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Home My WebLink AboutPermit Mechanical 1989-12-21 Job Address ~ CITY Uf SPK1NufIE~D COMBINATION APPLICATION/PERMIT " EIIERGY SOURCES: Heat ,(,; ,d Hater Heater---F5"/,,,T. Range N~_ ValuE of Nark: . legal Description INFORllATlON lINO 726-3753 Sq. Ftg. '.Iain ~q. Ftg. Access. Sq. Ftg. Other flew Add A Her Rep, -Fence Demo Change/Use _. Other- - " Owner&A f T /;q.fe /(0,," Pd (<; k...,,, '.i /.(h\<-"f" I BufldinQ Pernlit Info: Describe Work(l.e.. Family nesidence l'Iith Attached GaraQe\ Address Phone j~M /q/J [. i..., 'u. f Construction Lender Address DES I GN TEAI~ Phone (address' (lies. no.' (name} Primary ~ ~ V Structural Electrical Mechanical CONTRACTORS (name\ (address \ (1;C$, no.' Genera 1 Plumbino Electrical /; (/.J EI"j'f<-Tld- -::J/40t:.._T.....~'.6/ n/I/) ::1,,-/'11_ ~1echanical P~UIIBING E~ECTRICAL FFf nMRhF ..!ill....-- <<> fl-lllQht= NO Residence of SQ. FT. New circuits alts. ?5- / or extensions gtt-- .:.-- . SERVICES NO. . Each single fixture Relocated building (new fix. additional) S.F. Residence 11 bath\ Duplex (1 bath) each Additional bath Temporary Construction Change in existing res,i Q~J1ce multifamily, comm. or Inrluc;trial Water service Sewer Storm Sewer Of COM/.1. fI NO. FEEDERS Install/alter/relocate rli..trih. fppdprs amps. Of amps. Build Single c.~ C1~j;ollH.' ;! a.r (exoiresl - ~ (ohone no.~"\. (exoiresl (Dhone no.) /1J-/-'1t7 3~<P~3t. MECHANICAL furnace/burner to BTU's ~~r I CHARr.F Floor furnace and vent Recessed wall ~o~rp hp~tpr ~n~ vpnt Appliance vent SPOil. ra te Stationary evap. cooler Vent fan wi th sin9le duct Vent system apart from heatinq or A.C. Mechanical exhaust hnnd and duct Wood stove/heater TOTAL CHARGES WHERE STATE UI~ REQUI RES shall not be vali~ until the ISSUANCF OF PFRllIT TOTAL CHARGES If' 3-tTOTAL CHARGES that tile Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXM1INED the completed aprlication for permit. and do hereby certify that all information hereon 1s true and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Ore!]on pertaining to the work described herein, and that NO OCCUPAIKY 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. ~JI5i~ tJ.W:.:cic; ---rr M IW1E(please print) Vw1IklLJjta,;/ SIGrlATURE t"~_-:/LQ~ FOr. OrFICE USE O;ltY /' Sq. Ftg. t1ain Sq. Ftg. Access Sq. Ftg. Other Zone Fire Zone Tvpe/Const. Bedrooms Units Occy Load 'Dccy arour Flood Plain Stories BUI~OING PERflIT Charges an~ Surcharges Plan Ck. Comm/Ind 65%/Blda Ppr Fpp ------------ Plan Ck. R'es 30t/BldQ Per Fee Fence P~Uf~B ING PERMIT Charges and Su~charges ELECTRICAL PERJm Cha rges and Surcharges Demo _L6..:.?_c:.____ S1dewalk ,1.') AlC Paving MECHANICAL PERMIT Charges and Surcharl)es Curb Cut DATE / )~/~q ;~ , Value Value Value' . x x TOTA~ VA~UATlOtl syste.ms Development CharQ' tl. 5% " Total Comb. rermit TOTA~ IS-IS .. ~ . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map 11eference 1/ 03 4'3 2. examele- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. . .' 1. example- 1250 sq. foot house, SOD sq. foot garage 2. example- if new project, check new - if addition, check add. etc. F.' Building permit information: 1. example - construct single family house with an attached garage 2. examele - remodel existing garage into family room 3. exa~le - 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 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 fanm 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. --- Ill. 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 ather fees and charges are due and payable when the permit is issued. ~ \')113 b V. FOR OFFICE USE ONLY Permit Cl erk ~1\A1 I PROJECT CONDITIONS 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