HomeMy WebLinkAboutPermit Mechanical 1989-11-29
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Legal Description /-7- 02. ..- ~ '2- ~
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INFOR/1ATION LINE "
726-3753
Sq. Ftg, r"ain
~q. Ftg, Access,
Sq, Ftg. Other
New Add Alter P.ep,
--Fence Demo Change/Use
Other - -
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Job Address
1-/360
CITY Of SPRINGfJELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Meat
'3 I -j:('J.;&)D liater Ileater
Range
ValuE of Hork:
"71/~~oq'3 ~
rho~~ BuildinQ Permit Info: Describe Work{i-.e..
Familv nesidence With Attached Gara~e'
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I INSPECTION LINE
726-3169
Build Single
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Construction Lender
(fILL tm'"
Address
OESIGN rEAl1
(name)
Phone
(address 1
(lies. no. \
(exni res)
(ahOM no.
Primary
Structural
:
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(exoires\ (ohonr no. 1
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Electrical
Mechanical
CONTRACTORS
(name I
1t1f6's
(addressl (lies. no.'
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Genera 1
Plumbinq
Electrical
~1echanical
PLUIIBING
ELECTRICAL
MECIlANICAL
NO.
FEE CIl~JI(l
cr L .CIJARliE ...!!lL
er.r nl~
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
I Floor furnace
and vent
S.F, Residence
(j bath]
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~rp h~~tpr and vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sin~le duct
Vent system apart from
heatinq or A.C.
MeChanical exhaust
hoorl and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rfls.i de..ncf!.
multifamily, comm. or
Industrial
~Ia ter servi ce
CO~1,IINO, FEEDERS
Install/alter/relocate
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ISSUANCF OF PFRlIIT 0
, TOTAL CIlARGES m \ :1'\ \'S .oU
Electrical Contractor. the electrical' portion of this permit
Supervisor and returned to the Building Division
Of
amps.
TOTAL CIlARGES ~ TOTAL CIlARGES
, WIlERE STATE l,\li REQUIRES that the Electrical work be done by an,
shall not be vali1 until the label has been signed by an Electrical
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 Derformed 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 110 OCCUPAIlCY 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 701,055 '~hiS ~roject~.
NAf.lE(please print) C,n....\D,,~"""^'__ SIGrlATURE__~_-._ -" / DATE//-?9..,f!
FOP. OFFICE USE OIIL Y c i
Sq. Ftg. l1ain x
Sq. Ftl). Access x
Sq. Ftg, Other ,
Zone
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Value
Value
Value
Fire Zone
Flood Plain
TOTAL VALUATlOrl
BUILDING PERflIT . Plan Ck. Conm/lnd
Charges and __ __________ m/Bldo P.er Fee
Surcharges Plan Ck, Res
30l:/Bldo Per Fee
PLUI~BING PERMIT Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PERInI 'Sidewalk
Charges and ------------
Surcharges AIC Pavi ng
*, MECIlANJCAL PERMIT \~,UU Curb Cut
Charges and
Surcharges _nnt'7-1S---
.Systems Development '
CharQe (l,5~) ,
Total r.omb. Permit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A, Job Address
B. legal Description
1. examel~- Tax Lot 100. lane County Map Reference
17 OJ 43
2, example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources . oJ
1. example- heat/electrical ceilinQ/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq, foot house, 500 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
a ttached garage
2. examele - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G, . Value of work as defined in Section 303 (aj of the
Structural Specially 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 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, BUILOING OIVJSION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
0, 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
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
~ame
signature
.
date