HomeMy WebLinkAboutPermit Mechanical 1989-12-12
Job Address
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Description l'l() I~~:;)~' 0--~
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I INSPECTION LINE
726-3769
INFORlIATION LINE
726-3753
Sq". Ftg. '.Iain
~q. tg. Access.
Sq. Ft. Other
flew A Her Rep.
--Fence De ChangelUse
Owner 'r()~'\-(-l-l\TQ, \(~. kl()Ml~ ~alU' orr/~ Other-
Address ~\ "'f\.~ Phone BUlhl1nQ Perm\it Info: Oeser be Work(i.e.. Build Single
7\~ ~.l . \ '..Jl Fami1v,fl.eside~c~ Hi th Attached r.araae'
'\~ ,- L{r,)411K I ~()Jy
construction~et ) I IN:\ \\1'~\(,L"
~~~~~~';EAl1 (name' PhOt:ddressl '~'I") -(lies. no.l
CITY OF SPRINGFIELD
COMBINATION APPLICATIONIPERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
Ran!le
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Legal
{exniresl
(ohane no. j
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Primary
Structural
E1 ectrica 1
f~echanical
CONTRACTORS
(name)
(addr~ssl
(lies.no.\
(exoire$}
(ohnn~ no. \
General
Plumbino
Electrical ~ .
flechani~al \\~ Q \~'J:'f\
PLUrlBING CJ
4\Q~~ \\\(\~ f\~l~l ih\E\0l '1410--' JIdlL
ELECTRICAL MECHANICAL
..J!!h
FEF CH~RGF ND
FF ~ .cJJARlil .l!lL'
HI' rl~
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~rp he~~ vpnt
Storm Sewer
Of
amps.
Appliance vent
sena ra te
Stationary evap.
cooler
Vent fan with
sin!l'e duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
re~; <je.ncr
multifamily, COITTl1. or
Inrluc;.trial
~Ia ter servi ce
COMfI.IIND. FEEDERS
Install/alter/relocate
~i~tr;h. fpprlprc;.
Wood stove/heater
Of
amps.
I SSIIANCF OF PFRIIIT
TOTAL CHARGES
WIlEnE STATE L\\/ REOUIRES
shall not be vali1 until the
~ TOTAL CHARGES
that the Electrical work be done by an,'Electrical
label has 'been signed by an Electrical Surervisor
TOTAL CHARGES
Contractor, the electrical portion of this penmit
and returned to the Guilding Division
I HAVE CAREFULLY EXN11NED the completed aprlication 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 Ita OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my re!listration \'tith the Guilder's
Goard is in full force and effect as required by ons 701.055. that if exemp he asis for exemrtion is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 ~ used on this roject.
Zone
Fi re Zone
Flood Plain
Units
Occy Load
Occy Group
:;:;e~ SIGIlATURE
,
FOP. OrFlCE USE OllL Y
Sa. Ftg.
Sq. Ftg.
Sq. Ftg.
DATE /;:;'/;:21 l't''J
IlAI-IE(please print) 11l1rYEf' ,z::-/by,bl
x
Value
Value
Value
TypelCons t.
Bedrooms
Stories
rlo.in
Access
Other
x
x
TOTAL VALUATIOII
BUILDING PERHIT
Charges anC:
Surcharges
. Plan Ck. ConmlInd
____________....2.2l/Bldo P.p'r Fee
Plan Ck. Res
30t/Bldo Per Fee
Fence
'Systems Development I
Charae (t.5~)
PLUI~BING PERMIT
Charges and
Surcha rges
D~~o
'Sidewalk
AIC Pavin9
Total Comb. rermit
ELECTRICAL PERIHT
Cha rges and
Surcharges
TOTAL
j \~.~S
MECHANICAL PERMIT
Charges and
Surcharges
J~-,~___
. . ,\S
Curb Cut
1-
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. ~xamp]e- Lot I, Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceiling/or forced air Qas
2. exam"ple- waterheater/elect"lca liar ~
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
attached garage
2. example - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined ill Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAN 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, ~lechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the appl icant need fi ll-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 DN THE SCHEDULES
O. As lIoted on the CAP, the lobel must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.~ 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
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.
IQ-" ,& -6 q
\ 2540
V. FOR OFFICE USE DNLY
Cl"dlJ(V
Permi t
.
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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