HomeMy WebLinkAboutPermit Mechanical 1984-2-13
I IrISPECTlON LINE
726-3769
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CITY OF SPRINGFIELD INFORlIATlON liNe
COMBINATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq. Ftq. '.Iain
Heat ~q. Ftg. Access.
Nater Heater Sq. Ftq. Other
New Add Alter Pep.
Range -Fence Demo Change/Use
. l)'trlUE o~~~. Other- -
~~ BuilGino Permit Info: Describe Work(;.,e., Build Single
e Familv nesidence With Attached Garaoe)
f)4l\..ldJlo'l, ~~'f\'i\t\ t\or ~
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Job Address 4-9_ \~ "^C\ \ - r'\ d ~
Legal OescriPtion~""h1~? r!Jb \ LitO
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ownerU~ 0 i'0..n. u.\Ou\
Address
'f!: Qcr\ ~ ~fl f> - ,!i\0
Construction Lender
Address
Ue' HiN I eM
Primary
Structural
Electrical
Meehani ca 1
CONTRACTORS
Genera 1
Plumbino
{name)
Phone
(address)
(lies.no.l
I
(exoi res) (ahone no .'1
4,
i~
(name)
(address)
(1 in. no.l
(~xDirpsl (nhonp no. )
~~ ~ t't .i V' tIt-.
f\U~
MECHANICAL !
~r:r: 1....cHARG.E.
ELECTRICAL
NO, FEE CHARr,F Nn
Each single fixture
r:r:L...c..I:iAR.GE. NO
Residence of
furnace/burner to
BTU's
SQ. FT.
INew circu~ts alts.
or extenSl0ns
ISERVICES
I
!TempOrary Construction
'Change in existing
rp~j~en~p' .
Imultifamily, camm. or
Induc:tri..l
IOf amps.1
ICO~1./IND. FEEDERS I
IInstall/alter/relocate I
rti<:.trih. f,:.pnpr<;
IOf amp~1
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Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional' bath
~Iater service
Sewer
Storm Sewer
Floor furnace
and vent
Recessed wall
~o...rp hp<ltpr <Inri vpnt
Appliance vent
_c:poilr...~,p
Stationary evap.
conl~r
I Vent fan with
, sinple dVet
I Vent system apart
hp.~tino or A.C.
I Mechanical exhaust
hood and rlurt
l I Wood stove/heater
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ISSUANCE OF PFRrm (S .aul
15.CXJ
from
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
pernit
I HAVE CAREFULLY EXM1INED 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 Spri ng fi e 1 d and the laws of the S ta te of Oregon perta i ni n9 to the work descri bed herei n. and that NO OCCUPAUCY 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 ORS 701.055 will be used on this project.
IIAHE(please print) 5!e.4111!711
Zone
Fi re Zone
Flood Pia i n
BUILDING PERflIT
Charges and
Surcharges
PLUt1BING PERMIT
Charges and
Surcharges
ELECTR I CAL PERlm
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
,
R:e,,/ A'.h/ldsIGUATURE ~L /" /~ (,
/ / FOr. OFFICE USE 0I1LY v V'
Sq. Ftg. !iain
Sq. Ftg. Access
Sq, Ftg. Other
DATE
-i.-fr:0~ ·
I j
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
,
TOTAL VALUATION
Plan Ck. Comm/Ind
65%/Rldo Ppr Fpp
------------ Plan Ck. Res -
30%/Bldo Per Fee
Fence
Systems Development
Charoe (I.5~)
Demo
Sidewalk
------------
I A/C Paving
_-LSJX)__-' Curb C~t
., rt', I
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Total Comb. Permit
TOTAL
ICO.W
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. exam~le- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinqfor forced air qas
2. examole- waterneater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project, check-nfw - if addition.
check add, etc.
F. Building permit information:
1. examele - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. example - conve~~ single family resjdence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) 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 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. 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. ---
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
signa ture.
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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Ill.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
c9. ,.- \3-64-
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Permi t Cl erk~.U::l~...-/
Permit appl icant exempt fromregi strati on with the Buil der I s Board because-:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date