption: NAME (please print) 0 i"J J/ I 'r! I HA VE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon iI true and corred, and I further certify that any and all work performed shall he 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 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 iI noted heron, and that only subcontractors ond employees who ore in compliance with ORS-701.055 will be used on this project. SIGNATURE [~",,;.lJJ iLN~ h u .Q DAT1}J- f5Pl IV. /.J;;Irw...,,>d fOR OfflCurfE ONLY Zon~ Fire Zone Flood Plain Type/Canst. l.edrooms II;.torie-- Units nccy load Occy Group II;.,~. Fig. Main 11;..... Ftg. Access Sq. Fig. Other Value Value Value TOTAL VALUATION x x BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/BldQ Per Fee Plan Ck. Res 30%/ Bldq Per Fee Systems Development Charoe (1.5%\ PLUMBING PERMIT Charges and Surcharges Fe...~iIt MECHANICAL PERMIT Charges and Surcharges JQ a;:) .I( ) JW.:..OO_ .f DL/ Demo Total Comb. Permit elECTRICAL PERMIT Charges and Surcharges Sidewalk Ale Pavinll TOTAL Ic9()~ur Curb Cut " \i..J1.! APPLlCATION/PE.T (C~P') ~~..t:~'.:r'~ :,.-C'~f.C .! '\: .J;;'::,~ '\0]' "ri"~".'>-.r\ '. _' . \ ""'We--'" -',- PERMIT VALIDATION I", :--,,' ,-COMBINATION t -. \,1, Applicant to furnish 'A. Job Address :-. -, B. legal Description 1. example-tax lot 100. lane County Map Reference 17 03 43 2. example-lo!'l: Block 3. 2nd Additio'1.toSpringfield Estates. C. Name, etc. of owner and construction lender .......{ '/./ D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. i Square footo'ge or valuation, ete: . t' .' ,', .' 1. exa';'ple-1250 'sq.-fOO! house. 50"0 ~q:fooi garqge 2.. example-if new project; check flew-Jf addition, check . add, etc. \ . j F. Building permit information: 1. examole-construct single family house with an attached garage 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the St,uctu,al Specialty Code H, DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division f \ \ '. I Stafl \.must be able to contact appropriate persons regarding . laesign information or job site corrections, etc. , ' ,i . ' '. . . II. Abb,eviated-f\lumbi,;g.,Mechanic~1 & 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. a~'d Electrical Schedules are available at the Building Oivis!o'1 \\ 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 abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF Will Fill OUT All FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and dote Whenever possible, the initial application will be used as a worksheet only. Whe,e possible. Building Division Staff will prepare a typewritten 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 fees 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:OCc;UPANCY: .1 . 't h Additional Project Information: PLANS REVIEWED BY, nom" ",ignatur" . I ) (\/;. t .J. ' .... \ r ,. .' ..1 _ ". " , l'. ~i ~. .... :t), ; -'40' .-' t', Pe,mit CJe'~ l~, , ( -\.' .,.., - \ \... , --t' .'. ., " t .r .---;. .~. .,I.~ . I. ...'t I i' ) , ~. . ".~ i , .1' , , .... , ' 'ioto.' , .