HomeMy WebLinkAboutPermit Mechanical 1989-12-12
1 INSPECTION LINE ~
726-3769 .
-'-'~--.-
Job Address !:::>-3LjLJ--:~
Legal Description 11 0::;' 5 '3 ~ I
CITY Of SPRINGfiELD
COMBINATION APPLICATION/PERMIT
EflERGY SOURCES:
Heat
Ha ter Ilea ter
Ranfle
ValuE of Hark:
t/dJi!.
.
INFORllATlON LINE
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftq. Other
flew Add Alter Pep.
--Fence Demo Change/Use
-Other- -
J
Owner \J ,:::.W
Address 5'~ t/-L/--
_""'){J~L
ConstrLction Lender
m~
() rr__
Ph ;>'/77<'1 ..Buildino Permit Info: Oescr be \/ork(Le..
one Ilf _ )1 Hfamilv rtesidence l'lith ",ttached Garane\
~ --, c/-/~"" I orll ,j~
{address' (lies. no.) (exnires1
Bulld Single
~
..........
U.)
~
(Jfl! rO&
Address
DESIGN TlAH
(namel
(ohane no. I
Primary
~L
;~
Structural
Electrical
Mechanical
CONTRACTORS
(name1
(address \
(lics. no.'
{p.xoires\
(ohnl'lp nn \
Genera 1
Plumbina
Electrical
~lechanical
vos ~~ Po ~ J,/gti E1tu;!-PNlL-C/JJkl.1
1/~(}s
'-f~o <lf~ --(>s..r.L-
MECHANICAL
PLUIIBING
ELECTRICAL
NO.
FFF . CHARr.E
Nr...o-'
Residence of
'IE- .GHAJlliE NO.
':FF
rl"IRliL
f
Each single fixture
16{fO
SQ. FT.
furnace/burner to
BTlI' 5
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
rpsirlen~p
multi{amily. corrrn. or
Tnrlustrial
Water service
Storm Sewer
Of
COMfI./INO. FEEDERS
Install/alter/relocate
rlic:.trih. fppdPr<;
Wood stove/heater
Of
amps.
ClI/J/ /lID / n ""
WDkf hettUr
~ '3,(}()
4.57)
TOTAL CHARGES 10;.61) TOTAL CHARGES
WIlERE STATE L\H REQUIRES that the Electrical work be done by an--Electrical
shall not be vali~ until the label has been signed by an Electrical Supervisor
ISSUANCF OF PFRIIIT
TOTAL CIlARGES
Contractor, the electrical portion of this permit
and returned to the Building Division
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 work oerformed 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 rm OCCUPAI~CY 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 ORS 7t"Jl.055 \-lill be used'on this project.
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIr.IIATURE
FOP. OFF I CE USE DIlLY
Sq. Ftg. /lain
Sq. Ft!l. Access
Sq. Ftg. Other
DATE
HAI'IE(please print)
Zone
Fire Zone
Flood Plain
x
Value
Value
Value
'x
x
TOTAL VALUATION
BUILDING PERfllT Plan Ck. Corrm/lnd
Charges and ------------ 65%/Bldo Ppr Fee
Surcharges Plan Ck. R-es
30%/Bldo Per Fee
PLU11BING PERMIT __J5-'JlQ____ Fence
Charges and
Surcha rges .16 D~mo
ELECTRICAL PERI:IT Sidewalk
Cha rges and ------------
Surcharges A/C Paving
I1ECHANICAL PERMIT /5.00 Curb Cut
Charges and
Surcharges -----~1S----
Systems Development
Charqe (1. 5~ -
Total Comb. rermit
TOTAL
3/-15
,.
-
e
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100. lane County Map Reference
'11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examDle- heat/electrical cellinq/or forced air qas
2. example- waterheater/electrlca('tor solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check flew - if addition,
check add. etc.
F. Building penn it information:
1. examele - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyle - 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 TEAll AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonnation 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.
Ill. 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.
1553-;
V. FOR OFFICE USE ONLY
Permi t
/1!lrf 51
cler~,V
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