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HomeMy WebLinkAboutPermit Mechanical 1987-2-25 ',INSPECTION LINE 1IIt CITY UF SPRINGFIELD 726-3769 COMBINATION APPLICATION/PERMIT Job Address .3 3c9.0 ~ ~~~~GY SOURCES: Legal Description /7-00J,- 3 I--=)/ _ 0lS-07J I~ater Heater J drU /J ~if .mf'~ Range Owner 10j!-"v?l~ i f'a-r p k Address VCi L/}?Cj Mr/ /liiJ.b/.rJ/r Phone?t( 1 ~.1J};!'/ 372& construction~e~. ~l UE of Work: 1fSO BuilGina Permit Info: Describe Work(i~e.. Build Single Familv ~esidence With Attached Garaae) ~~,..;) ((}o-dd~ d~ I2A:/A 1~;" '1;/.-1 ~ "- tf~ . Address UES J GN r EAf1 (name) Phone (address) Primary Structural Electrical Mechanical CONTRACTORS (name) (addrflss 1 General Plumbina Electrical alAt tUi./ ~'i1IQ~/ PLUMBING Gl ELECTRICAL ~'echanical NO. FFF [HARr,r Nn Each single fixture Residence of SQ. FT. Relocated building (new fix. additional) New circuits a1t5. or extensions S.F. Residence (1 bath) Duplex (1 bath) .each' .,1 Additional bath I Water service I Sewer I SERVICES I Temporary Construction IChange in existing rpc;;irtpnr"t1 Imu'i t ffami ly, corm\". -at.. Tnrlustria1 Storm Sewer Of amps.1 1 1.")...1 :;- I I I CDMM./IND. FEEDERS I Install/alter/relocate rlic::t.rin_ fj:>j:>rlj:>rc:: 10f amps.1 I I I {NFOR/lATlON LINt 726-37S3 Sq. Ftg. r'lain Sq. Ftg. Access. Sq. Ftg. Other New 'Add Alter Rep. -Fence Demo Change/Use Other- - . !lies. no.) (exnires) \'~ I ~ .)rO ~'~ ~ ,}e J - (ohone no. A --it-__ YAf y....... fohni'll"! nn. l o<r C"MliE. ('. - q)"} -f'.f()O 11 iC':~ no_ l (pvn;l"esl I I I / I I' I 1 I I I TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\l~ REQUIRES that the Electrical work be done by an.:E1ectrica1 Contractor, the electrical portion of this pemit shall not .be- valid -unti.l-t-he-l-abe.1-has-been signe-d by an Electrical Supervisor and returned to the Building Division - ./l " ",', I ~ FFF I CHARGJ NO MECHANICAL 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 NO OCCUPAfKY 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 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. F./e4'..P'.-/ 5IGIJATURE~' d&.uL Fd~orFICE USE ONLY So. Ftg. 11aio Sq. Ftg. Access Sq. Ftg. Other NAf.1E(please print) G/Oteld.. Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Dccy Load Occy Group BUILDING PERHIT Charges and Surcharges Plan Ck. ___,________ 65%1Bldo Plan Ck. 3D%lBldo I Fence I Domo I-S1dewalk 1 A/C Paving ) S . (J"l) 1 Curb Cut --------.&~-I Conm/lnd Ppr Fpp Res Per Fee PLUllBING PERMIT Charges and Surcha rges ELECTRICAL PERI\lT Cha rges and Surcharges MECHANICAL PERMIT Charges and "\ 1_ Surcharges J~ furnace/burner to BTU's Floor furnace and vent I 1 I I -I 1 I I I I 1 1 Recessed wall ~o~rj:> hp~tpl" ~nrl vpnt. Appliance vent c:pn~ratp Stationary evap. rnl)ler Vent fJ.n .~d,th-': sinole duct Vent system apart from he~tin~ or Ar I Mechanical exhaust hnod and dud 1 ~Jood stove/heat,:r I 1 1 ISSUANCE OF PERlllT ,v .. ..... ,x Value x Va 1 ue x Value TOTAL V ALUA TI O~I "" . -,.-' Systems. Development Charoe tl:5~) . I i ITotal Comb. Permit I I TOTAL DATE,2~.s;- -1'1 ---" .~?~t-~~.... !5.~O ;70/3'7 . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II U3 43 2. example- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources ~--~:-*- - . '--..- --.--..-- 1. example- heat/electrical ceilinqlor forced air qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check:ruew - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached gara.ge 2. example - 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. OESIGN TEAH ANO CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or jOb site h corrections, etc. . ~ '>-.r _ _ _ II. Abbreviated Prumbin~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 ANO CHARGES ON THE SCHEOULES ' - 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 -lWhenever possibles t~e initial applicati~n wil, 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ....-, ~- .--.- .....- --,:,..._..... - ,;9? B ~ 7?0 ro '1~J-~ -f1 Permi t Cl erk (.1~ .~ - --------_.-.. ---...----. -~_. Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date I