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Home My WebLink AboutPermit Mechanical 1981-4-23 INSPECTION LINE 726-3769 . CITY 01' -SPRING~IELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 legal Description Heat Water Heater Ranqe I Value of Work: Sq. Ftg. Moir. Sq. ftg. Accen. Sq. Ftg. Other _New__Add_Altor_Rep. j__Fence_Demo_Change/use _Other. Building Permit Info: De5cribe- Work (i.e., Build Single Familv Residence With Attached Goraoe) -.j ..!;) :;l -:}\ I jl I-L~ Job Address J31f'l- rf r;,J ~~. .!?- ~ ;.,,</ \\0'). 2> '?:> ~ \ '-.0 ~() La Own.. v.xID".MALJ a! r~ tfl",-,.</J Add.... .I!J3J./Lf C~ ENERGY SOURCES: Phone Co~structian lender Addre" Phone DESIGN TEAM (nome) (address) (lies. no.) (expires) (phone no.) Primary ,.,.~..~\ Structural Electrical Mechanical CONTRACTORS (nome) (address) (lies. no.) (expires) . (phone no.) Mechanical {),~~~ i'- 6 S- ~ , f..u. ..vr 11 ~ r 'l. 7'11:.-33/,- G",nerol. Plumbinq Electrical PLUMBING ElECTRICAL MECHANICAL NO. FEE CHARGE NO. FEE I CHARGE NO. FEE I CHARGE Residence of / furnac;,e/burner to ~ 5, tU/J BTU's Appliance vent separate Stationary evap. tooler Vent fan with sinql. duct Vent sY5tem aport from heQtinq or A.C: Mechanical exhaust hood and duct ~.oo f Each sinqle fixture Relocated building (new fi.l:. additional} S.F. Relidence (1 both) ..,:ft. New circuits, alterations or extenlions SERVICES Duolu (l both) each Temporary Construction Additional both Amps. Watersenice Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM / 12~_"-YL.fw,. ISSUANCE OF PERMIT I I 1-'/.50 I I /O.fJrJ dO.S-O Amps. TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the EI.ctrical work b. done by the Electrical Contractor_ the .Iectrical portion of this permit shall not be valid until a label has been signed by on Electrical Contra do' and attached to the electrical panel. I HAVe CAREFULLY EXAMINED the campleted application for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all wori( performed sholl b. done in accordanco with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work ducribed herin, and that NO OCCUPANCY will be mad. of any structure without the permission of the Building Division. I further certify that my regi5tration wit'" the Builder's Boord is in full ~orce and effect 0 s required by ORS 701.055. that if ~x.mpt the basis for exemption is. noted h.ron, and thot only subcontroc;ton and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption: NAME (please print) c.lGNATURE FOR OFFICE USE ONLY DATE Zone Fire Zone Flood Plain Typel Const. Bedrooms (Ioril"" Unih r"ltcy Load Occy Group Sq. Ftg. Main Sq. Ftg. Access Sq. Fig. Other . Value '/alue Value . TOTAL V ALUA TlON . BUilDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%1 Bldo Per fee Plan Ck. Res 30%/ Bldo Per Fee SYltems Development Char". fl.5%l . PLUMBING PERMIT Charges and Surcharges Fence Demo I Total Comb. PiI!"rmit ELECTRICAL PERMIT Charges and Surcharges Sidewalk MECHANICAL PERMIT Charges and Surcharges I ____...d.t),.'>O I .3";1...1 AI C Pavina I TOTAL ~:l/. 3~ Curb Cut .' ;.