HomeMy WebLinkAboutPermit Mechanical 1985-10-22
I IrISPECTJON LINE
. 726-3769
Job Address .If 3' 0 /
Legal Oescription n (")2
.
50LoJ~_q
CITY OF SPRINGFIELO
COMB illATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Ranqe
/k~
32 ~I 6 '3'10 0
Owner <-rY7 tl-(C,L
Address t7
fir/A~'p/~J
ValUE of l'lork:
~
INFORllATJON L1N"
726-3753
SQ. Ftg, 1.lain
~q. Ftg. Access.
SQ. Ft9. Other
flew Add Alter Pep.
-Fence Oemo Change/Use
Other - -
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11 UJ. )
Buildina Permit Info: Describe Work(i.e'1 Build Single
Familv Residence With Attached Garaoe)
Ih~~~h /-Lf~
Phone
Construction lender
Address
. U"~luN I"AI1
Phone
(address)
(name)
(lies. no.1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
tnamel
(addrpss)
nire;;, no.'
General
Plumbincl
Electrical
&.b?tJe/C ~k tz.6~ M~ /
l ~CTRICAL r
FFF rHI\Rr.F p..,rn ~n. 1.....c.HARG.E. ~In
~1echanical
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/PLUllBING
-1!Q..,.
Each single fixture
Residence of
SQ. FT.
,
IRelocated building
(new fix. additional)
Is.F. Residence
(l bathl
louplex (1 bath) each
IAdditional bath
I~Jater service
I Sewer
Istorm Sewer
I
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I
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i
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amps.1
New circuits alts.
or extensions
ISERVICES
I
ITemporary Construction
IChange in existing
rp~ i ctpnrp
Imultifamily, camm. or
Tnrlu<;.trial
IOf
ICOMfI./IND. FEEDERS
IInstall/alter/relocate I
rli<;.trih_ f,:l,:lrl,:lr<;.
IOf amp~1
I
Zone
Tvpe/Cons t.
Units
riain
Access
Other
Fire Zone
Flood Plain
Bedrooms
Occy load
Occy Group
Stories
BUILDING PER~IIT
Charges an~
Surcharges
Plan Ck.
____________ 65%1Bldo
Plan Ck.
30%/Bldo
I Fence
------------, D~R1o
I Sidewalk
I A/C Paving
--L~~-S8?---1 Curb Cut
CO","/Ind
Ppr Fpp
Res -
Per Fee
fexoiresl (ohane no.
\~
~
VI
(pxoirpc;)
MECHANICAL
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~narp hp~tpr ~nrl v,:Int
Appliance vent
sana rate
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatino ar A.C
I Mechanical exhaust
hood and durt
j Hood stove/heater
rr,r; J\ O:'f>A:""""
II-L-/'D~
I ~7"
ISSUANCF OF PFRIlIT
x
Value
Value
Value
I
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I
I
I
I
I
TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES.
. WHERE STATE L,\ll REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED 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 Springfield and the Laws of the State of Ore~on oertaining to the work described herein, and that I/O OCCUPAIICY 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 701,05~ill be used on this project.
llAl-lE(please print) ..JIN BJ:Jhroc k SIGIlATUREYA'~~~ OATEJO~~:-
Foh OrFICE USF/iiilLY
v.,
So. Ftg.
SQ. Ft9.
SQ. Ftg.
x
x
TOTAL YALUATIOtI
Systems Development
Charqe (1.5~) .
PLurlBING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Charges and
Surcharges
'\MECMANICAL PERMIT
Charges and
,urcharges
\
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(ohnnp nn \
I~H Irl-l~
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101M>
I~
lo.?'D
thi s permit
ITotal Comb. Permit
iTOTAL ! /0 40
,
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100. Lane County Map Reference
II o'j 43
Z. examole- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1. examp.le- 1250 sq. foot house. 500 sq. foot garage
Z. example- if new project. check new - if addition,
ehee k. add, etc.
F. .Building permit information:
1. example - construct single family house with an
attached garage
2. examole - 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 (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 Pl~mbin9, 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 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 sign the electrical 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
5 i gna 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
II
PERMIT VALIDATION
.
.
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<f,.tc;f I " P
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
.
I
;.
date