HomeMy WebLinkAboutPermit Mechanical 1983-1-17
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I HAVE CAREFUllY EXMIINED 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 rm 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 ;s noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
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Sq. FtlJ. Access
Sq. Ftg. Other
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II iNSPECTION l!f:E.
I. 726-.376g ,
. Job Address :211..(., IYIAv'l& Sf,
legal Description B~~Q.ul
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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( ~ E!lERGY SOURCES:
fit~~, 7Z6rcJ2t!(), Heat
Hater Heater
INFORlIATION LINt
726-3753
Sq. Ftq. 1,Iain
~Q. Ftg. Access.
Sq. Ftq. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other- --
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Ran!1e
ValUE of Hork:
Phone
Builriino Permit Info: Describe Work(i~e.. Build Single
Familv nesidence With Attached Garaoel
fJ./;"'.1 I); I ~
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Construction lender
Address
DESIGN TEAl" (name)
Primary
Structural
Electrical
Mechanical R\L,~ RQ t L~
CONTRACTORS tname)
Genera 1
Plumbino
Electrical
~1echanical I?t ( .h PILH.e..
PlUllB I NG
Phone
(address )
(l its. no.)
(exnires)
.?"3-Zo C!1lkwfl)ltt.1l.. U.m 0.(.(,
(address1 'r", (lics, nn,l
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ElECTRICAL
MECHANICAL
NO. I
-----lEach single fixture
IRelocated building
(new fix. additional)
IS. F. Res i dence
(1 bath)
IDuplex (1 bath) each
Additional bath
FEF
cHARr,F
Nn~
Residence of
FCC
r"1lllliE. ..llil.....
furnace/burner to
BTU's
SQ. FT.
INew circuits alts.
or extensions
Floor furnace
and vent
[SERVICES
I
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
!TempOrary Construction
IChange in existing
rps i qp'n('p
Imultifamily. COffin. or
Tnrlll<:.tri~l
10f
ICO~1./IND. FEEDERS
I Install/alter/relocate
rli<:.trih. fpprlpr<:.
Appliance vent
seoaratp
Stationary evap.
cooler
/ I Vent fan with
sinole duct
[Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hnnd ~nd dud
I Uood stove/heater I
~-9:r "11 Jl?,~ I
I
I
~Iater servi ce
Sewer
Storm Sewer
amps.l
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I lSSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE lAll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
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thi s permit
DATEd7.h 3
Zone
Tyoe/Const.
Bedrooms
Units
Occy load
Occy Group
x
Value
Value
Value
Fi re Zone
Flood Plain
x
Stories
x
TOTAL VALUATION
BUILDING PERIIIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/81do Ppr Fpp
------------ Plan Ck. Res
30%lBl do Per Fee
Systems Development
Char~e (1.5%) ,
PlUI1B lNG PERMIT
Charges and
Surcha rges
Fence
------------1 D~ll1o
I'Sidewalk
I A/C Pavi ng
I Curb Cut
I
[
~ TOTAL
I
ELECTRICAL PERI~IT
Cha rges and
Surcharges
tlECHANICAL PERMIT
Charges and
Surcharges
-ITotal Comb. rermi t
____Is..~_~_
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IS:~~
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COMBINATION APPLICATION/PERMIT (CAP),
" .
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot rOO, Lane County Map Reference
17 03 43
2. exall)Ple- Lot: 1. 'Block 3, 2nd"Addition to
:::iprlngtield' Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ce;li~Q/or forced air Q3S
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. examole- 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 singl.e family house with an
a ttached garage
2. examole - 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. OESIGN TEN4 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. ---
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 ;s issued.
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PERMIT VALIDATION
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V. FOR OFFICE USE ONLY
Permit
.PROJECT CONDITIONS TO BE SATISFIEO BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name~7J~ ~~J;Y'signature~~
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