HomeMy WebLinkAboutPermit Mechanical 1988-1-14
, 9P ~,'N $0 ('.!.d. J.
CtTY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY ,jOURCES:
Heat /I:~
t~ater Heater
Range
.
INFOR/1ATION LINt
726-3753
Sq. Ftg, 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
II
00
~
a
C)
Build Single I ~
I~
,~
(ohone no.
~l
I INSPECTION LINE
726-3769
Job Address LJj 95 ffll1,'A'P-
Legal Oescription
.
Owner'
/
f,ee
fji/;~
Address
Phone
ValUE of,Hor~/tJ. ~
Bullc:iinQ Pennit Info: Describe Work(Le.,
Family ~es;dence With Attached Garaael
I' /;;t!;A11/
Construction lende/ ~ (/WifI/!4) ~,~
Address - 7Q (p - 77 & Phone /
U~SluN TlAH (name I (address)
I I
0ttuJ I- - UJ)
1/
. /
'rrM j,fla.l.II~
(l ics. no.)
(exo;res)
Primary
~.A
~
'f
t1l.((/5560
Structural
Electrical
Mechan;cal
CONTRACTORS (naD! I
General ~"-' .t.J.4-7"
,
(address)
(l ic!;;. no.)
(exo;rp~) (ohonp no.)
I~ '72.t 7#2..5"
107S'7 AI./I,
/9J2.. ,
Plumbina
, Electrical
~1echanical'
"t1
I
i'I.\lllll1l1G
ELECTRICAL
MECHANICAL
NO.
Each single fixture
I FEF I r:HARr,E Nn I I J:'n" I rJ..l.B.1lliE Nn ^ I
Residence of furnace/burner to
SQ, FT. I k~.OOd BTU's
I ~~L-I..c.HARG.E..
IRelocated building
(new fix. additional)
S.F, Resid...ce
(1 bath)
Ouplex (1 bath) each
IAdditional bath
I ~Jater service
I Sewer
I Storm Sewer'
I
I
I
I
I
I
New circuits a1ts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
l;;n~r~ h""~"'"",, ~nrf ".ont-
I
I
I
I
I
A\
tf4fIV
~I
I
I
Temporary Construction
Change ;n existing
res i d_ence
Imultifamily, COnJll. or
Industrial
10f amps,1
ICOMM,/INO, FEEOERS I
IInstall/alter/relocate I
rlic;tdn_ fpprlprc;
10f amp~1
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood anc1 nlJ('t
Wood stove/heater
ISSUANCf OF PFRlllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES / s: -.-
WHERE STATE L\lI REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
shall not be valiJ 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 oerformed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the State of Oregon pertai ni ng to the work descri bed here; n. and that un OCCUPAHCY wi 11 be made
of any structure -ntnout the permission of the Building Division. I further certify that my registration with the Builder1s
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 ORS 7nl.055 will be used on this project.
IW1E(please print) (}, ENE \--\ Ii '-I SIf,IIATURF /.L~f z..~h
r
OATE/ --/~-8-d-'
FO~ OfFICE
USE OIIL Y
Sq. Ftg. Ilain
Sq. Ftc). Access
Sq. Ft9. Other
x
x
Value
Value
Value
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
OCC,Y Group
x
TOTAL VALUATION
BUILOING PERmT
Charges ant::
Surcharges
Plan Ck. Comm/Ind
____________~/Bldo PJ.r Fee
Plan Ck, Res
30%/Blda Per Fee
I Fence
I D~mo
I'Sidewalk
I A/e Paving
I Curb Cut
I
Systems Development
Charqe (1.5~)
PLUt1BING PERMIT
Charges and
Surcharges
I
I
ELECTRICAL PERliIT
Cha rges and
Surcharges
ITotal Comb. Permit
IIECHANICAL PERMIT
Charges and
Surcharges ~
___(1i:.~___
, 7::;-
I
I TOTAL
IS:?S .I
,.
.
.
" ,
'"
.~.:. -'A'\\\'\ \'.\' \~
PERMIT VALIDATION
COMBINATION APPLICATION/PERMIT (CAP)
III.
t. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane'County Map Reference,
II oj 43
2. examEle- '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. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I, example- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
a ttached garage
2. exam~le - remodel existing garage into famil~ room
3. examOle - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
\,' " Structur:al Spe~ia..lty, Code ~ ~,....... ~ \ ... ~
H.' OESIGN TEAM'ANO' 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 avai~able at~the Building Division
i. 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
fu 11 schedu 1 es
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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~si9n the electrical label. -
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
CC/
PROJECT CONDITIONS TO BE SATISFIED BEFO~E OCCUPANCY:
"
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
,
.
PLANS REVIEWED BY:
name
signature
date
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