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HomeMy WebLinkAboutPermit Mechanical 1984-1-13 . .. 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 I I I I I I I 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 I 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 I I I INFDRlIATIDN UNt 726-3753 Sq. Ftg. I.!ain Sq. Ftg. Access. Sq. Ftg. Other flew Add Alter Rep. --Fence Demo Change/Use Other- - ~ ,~ 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 I I I I I I I I lIS. 00 I I I 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 ---!_':?~-~-- . 00 ~~_D~TE I ;;3if~ V V x Value x Value x Value TOTAL VALUATlOII Systems Development Charoe (1.5%) '. I I jTotal Comb. Permit I I TOTAL .. /5'.(00 . . 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. \ -/\3--81- lo t~~l v- .I, 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