HomeMy WebLinkAboutPermit Mechanical 1984-1-13
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INSPECTION LINE
726-3769
CITY OF SPRINGFIELO
COMBIIIATION APPLICATION/PERMIT
EiIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork: 6"
:5-C:;>,-;--
Buildina Permit Info: Describe Work(i.e.,
Familv Residence With Attached Garaae)
hA':RC7 a-' 5
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TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
. WHERE STATE L.'l~ REQUIRES that tile Electrical work be done by an--Electrical Contractor,the electrical portion 'of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Job Address 3tJtJ,l /Yl/l/A.J! 5fPrt./L
Legal Description 11 0?--::?I~1')1
Owner
J OYt,l-\ }J {9 Ql1- k ~ vf
'3rJt9 J.... MAL-d _
Phone
??~. "::-Y"""""
Address
Construction Lender
SeL.-F
Addr~ss
Ut~ I {ifl TEAr.,
Phone
(address)
(name)
(1 ics. no.l
Primary
Structural
5'Y"..., 1/ "" -
1./ .?ocxI
Electrical
Hechanical
CUN-'kAClliHS
{name)
(addre<:<:; )
(1;c~^ nn.)
Genera 1
Plumbina
Electrical
~lechan;cal
~
PLUllBHIG
ITLJJ:IiARliE.! NO
ELECTRICAL
NO.
FEE CHAOr,E.JJO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
ISERVICES
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ITemporary Construction
IChange in existing
rpc;.idp.n('p. .
Imultifamily, camm. or
Indll<:t.ri..l
S.F. Residence
(] bath)
IDuPlex (1 bath)
IAdditional bath
~Jater serv; ce
each
Sewer
Storm Sewer
Of
amps.
COMI-1. /IND. FEEDERS
I Install/alter/relocate
. rli<:tl"ih. fppflprc:
IOf amp~1
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INFDRlIATIDN UNt
726-3753
Sq. Ftg. I.!ain
Sq. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other- -
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I~
\J
Build Single
tUo..-I
~.Ae.
(exoire<~.~ ". (ohone no.')
-~
(pxnirpc;. )
(ohnnp nn.)
MECHANICAL
~~L -.C.HARGL
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~rp np~tpr ~nrl vpnt
Appl iance vent
SPOrl rA. tl'>
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood rlnd duct
I ~'Jood stove/heater
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ISSUANCE OF PFRillT
I HAVE CAREFULLY EXM1INEO 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 rw 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 7Ql.055' e used on this project.
HAI-IE(pl.ase print)
~o~~ DOlL-\k-e.w
SIGHATUR.
"-O~ OFFICE USE OIIL Y
Sq. Ftg.
Sq. Ft9.
Sq. Ftg.
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
t1ain
Access
Other
BUILDING PERfllT
Charges an':
Surcharges
Plan Ck. Comm/Ind
6S%/Rlrln Ppr FI'>f>
Plan Ck. R-es
30%/Bldo Per Fee
I Fence
I Demo
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICP.L PERIHI
Charges and
Surcharges
'Sidewalk
A/e Paving
I Curb Cut
I
IIECHANICAL PERMIT
Charges and
Surcharges
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. 00
~~_D~TE I ;;3if~
V V
x Value
x Value
x Value
TOTAL VALUATlOII
Systems Development
Charoe (1.5%) '.
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jTotal Comb. Permit
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I TOTAL
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/5'.(00
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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
11 oj 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilin%r forced air Qas
2. examp1e- waterheater/electricaf';or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example. if new project. check-new - if addition,
check add, etc.
F. Building pemit information:
1. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examDle - convert single family residence into
restaurant (change of use) .
G. Value of work as defined in Section 303 (al 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 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
fu 11 schedu I es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CMARGES 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
~ 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.
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V. FOR OFFICE USE ONLY
Permit clerk~rJl!fJ.._~
~
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