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
. .