HomeMy WebLinkAboutPermit Mechanical 1988-10-10
JINSPECTION LINE
726-3769
Job Address 5 34 LI
Legal De,cription
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork:
;
INFDRlIATIDN lINl
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
-Other- -
M~
y
00
0\>
D
'-C.
16'
10'
ownerl J.OJ()AO-",p t=~~vJCub
Address ':::;311 Ll VVI..~ Phone
Construction Lender
BuildinQ Permit Info: Describe Work(i.e.,
Familv Residence With Attached Garaae)
1/ iTd ~.o Y- LA../ Me
" p~
Build Single
Address
DESIGN HAH ---liiame'
Phone
-- {address Y'
(lics.no.)
(exoiresl
{ohane no.,
Primary
.""'
trIA (F./
~
,-'"1. 00
J .,
Ii
j\\
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrpss)
f1 ics no.)
(pxoirp""
(OI""nrlP nn ,
General
Electrical
'[f[U
I
Plumbina
Mechanical
()U j;1/A )
PLUI.IBING
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
I FFF I CHARt;E Nn I I 'ILt.Cl:iARGI ---HC_1_____ . _._. I ~:~I
Residence of furnace/burner to
SQ. FT. BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
II bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p ~p~tpr ~nrl vpnt
Of
amps.
Appliance vent
c;.Pn~ratp
Stationaryevap.
cooler
Vent fan with
s.inole duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hnnr:l and dur:t
~Iater service
I Sewer
'Storm Spwer
Temporary Construction
Change in existing
rps i dJ'prp
multifamily. comm. or
Industrial
COMI.1. /IND. FEEDERS
1 Install/alter/relocate
didrih_ fpprlprc;.
IOf amp~
1
I
I
Wood stove/heater
ISSUANCE OF PFR!1IT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\~ REQUIRES that tile Electrical work be done by an.
shall not be valid until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore~lOn pertaining to the work described herein, and that flC 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this project.
NAI.IE(please print)Lbf?dfd.f.. .7fUi J)j}pAJ /I (/ SIGIIATUREY; ~J?/ ~ t'9/
. FOR OfFICE USE DIlLY
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
DAH/6 -; 0- 8'~'
mj
Zone
Fire Zone
Flood Plain
riain
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERmT
Charges and
Surcharges
~."
Plan Ck. Comm/Ind
65%/Bldo pp! Fee
Plan Ck. Res
3D%/Bldo Per Fee
Systems. Development
Charqe (1.5~) .
PLUMBING PERMIT Fence
Charges and..''''-- ------------
Surcharges . D~o
ELECTRICAL PERIHT I'S1dewa I k
Charges and ---------___
Surcharges I A/C Paving
MECHANICAL PERMIT IS. 0.0 I Curb Cut
Charges and \ I"l. ____________1
Surcharges V/ I 75 . .
I
I
I
ITota' Comb. Permit
I
I TOTAL
(S-7S
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Reference
'17 oj 43
2. exam~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examele- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I. exam~le- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. check new - if addition,
check add. etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exam~le - 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 TEAM 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
will 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
fees are paid. All other fees and charges are due and
payable when the permit is issued.
(~S50
, (^/g~
I i[)"- U
V. FOR OFFICE USE ONLY
Permit Clerk
C"L
.
]
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
signature
date