~ ~-'.. ....:". ,_...._._..:~--..._.. -.... COMBINATION. APPlICATlON/aIT (CAP) t :-., I. Applicant to furnish A. Job Address B. legal Description 1. example.tax lot 100, lane County 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.heot/electrical ceiling/or forced air qas 2. exomole-water heater/electrical/or solar E. Square footage or valuation, etc. I. example.1250 sq. foot house, 500 sq. foot garage 2. exomole-if new project, check new-if addition, check odd. etc:. F. Building permit information: 1. example-construct single family house with an attoched 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 (0) 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 informction or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules' A. Except where blank spaces occur in the description portion of the Mechonical and Electrical Schedules, the applicant need fill~in only the No. Boxes adjacent to the appropriate item(s) to be instolled 8. Full Plumbing, Mechanical, and Electrical Schedules ore 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 ore 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. Where possible, Building Division Staff will prepare (] typewritten copy and return it to the applicant ot the time the actual permit is issued for his signature. IV. Fees and Charges Pion check fees ore due and payable at the time of the application, and no pions will be processed until these fees are paid. All other fees and charges ore due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: I PLANS REVIEWED BY, AU-. nom"" . -:ignature- . Permit CJer~ PERMIT VALIDATION \. I J J I j J j I J -iato Y-:.23-g/ INSPECTION liNE 72,6-3769 . CITY of SPRING;"'D COMBINATION. APPliCATION/PERMIT . INFORMATION LINE 726-3753 Legal D.,uiption J31f'l.f a.d ~~_ ?>- .3 , .:t I ENERGY SOURCES: Heot I Wat.r Heater Ranqe I Yolue of Work: Sq. Ftg. Main Sq. Ftg. Accen. Sq. Ftg. Other _New._Add_AJter _Rep. I' _Jen<<,_Oemo_Change/U,. _Other. Building Permit Info: Describ. Work (i.e.. Build Single Fomilv R:,..irf."r.. With Attached Goratlel cfJ' Job Addreu Owner '7/_dD"~ '1 r?-u.~ ttl/'k.</l .i;-3Ut( C~~ Phone o ~ o<J ...L. Addre" Construction Lender Addreu Phone I DESIGN TEAM I I I (I\ame) . (addreu) (lies. no.) (~xpire') (phone no.) Primary ..'0..:.... StTuctural Electrical Mechanical CONTRACTORS (name) (oddr.,,) (Iics. no.) (upinn) (phone naJ O",norol Plumbinq Electrical Mechanical {),~~~~ :;6S-/v, -;I-u' ~ 7'16 - 33/'2- PLUMBING ELECTRICAL MECHANICAL " NO. I fEE I CHARGE NO. Each ,inqle fixture I Relocated building I (ne.... fi..:. additional) S.F. Re,idenc. I (I bath) Dual.. (l both) each ! Additional both I Wat.r ,er...ice I Sewer I Storm Sewer I i fEE CHARGE NO. .1 furnas,e/burner to '7,S."1'1! BTU', Appliance venl separate ' Stationary evap.: cooler Vent fon wilh single duct Yent system aporl from heating or A'.C. Mechanical exhaust hood and duct fEE CHARGE I {".OD Residence af .~: ft. New circuits, alterations or extensions ,/.. SERVICES Temporary Construction Amp,. Wood stove/heater I I I FEEDERS Heat Pump Air handler to 10.000 CFM I Air handler over , 10.000 CFM Amp,. I r I I ,&.h,.- I I f _'7', -r,.t.fll. -'Iso I TOTAL CHARGES TOT At CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES /1J.(JrJ' ';;0. s:-o WHERE STATE LAW REQUIRES Ihat the Eleclrical work b. cion. by the Electrical Contractor, the eJecr!icaJ portion of this p.rmit shall not be valid until a label hat b..n signed by on Electrical Contrador and attached 10 the electrical panel. I HAVE CAREFULLY EXAMINED Ihe completed applicatian far permit, and do h.reby certify that all informofjon hereon is true and correct, and I further cerMy Ihot any and all worlt perfarmed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the Stote of Oregon pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permission of Ih. Building Oi...ision. I further certify that my regi'tralion wilh the Builder's Soard is in full force and effect as required by ORS 701.055, fhot if exempt the basis for ..emption is. noted heran, and that only subcontroctors and employees who ore in complionce with ORS 701.055 will be used on this project. . Sosi, for Builder's Board exemprio' . NAME (please print' ~IGNATURE fOR OFFICE USE ONLY DATE z.