HomeMy WebLinkAboutPermit Mechanical 1987-7-27
1 INSPECTION LINE
726-3769
Job Address
legal Description
'-13 Go
1IIIt CITY Of SPRINGfiELD
COMBIIIATION APPLICATION/PERMIT
EilERr,y SOURCES,
Heat
l'later Heater
Range
m a.iAJ
-/A.I@/lL- ,,/_ ,._ 1
Owner Ii Jf;ih ~ Itf'/,Lot/)/'7U
Address '-/3 ro () fill rt<Av
Construction lender
Address
Ut,IGN ftNI
Primary
Structural
Electrical
l1echanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~lechan; ca 1
110.
Each single fixture
Va~uy of Hark:
'7 "8c::::>C>. c>J?:.
Buiitiina Permit Info: Describe Work(i~e," Build Single
Familv nesidence I-lith Attached Garaae)
Wz,ofdi!t.dJ/ hbl1 ;:J.tI~.bl Aj-
1~/tJf'J1b1/117 ~ / 1"
Phone
(name)
Phone
(address)
f1 ics. no.)
~
f
.
INfORlIATION LINt
726-3753
Sq. Ftg, /.Iain
~q. Ftg. Access.
So. Ftg. Other
Ilew Add A lter ~ep,
-Fence Demo Change/Use
-Other- -
00
-......)
o
IkJ
Iw
I
I
(exn; res)
(ahane no.l
c, 9;:><6, ')~Dc)
lJ, 117'6
(name)
(addrf>ss)
(lies. no. \
M,~~
)J()/U))1tL,fNLffLM..;)
PLOIIBING / .
FEE CHARGE Nn
~o -f'c;C
1jz..7c:::,/-/(J()
ELECTRICAL
~~L...c.J:iARG.E. NO
Residence of
SQ. FT.
Relocated building
(new fix. additional)
~ New circu~ts alts.
or extenslons
IL/,I!f<;,-<</7'.
SERVICES
IS-
S.F. Residence
(I bath)
Duplex (I bath) each
Additional bath
~!a ter servi ce
Sewer
Storm Sewer
Temporary Construction
Change in existing
re<;jnj',nce
multifamily, comm. or
IndlJc;.trial
Of
amps.1
CO~1./IND, FEEDERS
Install/alter/relocate
nic;.t.rih_ fppnprc:
I
I
I
I
I
I I
/,5"": _t:>
IOf
I
I
I
amps.
uti
;'1
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the BUilding Division
(pxoirp~l
(ohnnp no. )
(;,-3 ()-f1
/2-1-9'J
C(f5-,ff~
;3 r;r;~f~1
MECHANICAL
1=1='1=' n
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa 11
~OArp hp~tp~ ~nrl ~pnt
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
~inole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hnod and dul'" t.
I Hood stove/heater
~ /P1J7?9'L L .(~w- i
I ~r- p,,->/>';>~
(.r,.... I
ISSUANCF OF PFRtllT
TOTAL CHARGES
/s:~-
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 Derfonmed 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 tlO OCCUPAtlCY will be made
of any structure without the permission of the Building Division. I further certify that my registratlon with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exem~the'baSi~r exemption is noted hereon, and that
only subcontractors and employees who are in comDliance with OP.S 7nl.055 W\'J be used n this project.
tlAI.IE(please print) U/ U.sc/IA/lIP5 SIGlIATURE JA-t1 f '...#'l.,,~,v/t... DATE 7-;17"07
FO~ OFF I CE USE OiIL Y /I
Zone
Fi re Zone
Flood Plain
BUILDING PER~IIT
Charges and
Surcharges
PLUt1BING PERMIT
Char..ges and
Surcharges
ELECTRICAL PERI~IT
Charges and \1
Surcharges '1
I1ECHANICAL PERMIT
Charges and
Surcharges \p
Sq. Ftg. f1ain x Value
Sq. Ft!]. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION
Shstems Development
C aroe (L5~)
TYDe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Plan Ck, Comm/Ind
____________~/Bldo Ppr Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
D~mo
, 15~ --=
- --- - -.=-"7S=
15: --=
----------;:=-
. ?5
Sidewalk
A/C Paving
Curb Cut
Irotal Comb. Permit
I
I TOTAL
?/Sb
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. legal Description '. '> .
1. example. Tax lot 100, lane County Map Reference
11 03 43
2. example- lot 1. Block 3, 2nd Addition to
~prlngt;eld Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electr;cal/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
attached garage
2. examyle - 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.
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
signature.
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.
FOR OFFICE USE ONLY, "
II.
I I I.
IV,
V,
PROJECT CONDITIONS TO BE SATI~FIED.BEFORE OCCUPANCY:
.'
..
..
PERMIT VALIDATION
6bt6f3 '
1/;2 7//1
\
Permit Clerk
{f/
II
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date
~ . .