HomeMy WebLinkAboutPermit Mechanical 1989-5-16
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Job Address ;2 /..5- .2
l.e?al,Oe"ription /7 03
L11 Y ,"' SI'H JrIGr I [lU
COIIBJrIMIOIl APPI.ICATIOIl/PERMIT
.,
I E!IERtiY SOURCES:
Ileat
Uater Ileater
RanrJc__
llfOlUtAl:.:1 ll....
716-375;
$0. HQ. "~lain
~q. !"ll). Access.
So. Ft9, Other
Ile\~ Add JI.lter :~eD.
--rente Oemo Change/Use
Other- -
Describe Harkt i.e.. ilui Id Single
~ttached r.aranel
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TOTAl CIIARGFS' TOTAl CIIARGES I TOTAL CIIARGES nil J 11 Ie;') ,00
/' WIIEnE STATE L.'I.J REQUIHES that tile Electrical \'tork be done by an Electric....l Contractor. the electrical r'lortion of this pemit
shall not be valH untq the label has been signed by an Electrical Supervlsor and returned to the Building Oivision
I HAVE CAfl[fULLY [XMIlfI[() Vu? complelt'd apr1ication (or lJcrmit. tlnd do hereb.v certify that all infoJ"/!lation hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and thp. Laws of the Stclte of Orenon oertainin9 to the work described hel"ein, and that 110 OCCl!PMICY ,...ill be made
of any structure without the nermissioll of thp' llllildin!l Division. I further certify that 1ll,Y re!1istration ~Iith the Guilder's
OOclrd is in full force dnd e((ect as required by or:$ JOt.O!i5. tiltH if cxemot the basis for exernntion is noted hereon, and that
only subcontractors and er.lplo,Yees I...ho are in conl:>liance with ons 7111.055 \.,"j d on this nroject.
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Mill'''' sJ
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Owner ~C\. '\\t'\ \{\()\ll\j-; .~ l:5\Ol\V\CW
"ddres'C!;J/ <;=; ~ fY"l) (Jf\ ) Phone
constru~~~~' ^ J fJfJ q 14 0 i)
Valur
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(ex:O,)
,\Jdress
UDILrl Ill\/l
Phone
(address)
\lIallleJ
(I ics. no.)
Primary
Structural
Electrical
!Iechanical CornJ'Y}erc/f1L..
COr/TRACTORS (nilme) .
Genera 1
A/IC
-?6fj"D
(clddress)
)VrJ'1' .s 1t
( 1 ics.
Pll,mbino
Electrical
t1er.h"nic,,1
,/1 M c.
A b,nVf"':l~
,
d.J
PlUf1BIrIG
ELECTRICAl
~1[(I1A1l1 CAl
1';U.1
-----lEach single fixture
-----/Relocated building
(new fix. additional)
IS.F. P.esidence
(I holth I
-----louPlex (1 bath) each
/Additional bath
IHater service
I Sewer
I Storm SCI'ler
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-----I
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I CIIARr.r
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JILl
Residence of
'" LClUlRliL flfI,
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furnace/burner to
/.lP,d17V OW's
SQ. FT.
New circuits alts.
or extensions
I Floor furnace
and vent
,____ I ~eccssed wall
I-----r-n~rp h~~tpr ~"rl VP"t
I Apol iance vent
o;eoat',Hp
I Slat ionary evap.
cooler
I'Vent fan with
sinnl~ dun
I Vent system apart from I
heatinn or A.C.
~Iechanical exhaust
_l!noc1 ,"Ind rlll("t
ISERVICES
-----I
I Telllporary Construction
IChanl'Je in existing
rf'sidf'.Oi~
Imultifamily, COOI!l. or
lorlu<:.tri;1I
10f
alllPs.1
cor~I./I1l0. FEEDERS
I os tall/al te-r/re locate
_ r1i<:.trih.-.L~C.Qpr<;
IOf
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lIood stove/heater
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amps.l
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ISSUAtrCF nr PFmllT
/lNIE(ple..e nrint),1?, "'I A r Ie
--z;:. / J1-tLiA./ 1 ~
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vl FO~
x
x
Value
Value
Value
SIr.Il^TURF.
orFIC, USE
Sn,
So,
S~.
lone
Fire lone
Flood Plain
Tyoe/Const.
Gedrooms
Stories
Uni ts
Ocey Load
Occ.v Group
Ftg. nther
x
TOTAL VAltJATIOII
OUllDlflG PERI,lIT
Ch"r']es an~
Surcharges
Plan Ck. Comm/lnd
65!/OldQ Per Fpp
Pldn Ck. r~es
30t/Oldn Ppr Fe(>
Fence
Systcr.ls Development
CharQe (I. 5")
------------
PlU'1BHlG PERMI T
Charges and
SurCharges
------------
Demo
,ElCCTRICf.l rERI:1T
Charqes and
Surcharges
IIEClIA" I CAl PEP.lH T
Charges and
Surcharl'\es
Sidewalk
------------
..1 AIC Pavinq
.._tZ:::Lnr ) -' Curb Cut
,1\5 I
ITotal (amb. rp.rmit
I rOTAl
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li.L .CJIARGE .
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COMBINATION APPLICATION/PERMIT (CAP)
.
I. App 1 icant to furn i sh
.A. Job Address
B. legal DescriPtion
1. example~ Tax Lot IO~, lane County Map Reference
1/ uj 43
Z. eXolmple- lot 1. 1l1ock 3, 2nd Addition to \
~pringfieJd (stales
"C. Name, etc. of owner and construction lender i
D. Energy Sources \
1. example- heal/electrical Ct'ilinq/or forced air Qas
2. examoJe- walerhealer/electl"ica llor solar
E. Square rootage or valuation. elc. -
1. examolca ]250 sq. foot house. 500 SQ. foot garage
2. example- ITnew project. checknew _ if addition,
cheCK add. etc.
F. Building permit information:
1. example - construct sin!)le family house with an
a ttached gar~ge
2. examole - remodel existing garage into family room
J. exanlllle - Convert single family residence into
restaurant (change of use)
G. Value of \'iork as defined in Section 3D3 (a) of the
Structural SpeCialty Code
II. OESIGN TEN! AND CONTRACTORS
To avoid desiC)n or construction delays, Building
Division Staff must be able to contact appropriate
persons regard i ng des i9n in forma t1 on or job site
corrections, etc.
II. Abbreviated Plumbing, Nechanical, & Electrical Schedules
A. Except './here blank spaces Occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need (ill-in only the No. Boxes adjacent
to the appropria te j tem( s) to be ins ta 11 cd
8. Full Plumbing, f>lechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
Z. If the item(s) to be installed are not Covered on
the abbreviated schedules you should consult the
full schedules
C. BUllOING OIVISION STAFF Will Fill OUT All FEES AIID
CHARGES ON TIlE SCHEUUlES
O. As noted on the CAP, the label must be delivered to the
electrical contractor' for signature by his electrlcal
Superv1sor. The general contractor 1s 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, Bui Iding Division Staff
wi 11 prepare a type Wrl tten copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check iees are due and payable at the time of the
application, and no plans \.dll be processed until these
fees are paid. All other fees anu charges are due and
payab 1 e when the permi tis issued.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArICY:
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PERMIT VALIDATION
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Permit'Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Add i ti ona 1 Project I n format i on:
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PLANS REVIEWED BY:
name
signa ture_
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date
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