HomeMy WebLinkAboutPermit Mechanical 1987-2-23
'I INSPECTION LINE
726-3769
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.
Job Address
CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
D56f)f() Hater Heater
Range
ValuE of Work:~c)
INFORl1ATION UNl
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
Other- -
Builtiina Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaae)
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lohone no. l
Legal
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Description / Ii b :23 /, ~ I
Owner.
YA1/! ~A /J I d ,'dvu j
.-?;;Lns- m~
Phone 717
IJff) 7
Address
Construction lender.
Address
DESIGN TEAI1
Phone
(address)
(name)
flies. no.)
(exoiresl
Primary
Structural
j)c.(
~f
Electrical
Mechanical
CONTRACTDRS
(name)
(address)
nice;.. no.)
(f!xoirpc;,)
Genera 1
" Lint)
Plumbina
G"'" &)..).~.
Electrical
A / j A" I
/If/Aide... / {/}ulUJfli?{
PLUI,IBING r
MECHANICAL
~1echan;cal
v
ELECTRICAL
--1!Q."
FFF r.HARGE Nn <<L J:IJARliE. NO
Residence of furnace/burner to
SQ. FT. BTU' 5
Each single fixture
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
IDuPlex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Appliance vent
seOijri'ltp
Stati onary evap..
cooler
V"ent fan with
sinlllp rlllrt
Vent system apart from
heatinCl or A.C.
Mechanical exhaust
hnnrl ~nt1 r:lurt.
Temporary Construction
Change in existing
rpsi~p':nrp'
Imultifamily, corrm. or
Tnrlll<:.t.rial
IOf amps.1
ICO~1./IND. FEEDERS
I Install/alter/relocate
rli<:.trih^ fppdpr<:.
IOf amp,,1
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I
ISSUANcr OF PFRrllT
~Ia ter servi ce
Sewer
,\ Storm Sewer
Wood stove/heater
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TDTAL CHARGES TOTAL CHARGES TOTAL CHARGES Ic~ & f)
WHERE STATE L,'\~ REQUIRES',that the Electrical work be done by an,'Electrical Contractor, the electrical portion 'of this pemit
shall not be vali~ until the'label has been signed by an Electrical Supervisor and returned to the Building Division
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 oerformed 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 OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with t ilder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted re ,and that
only subcontractors and employees who are in compliance with ORS 701.055 will~be US:d on ~hiS ~.
NAf.fE(please print) WIW?}iVI Sl-Icf<IDP.(\) SIGIl^TUREV~~,
'FOP. OYFICE USE DIlLY
Sq. Ftg. 11ain
Sq. FtO. Access
Sq. Ft9. Other
~ATEh~ 7! 55f
Value
Value
Value
Zone
Fire Zone
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERitlT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Rldo Ppr Fpe
------------ Plan Ck. Res
30%/BldQ Per Fee
I Fence
I D~R10
I'S1dewal k
I A/C Paving
N 15. 00 I Curb Cut
--------~o-I
Systems Development
CharQe (1.5~) "
PLW1B ING PERMIT
Charges and
Surcharges
I
I
ELECTRICAL PERI~IT
Cha rges and
SurCharges
ITotal Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
1S.~o
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
~
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot lOa, Lane County Map Reference
II 03 ..3
2. exam~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates -
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. example- waterheaterjelectrical/or solar
E. Square footage or valuation, etc. -----
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
thee k add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
2. examole - remodel existing garage into family room
3. exam~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 jab 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 appropr4ate 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 1 es
C. BUILDING DIVISIDN STAFF WILL FILL OUT ALL FEES AND
CHARGES DN 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. ---
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.
7 !o 1YY! 1
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V. FOR OFFICE USE ONLY
Permit Clerk
~
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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