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)
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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)
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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
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1 I
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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
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~
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