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Home My WebLink AboutPermit Mechanical 1986-5-19 'INSPECTION LINE 726-3769 . .':.,.. .:-..------.-- ,..._.._..~~~ ---""'-'-~'- ".-'-'--'". ".'-~ . -~", ." .. '" . Job Address 33~o rY\.~ CITY Uf SPRINGFIELD COHBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat [later Heater Ranoe ValuE of Hark: InFOR/lATlON LINl 726-3753 So. Ftg. Hain ~o. Ftg. .Access. So. Ftg. Other New Add Alter Pep. -Fence Demo Change/Use Other - - I o<;J o 10 I~ l\J\ I I no. \ I I ~ I I ,. Legal Descript10n Owner (~ ~tJ~eI AddresstJ -;r.f;;;itJ() Ii1l1wlL Address Ul~IGN TEAH (name) Phone (address) BuiltiinQ Penmit Info: Describe Workli.e.. Build Single Fa~;;:;;:d G?l 7L4/ !r~ Phone 111 3 7 ;;)h Construction lender flies. no.l (exniresl ( Ohone Primary it.. db' vM -'J?' ...:~ Structural Electrical Hechanical CONTRACTORS ( name) , address) '(lies. no.l (pxnirp,,) (Ill<lnl"lp nn General Plumbina Electrical Hechani~al ,I..--r ~.~,1 9t-vn.QA.) . PLurlB I NG ELECTRICAL HECHANICAL NO. Each single f1xture I FFF I rHI'JBliL -1Jn I I tEL.,I.cJlAIllif. NO I Res i dence of furnace/burner to SQ. FT. BTU's 'CELl Relocated build1ng . (new f1x. addit1onal) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp hp~tpr ~n~ VP"t Storm Sewer Of CO~1./IND. FEEDERS Ilnstall/alter/relocate ~i~trih fpp~pr~ fOf amps.1 -I I I amps.1 Appliance vent I ~o!lratp Stationary evap. I cool@r Vent fan with I sinC'lh. rlur.t - Vent system apart from I-I heatinCl or A.C. I Mechanical exhaust I tlnnrl and r1IJrt I Wood stov~/heater I I -~~WII Lff<> I (S.oo Water service Temporary Construction Change in existing rP<ijetrflrp multifamily. comm. or __'nrlll~tri"l Sewer -, I I TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be va111 until the TOTAL CHARGES ISSUANCf OF PFRIHT TOTAL CHARGES 1.&0 (S.&JfJ that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this pemit 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 performed shall be. done in accordan~e with the Ordinances of the City of Spr1ngfield and the Laws of the State of Oregon pertaining to the work descr1bed herein, and that NO OCCUPAWCY w111 be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderls 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 ORS 701.055 will be used on this project. IlAllE(~lease print)..JhdA E:S S; IMP I L/ I\l.s;. SIr.IlATURL.L4 . #,~ !:/ "ATF ...s --;"~:$'< ^ , . . FOP. OFFICE ~It' mill ;--:'J ,) . Units .!.Io. Ftg. 1181n x Occy Load So. Ftg. Access x Occy Group So. Ftg. Other x Zone Fire Zone Tvpe/Const. Bedrooms 5tor1es Value Value Value Flood Plain TOTAL VALUATION BUILDING PERlHT Charges and Surcharges Plan Ck.. Co,,"/Ind ____________ 65%{RldCl Pj'r F'jlop Plan Ck. Res 30%/Blda Per Fee Fence Syste~s Development Charoe t!.5%1 . PLUMBING PERMIT Charges and Surcharges Detao I Sidewalk ------------1 AlC Paving .( S. 0,.0 I Curb Cut. -------~~:O--I , . ELECTRICAL PER/HT Charges and Surcharges HECHANICAL PERHIT Charges and Surcharges ITotal Comb.. Permit i TOTAL {(;. Ct,O". . c . ., . .' .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference II UJ 43 2. example- Lot I. Block 3. 2nd Addition to sprfngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources , ' 1. example- heat/electrical ceilinq/or forced air Qas 2. exa~le- waterheater/electrlcallor solar E. Square footage or valuation. etc. ------ j I. exam~le- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new.- if addition. check add. etc. . F. Building pennit infonnation: , 1. example - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - 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. 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. 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. --- III. Applicant to sign and date Whenever possible, the initial application will b~ 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: , . - ' PERMIT VALIDATION , . -j ,.. ~J.1)\ ;~ b ~ (0' \o.J S/ .. .. Pennit Clerk QG Pennit applicant exempt from registration with the Builder's Board because: Additional. Project Infonnation: PLANS REVIEWED BY: / name / signature ". date 10 ......,p....~ ..f"';...co'. 'lC--~..,;.~-~~.'li,:.