HomeMy WebLinkAboutPermit Mechanical 1987-12-16
I INSPECTION L1I1E
726-3769
Job Address J-./{)3;t.
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CITY OF SPRINGFIELO
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work:
rn~ \5t:.
Legal Description
Owner ./kolA vv! G. \P5.fnGe...r
Address LfD3~ mQ.i...-tu G...t..
SrY1;"r, ~:e-ld Of2-, q(l-1-7~
Construction lender I I
Phone
Address
DES I uN TEAl.'
(name)
Phone
(address)
i Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address 1
General
Plllmo;nC1
, Electrical
~'echanical
~/1AJ1/lJ II
PLUIIBI NG
NO.
FEF cHARGF Ij(\
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
SERVICES
INFORlIATION UNE
726-3753
Sq. Ftg. I'lain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Pep.
-Fence Demo Change/Use
Other- -
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Buildino Permit Iflfo: Describe Work(Le.,
Family nesidence With Attached Garaae)
Build Single
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f-J1Irr 11;Ja, i/iiJ,fJJy - (J/>I- 04--
(l~s. no.) fWlJires) (ohone
no. )
C:(~ r I
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(lies. no.)
(pxoirps)
(ohnnp M. l
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ELECTRICAL
MECHANICAL
~~~ r~~ NO
'll- .cHARliE.
SQ. F1.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~o~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
r~<:;jrtf>JlcP
multifamily, comm. or
tnrllJ';tri<'ll
Of amps.1
COMI.!. /IND. FEEDERS I
Install/alter/relocate I
rlie;trih fpprlpr'c:.
Appliance vent
<;pOilriltp
Stationary evap.
cooler
Vent fa'n with
"inn'~ rluct
Vent system apart from I'
heatino or A.C.
Mechanical exhaust
hood and rlurt
~later service
] Sewer
lstorm Sewer
---....
(;0
Of
Wood stove/heater
I
I
I
I
I
amps.
ISSUANCE OF PFRlIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,'l4 REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor 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 performed 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 rw OCCUPAr~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 ons 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.
SIGNATURE j.. ~~~E 12-/Jo/~}
FOr. b'rFICE USE OilLY
Sq. Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
IWIE(please print) /?<<,,j /,k
f...c)e.51aVe.V
Zone
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
Fire Zone
Flood Plain
Stories
BUILOING PERIIIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65X/Rldo Ppr Fpe
------------PTan Ck. Res
30%/Bldq Per Fee
'I Fence
------------1
D~mo
I'Sidewalk
------------1 A/C Paving
I Curb Cut
I (? /l 0.- -f/~
/'. - -
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I'
Value
Value
Value
TOTAL VALUATION
x
x
x
Systems Development
Char9. (1.5~)
t.Vxd..;:j t:DOe...-
j,"') _ 0 V
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I {\.:f' Y
1- j~" 00
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'_.c_~n
, ,\/,,,
F-
I
ITotal Comb. Permit
_7.C:
I
I TOTAL
1;-0.75'
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examp.le- 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
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exampJe- waterheater/electrlcal/or solar
E. Square rootage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, ete.
~. Building pennit information:
1. examj>le - construct single family house with an
attached gar.ge
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. OESIGN 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
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__si9':1 the electrit:al_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. .~
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V. FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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,
,
,
,
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'P~rmit applicant exempt from registr\tion with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date