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HomeMy WebLinkAboutPermit Mechanical 1985-1-29 I INSPECTION LIIIE 726-3769 Job Address dJ 5/ . CITY OF SPRINGFIELD COHBIIIATION APPLICATlON/PERMlT ElIERr,y SOURCES: Heat Nater Heater Ranqe ValuE of Hark: . INFORllATlON LINE 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Her Pep. --Fence Demo ChangelUse Other - -- \t:l PI fl/,J Legal Description Address '/ A $'[/( -:R0-(Z(...,tbn L5TY bk '6 J . jL"j Phone Build;na' Permit Info: Descr.be Work(Le., Build Single Familv nesidence With Attached Garaael Owner Construction lender Address Ut~ HiN r t.Ar,' {nameJ Phone (address I Mechanical CONTRACTORS (name) (address) (lies. no.) (exo;res) (ohane no.', ~ , (lir", nn.) (pyoirpc:.l (ohnnp nn l Primary Structura 1 Electrical General Plumbina Electrical Mechanical -::Dv.) ~\A05D,0t\rl'~?O<S /lJJffi PLUMBING ELECTRICAL 7"17-(."/6 '\ MECHANICAL NO. ' FEF 'CHARGE jJn ~~~ r':iAB.G.E. -1!ll.... I..fH r~~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp np~tpr ~nn ~p~ Storm Sewer Of amps. Appliance vent f~':l~r~tp Stationary evap. cooler Vent fan with sincle duct Vent system apart from I heatino or A.C. Mechanical exhaust nnnd and du('t. I I C",.....C4,C/D ( p"/"-f...f- Lr~; I I /O~ Water service Temporary Construction Change in existing rp'l j qe.n('e multifamily, conm. or Tnrlu..trii\l Sewer CO~1./IND. FEEOERS Install/alter/relocate rli..trih fppnPrC Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be va1i1 until the I TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANCf OF PFRltIT TOTAL CHARGES I () :ff2. Electrical Contractor, the electrical rortion of this permit Supervisor and returned to the Building Division 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 Spri ngfi e 1 d and the Laws of the Sta te of Ore(]on perta i ni n9 to the work descri bed herei n, and that rw OCCUPArKY 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 DRS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project. IlAI-lE(please print) tJn..,AI ~ L. Mmx.,c::. SIGUATURE /f/ h.;l,ou DATE 1/J..9kJ- FO~ OFFICE USE DilLY Zone Tvpe/Const. Units Sq. Ftg. t1ain Fire Zone Bedrooms Occy Load Sq. Ft!J. Access Flood Plain Stories Occy Group Sq. Ftg. Other x x Value Value Value x TOTAL VALUATlOU BUILDING PERIIIT Charges and Surcharges . Plan Ck. Conm/lnd 65%/Bldo Ppr Fpp ------------ Plan Ck. Res JO%/Bldo Per Fee Fence 'Systems Development Charqe (1. 5~) PLU11BING PERMIT Charges and Surcharges Oemo ELECTRICAL PERI~IT Cha rges and Surcharges 'Sidewalk ___.f~t!.=____ .-fO AIC Paving I Curb Cut I Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges TOTAL '.yo /0.:_.-- J /01:Q , ) )-" ] . lJ CIT-,F SPRINGFIELD City Hell , Springfield, Oregon Department 0' Public Work. OFFICIAL RECEIPT No. B ') COMBINATION APPllCATION/PERMIT (CAP) 6.1:QO . ... " I. Applicant to furnish A. Job Address B. legal Oescription I. example- Tax lot 100, lane County Map Ref II oj 43 2. exam~le- lot I. Block 3, 2nd Addition to ~pringtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forcE 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. fo, 2. example- if new project. check-nfw - if ( cheCK add, etc. F. Building permit information: 1. examele - construct single family house \ attached garage 2. examDle - remodel existing garage into f. .y) 3. examole - convert single family residenc ~~ restaurant (change of use) G. Value of work as defined in Section 303 (a) Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, 8uil Division Staff must be able to contact apprc 'persons regarding design information or job .0::,') corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical ~ A. Except where blank spaces occur in the descl portion of the Mechanical and Electrical Scl "d'.' the applicant need fill-in only the No. Box! j to the appropriate item(s) to be installed B. Full Plumbing. Mechanical, and Electrical SI are available at the Building Division 1. To conserve'space on the permit form th have been abbreviated 2. If the item(s) to be installed are not the abbreviated schedules you should co full schedules C. BUILDING DIVISION STAFF WIll FIll OUT All F CHARGES ON THE SCHEDULES O. 