The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 1983-2-17 r \'{\(ti.,f\ Legal De,cription /7--4~.::j'~.~ / C><fJ'/t::s/ 41140 CITY OF SPRHIGFILLD COMBIilATlON APPLlCATlDN/PERMIT ErIERGY SOURCES: Heat Hater Heater ~, INFDRllATlDN UNE . 726-3753 Sq. Ftq. 1'1ain ~q. Ftg. Access. Sa. Ftq. Other Ilew P,dd A Iter Pep. --Fence Demo Change/Use -Other- - w w ~ ....... ~ . IrISPECTl ON L 1I1E. 726-3769 Job Address Owner c:: tE c::/,- Address .:2R3? W/~t.",,""'.E'7rE. 5~~q Range Valu€ of Hark: '. Address DESIGN TEAll (name) Phone (address) Buildino Permit Info; Describe Work(l.e.. Build Single Familv nesidence With Attached Garaael jN'STA Co Co 77iPE r~o~ I.?\f~~ rp,.,..E~ .,i?.......c:. F' ~. I ~8~ (JF,r.:; CJ; ~ 7S , flies. no.) (exoires) (ohane no.) 'a~~3// Construction lender Primary /1echanical CDNTRACTDRS (namel (address) (l i~,. nn. 1 (pxnil"pc;) ~ (I)honp nn. 1 Structural Electrical Genera 1 Plumbina Electrical ~lechanical F6.... /?'lA-/,,}'T/h 5A-e-e:;r //7l!!'-r..,.,-c.. ? Y&:i-8c;J~ / PLUliBlIIG ELECTRICAL MECHANICAL 110.1 -----lEach single fixture IRelocated buildin9 (new fix. additional) l"s.F. Residence (1 bathl IOuPlex (1 bath) each IAdditional bath I ~Ia ter serv i ce I Sewer I Storm Sewer , FFF 'r~~ FFF rl-l~ NO FFF 1J:liAIlG.E /, Residence of SQ. FT. furnace/burner to BlUls I New circuits alts. or extensions ISERVICES I Floor furnace and vent Recessed wall ~"~rp hp~tp~ ~nrl vpn~ ITemporary Construction IChange in existing rp<;, i d~nrp Imultifamily, COI11Tl. or Tndu<;.trial 10f IC0I11'1./IND. FEEDERS l'Install/alter/relocate I rli<:.t,.ih f",,,,rl,,,,.<:. IDf I I I I TOTAL CHARGES I TOTAL CHARGES WHERE STATE L,1H REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical I I I I Ill.""''''' I ~'Jood stove/heater I I I ......I~?;;P/n-.e-- I_I~... l I -- I I I I I I I ,I TOTAL CHARGES 'Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division amps.l Appliance vent ~,=n~r.:lt.'" I Stationary evap. cooler I Vent fan with sinolp duct I Vent system apart from I heating or A.C. ...... I Mechanical exhaust hood and dud amps. I SSUAIICE OF PFRI'-IT /~ .... /6.S'" I HAVE CAREFUllY EXArlINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and al' 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 NO OCCUPA!~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 OP.S 701.055 will be used on this project. IIAI,tE(please print) Zone Fi re Zone Flood Plain Tvpe/Cons t. Bedrooms Stories Units Occy Load Occy Group SIGIIATURE ____ FDP. OFFICE USE O;U"Y-" Sq. Ftg. flain Sq. Ft~. Access Sq, Ftg. Other DATE x x Value Value Value x TOTAL VALUATION 11ECHANICAL PERMIT Charges and Surcharges /~..s .A. ------------ .~~ Plan Ck. Comm/Ind 65%/Blda P~r Fpp ------------ Plan Ck. Res 3D%/Blda Per Fee I Fence I D~mo I Sidewa I k I AIC Paving I Curb Cut I Syste~s Oevelopment Charae O.5~) BUILDIIIG PERIIIT Charges an': Surcharges PLUI1BING PERMIT Charges and Surcharges I I I I Total Comb. Permit I II LL__. I 17./~ ~ ELECTRICAL PERf~IT Cha rges and Surcha rges r - ~ COMBINATION APPLICATION/PERMIT (CAP) I. Appl ieant to furnish A. Job Address 8. legal Description -. I. example- Tax Lot 100, Lane County Map Reference ( II OJ 4J 2. example- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example. heat/electrical ceilinq/or forced air c 2. examyle. waterheater/electrical/or solar '(' E. Square footage or valuation. etc. - I. examDle- 1250 sq. foot house, 500 sq. foot garas 2. example- if new project, check new - if addition check. add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examele - remodel existing garage into family ra ( 3. examole - 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 TEM4 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 adjacer ( 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 schedulE ( have been abbreviated 2. If the item(s) to be installed are not covered or 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 nDted 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. --- Applicant to Sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building ~ivision 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. III. V. FOR OFFICE USE ONLY ~. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: r , ~ ( wTY OF SPRINGFIELD . City Hall Sprlnglield, Oregon Department 01 Public Works OFFICIAL RECEIPT , No. B 60435 ( Date ,:-~. /:J 19 ~ ~ , Rec'dFrom C~./L ~XOH Address '2&3''/ k//L.LA'.r?7P77..=' :r ~::: ,or , / ,b~ e'3o/>9 . Received For. ( MP. Tr~ //:..SC> .bb - "C~ /7. /~ ( <: ~-/f# ??=?C- //.~ Amount Received - d~--v7Z-~,"'.,' v/ AUT~lORlieOS1GN;.ruR~ ~ /' \... r !!_( \ 8RlOClS P'RINTERII/UTHOOR"P'HERS. EUOItNI:. OREQON Permit Clerk j Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature i . date