HomeMy WebLinkAboutPermit Mechanical 1986-9-30
iINSPECTION LINE
726,3769
,_.
CITY OF SPRINGFIELD
C0I1BIIIATlON APPLICATlONfPERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Ranqe
ValuE of I-/ork:
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INFORllATlDN LINE
726,3753
Sq. Ftq, 1,1aln
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Pep.
--Fence Demo Change/Use
Other - -
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6'
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Job Address
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Legal De!i.cription
Owner '\.,.;..,t..AI\AJL.L. \0 0 .A:.u. L~
Address ~ e (') tV I ;) 5 I'rl
Phone 1Zfo
Builciinq Permit Info: Describe Work(Le., Build Single
Family nesidence I~; th /I.ttached Garaoe)
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Construction Lender
^ddress
DESIGN lEN'
(name)
Phone
(address)
tlies. no.)
(exn; res)
.
(ahone no.
Primary
~ A
.~
'~
Structural
Electrical
l1echanical
CONTRACTORS
(name)
(address)
(lir<:;, nn.)
(pxniresl
(oh(lnp f"I(l \
General
Plumbina
Electrical
f.lechanical
9cl.}. th
PJl~' 11 )
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PLUIIBING
ELECTRICAL
MEeHAN I CAL
NO,
FFF I rHARriF: Nn
I ~~r I rl-Hl.IH~r NO I
I I="n I rlllUU:r.
Each single fixture
Residence of
sq, FT.
furnace/burner to
BTU's
Relocated building
(new fix. addit1onal)
S.F. Residence
(1 bath)
Duplex (1 bath) each
I'New circu1ts alts.
or extens10ns
I SERVICES
I
Floor furnace
and vent
Recessed wall
~~~CP np~tpr ~nrl vpnt
~Iater service
ITempOrary Construction
IChange in existing
rpS.i dli::n('~
Imultifamily, comm. or
Inrlu<;trial
10f amps.1
I COMI'1./IND , FEEDERS
l'Install/alter/relocate I
rli<;trih. fpprlpr<;
IOf amps.1
I
I
I
Appliance vent
seoar~tp
Sta t i onary evap.
cooler
Vent fan wi th
c;.;nole duct
Vent system apart from
h~;:ltinq or A.C.
Mechanical exhaust
hood "nd duct
I Hood stove/heater
I
I c.;~
I
IS OC
Add1tional bath
Sewer
Storm Sewer
i1/Jn
I
I SSUANCF OF PFR!lIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES IS, (,;, V
WHERE STATE L\\~ REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valii until the label has been signed by an Electrical Superv1sor and returned to the Bu1lding Division
I HAVE CAREFULLY EXNlINED the completed apf1lication for permit. and do hereby certify that all informat1on hereon 1s true
and correct, and I further certify that any and all work oerformed shall be done in accordance w1th the Ordinances of the City
of Springfield and the Laws of the State of Orel.:lOn pertain1ng to the work described herein, and that UO OCCUPAHCY will' be made
of any structure without the permiss10n of the Building Division. I further certify that my reg1stration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemrtion 1s noted hereon, and that
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FOr. orF I CE USE QiIL Y
Sl1. Ftg. t1ain
Sq. Ft~. Access
Sq, Ft9. Other
Zone
Fi re Zone
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Dccy Group
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATIDrI
BUILDING PERflIT
Charges and
Surcharges
Plan Ck, Commflnd
65%/Rldo Ppr Fpe
------------P'f'an Ck. Res
3Dt/BldQ Per Fee
PLU'1BING PERMIT
Charges and
Surcharges
Fence
Isyste,ms Development
CharQ. (1. 5r,)
I
I
I
I
ELECTRICAL PERlm
Charges and
Surcharges
Dljmo
I Sidewalk
------------
I AfC Paving
16- . DO I Curb Cut
---hh-.-~v-I
ITotal Comb. rermit
I
I TOTAL
ts; ,00
11ECHANICAL PERMIT
Charges and
Surcharges
~-.. '; ..
.....
.
.
.
"
.
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2. exa~le- lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air Qas
2. examyle- waterheater/electrical/or ~
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 permit information:
1. example - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family room
3. exa~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, DES IGN TEAl" 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
8. 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 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 lssued.
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V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date