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. --- 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. L Ar.t ) -:z-q 19 S":l<," Date f J Rec'd From 7)0.) jf.zt., l\G, .+,,~;::. 'J Address (J,,,..,,) ?-2..<;" / ~ ~/,^ ) S:r. ) Received For: REI u~ lkf/.k-rr "J(j c> F f'.IJm~r?>z{>"4 RF'FTot-Ihi'XA7]."'ht) ) /V'1/d/ll11llh? ~ I ~'F :'W"-~ //J ~ .4-a Amount Received . o~~. 4 ;JL n47)LL., .., ) -, '.UTHO,.ZEO SlGNATURE ) . j r . '" '~I..t~~ tn.....~ ,",, f'illlIU,_.,U I I 1. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: /JOt ;eEorj r~l Additional Project Information: PLANS REVIEWED BY: name signature date j ~ . >> ) ) ) ) ) ) ) '. 'I INSPECTION LINE 726-3769 CiTY UF SPRINGFIELO . INFORlIATlON L1N" COMBINATION APPLICATlON/PERMIT 726-3753 E!IERGY SOURCES: Sq. Ftg. 1.lain Heat ~q. Ftg. Access. Water Heater Sq. Ftg. Other /lew Add A Her Rep. Range --Fence Oemo Change/Use e ValuE of Work: Other- - :::::ss(d~ ~1\~Phone 7</..~- ~~~l~~nRe~~d';~~eInf~~ A~~~~h;~eG~~~~~l.e.. BUi~d Single \. 97'1'17 7tu!' ~.4'fA./~ ~ ,~~.~~ Constructio - {/ . Job Address ;);; S I -m 11./.-<.~ Legal Description Address Ul:.~r(jN fE-AI" (name) Phone (address) (lies.no.l (exoires) (ohane no.' ~I .~ cx.-I I Primary Structural Electrical Mechanical CONTRACTORS (name) (address) l1ic<;,.nn.l (pxoirpc:.\ (ohnl"lp on 1 General - .. "JI1,J Plumbino fV,/~f>>0..pyU. f Electrical ~41 J)/.Jf ~fl ok 97'177 ~lechanical PLUlIBI/lG ELECTRICAL MECHANICAL NO. FFf ..QjARGF NO ~~~ r~~ _NO. J;:J:'J:' rl-l.;RGE Each Single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor fu rnace and vent S.F. Residence (] bath I Duplex (1 bath) each Additional bath ISERVICES I Recessed wall ~n~~p hp~tpr ~nrl vpnt ~Iater service ITempOrary Construction IChange in existing rPsjqp.,n('p Imultifamily, comm. or Inrlll<:tri~l Storm Sewer ,1 .(U~ ",) lorn Of COMfI./IND. FEEDERS amps. Appliance vent SPlJaratp Stationary evap. cooler Vent fan with sinale duct Vent system apart from I heatino or A.r. I'Mechanical exhaust hood i1nd du('t I Hood stove/heater I I I Sewer I Install/alter/relocate rli<:trih_ fpprlpr<: jOf I I I amps. TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali1 until the /1> (ft) TOTAL CHARGES I SSUANCf OF PFRIHT TOTAL CHARGES that the Electrical work be done by an.'Electrical Contractor, the electrical portion .of this permit label has been signed by an Electrical Supervisor and returned to the Building Division 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 110 OCCUPAr~CY 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 ons 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. NAHE(please print) f C TEl' c:i/,1-jJ/A/ SIGrlATURE ~~ FOP. OFFICE USE OIIL Y Zone Type/Const. Units Sq. Ftg. f1ain Fi re Zone Bedrooms Occy Load Sq. Ftg. Access Flood Plain Stories Occy Group Sq. Ft9. Other cL~ x x OATE I-.:s 0 -J"....s-! Value Value Value / x TOT^L VALUATION BUILOING PERmT Charges and Surcharges Plan Ck. Comm/Ind ____________ ....Q..2!/Rlda Per Fpp Plan Ck. Res 30%/Bldo Per Fee _____1(2J!~_ Fence tV' 0 DemO I'Side';a 1k ------------ I AIC Paving I Curb Cut ____________1 Systems Oevelopment Cha roe (I. 5~) . PLUHBING PERMIT Charges and Surcha rges ELECTRICAL PERrHT Cha rges and Surcharges I ITota' Comb. Permit MECHANICAL PERMIT Charges and Surcharges I I TOTAL ) 0 </0 . . . I, COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I I 1. I. Applicant to furnish A. Job Address B. legal Description I. ~xample- Tax Lot 100, Lane County Map Reference 11 03 43 '2. exam~le- Lot 1. Block 3,,2nd Addition to ~ Sprlngtield Estates , C. Name. etc. of owner,a~d construction lender D. Energy Sources '. 1. examele- heat/electrical ceiling/or forced air Qas 2. exa~le- waterheaterjelectrlcallor solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examp.le- 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. example - remodel existing garage into family room 3. example - 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 TEAfI 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 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. --- 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. .. ' " . ".~I- _~ ~I PY'" 'tel 1/1/J'J/ .' .~ , . \ V. FOR OFFICE USE ONLY Permit Clerk~/ . . . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . , name signature date . .