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Home My WebLink AboutPermit Mechanical 1985-2-8 I JrISPECTlON LINE 126-3769 ~O alJ --m fV~ Legal DmriPtion\\r-n~\cA~~ . CITY OF SPRINGfIELD COMBINATION APPLICATION/PERMIT E!lERGY SOURCES: Heat !~ater Heater Ranqe - ~ (J, '~~77 INFOR/1ATION liNe 726-3753 So. Ft9. '.Iain ~q. HI). Access. S9. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - ':;r- '..-, ....... t) ~- ~ Job Address ValUE of Hork: Phone 7<t 7 k"1./ ~ I BullciinQ Pennit Info: Describe Work(Leo. Build Single "Familv nesidence With Attached Garaoel Address Ut~lliN 1I:.Af" {name} "\ Phone (address) flies. no.) (exo; res.) ~ ~ . (ohane no.' Primary Structural Electrical 11echan; ca 1 CONTRACTORS. ll'!1me) General ~~ (address) (11r.S, no..) (pxoirpc;.) (ohnnp nn ) ,. Plumbino Electrical Hechanical PLU1IBING ELECTRICAL MECHANICAL NO.1 -----lEach Single fixture IRelocated building (new fix. additional) S.F. Residence (] bathl Duplex (1 bath) each Additional bath FEE CHARGF Nn ~ ~ ~ r~.;&GI 1.._tl.Q"'L..J Residence of furnace/burner to SQ. FT. BTU's I F'I='F' I r~ARG..E. New circuits alts. or extensions Floor furnace and vent +----- I I I Recessed wall 50ace heater ~nrl vpnt , IJ&>! SERVICES ~Iater service I Sewer IStorm Sewer Temporary Construction IChange in existing rp'l i rl_p.nrp Imultifamily, comm. or Tnrlustriil,l IOf ICO~1,/IND. FEEDERS IInstall/alter/relocate I rli,tril'L fpprlpr, Of amps.j amps.1 Appliance vent sena ril. tp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from heatino or A.C. Mechanical exhaust hoorl and durt Wood stove/heater I I I I / /) rTP.. TOTAL CHARGES TOTAL CHARGES WHERE STATE LA\; REQUIRES that the Electrical work be done by an shall nOt be valiJ until the label has been signed by an Electrical ISSUANCF OF PFR'1lT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXAmNED the completed apfllication for permit, and do hereby certHy that all infonnation hereon is true and correct, and I further certify that any and all work Derfonned shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oreqon pertaining to the work described herein, and that flO OCCUPAIKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by DRS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. ~' "?~ ~ DATE 62./~ ~ ; IWtE(please print)~"':'" \ 1<,0.. '\l"lW SIGlIATURE FO~ OFF! CE USE OlIL Y Sq. Ftg. S9. Ftg. Sq. Ftg. llain Access Other x ,x x Value Value Value Zone Fi re Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group TOTAL VALUATION BUILDING PERf tIT Charges and Surcharges Plan Ck. Comm/Ind ____________ 65%/Blda P"pr Fpp Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development Cha roe (1. 5~) PLU'~BING PERMIT Cha rges and Surcha rges I Demo I Sldewa 1 k I A/C Pavi ng _____Lo_-_tlV-' Curb Cut (,,/0 I Total Comb. Permit ELECTRICAL PERI:IT Cha rges and Surcha rges /1ECHANICAL PERMIT Charges and Surcharges I I TOTAL "'~O , /0- . . . COMBINATION APPLICATION/PERMIT (CAP) .\ I. Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax Lot 100. Lane County Map R~fer~nce 11 03 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 ceiling/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examp1e- 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 a ttached garage 2. examEle - 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. OESIGN TEN4 AND CDNTRACTORS 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 OOT ALL FEES ANO 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. V. FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ... ' ~ .... \ , \ PERMIT VALIDATION ~ '. ' \ .. tf4t ~2tg.j.. 7 ii ~/i~ J/ \ ( .. ~ ~~ ,( Permit" Clerk M \ Permit applicant exem~t from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature '.", \, date , .