~ Fire 2a". Flood Plain Type/ Canst. It.droam, C;torie" Units t"\ccy Load "'ccy Group Sq. Ftg. M;;Jin ~~. Ftg. Access Sq. Ftg. Other Value Yolue VaJul TOTAL VALUATION . . BUilDING PERMIT Charge, ond Surcharges Plan n. Comm/lnd 65%1 Bldq Per Fee Plan Ck. Re, 30%/8IdCl Per Fee Syslems Development Choroe /1.5%1 PLUMBING PERMIT Charge, and Surcharges Fence Oemo I TOlal Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk Ale Pav.n.. MECHANICAL PERMIT Charges and Surcharges .___~LJ',S-D Curb Cut ,,";I-I I TOTAL ~;(/. 3~ .....: '.:. ..;....:...~~_.-........ .'.... COMBINATION APPLlCATlONi.MIT (CAP) I. Applica", ta furnish A. Jab ;.i:.ddress B. Legal Descriptian 1. examale.tax lot 100, Lane Caunty Map Reference 17 03 43 2. examale.Lat 1. Black 3,.2nd Addition ta Springfield Estates C. Name. etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced air Qas 2. examCle.woter heater,' electricol/ or solar - ( - \' E. Square footage or valuation, etc. l- 1. examale.1250 sq. foot house, 500 sa. feat gore 2. examole.if new project, check new-if addition, ~k add. etc. F. Building permit information: 1. example-construct single family house with on (c. garoge 2. example.remodel existing garage into family r. J. example-convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Cade H. DESIGN TEAM AND CONTRACTORS (' To avoid design or construction delays, Building Oi Stoff must be able to contact appropriate persons I design informction or' job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedl A. Except where blank spaces occur in the description af the Mechanical and Electrical Schedules, the apF need fill.in only the No. Boxes adjacent to the appl item(s) to be installed 8. Fuil Plumbing, Mechanical, and Electrical Schedule. are available at the Building Division 1. To conserve space on the permit form the sched hove been abbreviated 2. If the item(s} to be installed are not covered on . ored schedules you should consult the full sched C. BUilDING DIVISION STAFF WilL FILL OUT ALL FEES CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible. the initial application will be used worksheet only. Where possible, Building Division Staf prepare a typewritten copy and return it to the applicc 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 and no plans will be processed until these fees ore pail other fees ond charges ore due and p'ayable when the is issued. IV. V. FOR OFFICE USE ONLY ,. . . ._~ PERMIT VALIDATION .... .......n;II:O SIQNATUlt". ....:L O"'TU"".ULL ""'''Yl''.' lUGlHl. 0" .". ( CITY OF SPRINGFIELD c CIty Hall Springfield. Oregon Department 01 Public Works OFFICIAL RECEIPT ( ( No, B 56359( Date 4- - 2.- ~ 1~ I : Rec'd Fram I'nmO&lu.J ~. (j111'l C Address A V; 5" kJ. ri.gfh .s& ' ( ( Received Far: e.n ( vh\..O \ taL '( 'if ,. .. '. fl C Amount Received ( _?(/ <D ( ~Z__ ( ( c J. I ,,12. c_qrJ.; ( r~. ...,...C- C' ~T ( AUTHOIII1ZI:D SIQNATUIIIII: .HlLYO"'TU"H.ULL """"TIlt.. lUOlHI, 0.. .'.0' PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCU~ r:' ,,-- .,.. .'"'' ,'. .~ I Additional Project Information: PLANS REVIEWED BY, nam- . --.ignaturp' I I I /. ~tL ""'e Y-;.23-g'/