HomeMy WebLinkAboutPermit Mechanical 1982-11-9
-
Owner
00Jn\...R0
.~nL/? ,q
CITY OF SPRINGFIElD I lNFORllATlON LINt
COMBliIATlON APPliCATION/PERMIT 726-3753
/ A no J I' "..L I E!lERGY SOURCES: Sq. Ftq. 1.la i n
Ie J / !I.4Wj1 ~L.' Heat ~q. Ftg. Access.
\ '" r--..--:l. ? I ()L\ 0.. r--./V'" / /'1] l'later Heater Sq. Ftg. Other
, It ): J ,J r-.l. I J N--..U Ilew Add Alter Pep.
i Ran~e -Fence Demo Change/Use
~ p ~ Valu, of Hork: Other- -
n.. ll'" ... n PhonellH-OY~ (Buil<iina P~rmit Info: Describe Work(;..e.. Build Single
y ~ ~ ~ Fam,lv ~esldence W,th Attached Garaoe)
M Q1U.,..,-1'-f11LCftllY11 (' cuI.
:...JJJ.L./ - n~
I
,
I INSPECTION lINE.
726-3769
Job Address
Address
~
~
(II)
-C>
U\
Legal Description
'i:-.)O )Jet
Construction l~-
Address
DES I GNI EAI.1
(name)
Phone
(address)
Mechanical
CONTRACTORS
(name)
(addre~s)
(l ics. no.. ) (exnires) (ohane no.
* I
(1 ice;." no.) (exoires.l (OhOM no. )
Primary
Structura 1
Electrical
Genera 1
Plumbina
Flprt,rlril.l
- --. .-
mn /\ M oJ... UJ.. .)
I
~lechan; ca 1
PlUllBING
ElECTRICAl
MECHANICAl
Each single fixture
I FE'F I rHARr.F Nn..a.-' I ~~I=' 'r~ARG.E. _t::l.Q......-'
Residence of furnace/burner to
SQ. FT. BTU's
'I='~T '..cHARGE
~'
IRelocated buildin9
(new fix. additional)
IS,F. Residence
(1 bathl
IDuplex (1 bath) each
IAdditional bath
I~Jater service
Sewer
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
Recessed wall
Snacp hpatpr and vpnt
t..o~O
Storm Sewer
Temporary Construction
Change in existing
rec;5 dftnce
Imultifamily, COITlT1. or
Industrial
IOf amps,
ICOMM./IND. FEEDERS
l'lnstall/alter/relocate
rli<:tl"ih. f""""ri""l"<:
I Of amps.
I
I
I
Appliance vent
spoarate
S'tationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq CJr A.C.
Mechanical exhaust
hond and dud
Wood stove/heater
r~ hn.L
~.(()
ISSUANCf OF PFRllIT
/D.OO
I~.OO
thi s pemit
TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES
. WHERE STATE lAli REQUIRES that the Electrical work be done by an.Electrical Contractor. the electrical portion of
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXMlINED 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 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 OCCUPAllCY 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 7Q1.055 will be used on this project.
IW1E(please print~'-J R RJ':l....
,
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
SIGIIATURIi ~ <"w.<.--o
FOr. OFF I CE USE DillY
So. Ftg. Ilain
Sq. Ftl]. Access
Sq. Ftg. Other
w. ~ R. RDAT~
x
Value
Value
Value
x
x
TOTAl VAlUATION
BUIlDING PERfIlT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________..i2!/Bldo Ppr Fpp
Pl an Ck. Res
3D%lBlda Per Fee
Fence
Systems Development
Charae (1.5~)
PlU!~BING PERMIT
Charges and
Surcharges
DelllO
'Sidewalk
A/C Pavi ng
I.
ElECTRICAl PERI~IT
Cha rges and
Surcharges
Irotal Comb. Permit
IIECHANI CAl PERM IT
Cha rges and
Surcharges
Curb Cut
I
TOTAl
Jl8. 7i
~--
I
i
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax lot 100, Lane County Map Reference
II o'j 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheatertelectrlca(tor 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,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
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. 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
fu 11 schedu I es
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 issued.
,; Ii 9 q5'd-
CJvrf
CA
'!.
\
~
%~
V. FOR OFFICE USE ONLY
Permit Clerk
(lL
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant' ex~mpt from ,registration with the Builder.'s Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
I
name
.
--
~~
signature
date
....... ;"';"'....:........-......._,~!:._.-.. ~r.=~..,
-:'.'_"'''-I._.::..-~~...~,_JIZ'..................___.,.......,_........___..r::.::r..~