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HomeMy WebLinkAboutPermit Mechanical 1983-1-17 ..t jf1 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. IWIE(please print) (2/l,e'()L . J. ;?GEeG" SIGil^TURE~ Q. g", , . FO~ OFFICE USE miL Y Sl"!. Ftg. f1ain Sq. FtlJ. Access Sq. Ftg. Other .. . . . . '. : ,/ I I II iNSPECTION l!f:E. I. 726-.376g , . Job Address :211..(., IYIAv'l& Sf, legal Description B~~Q.ul < d~3-36-'1:z... 2/OC:::> Owner' Y . ~ l'-..~I.I't""s..n"^-! LDI\..",,""ol.ft r,.:.......... Address ~~ n --J"'~\ p ~ ur. 1r /)/ ~ CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT , ( ~ 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- -- '- Ran!1e ValUE of Hork: Phone Builriino Permit Info: Describe Work(i~e.. Build Single Familv nesidence With Attached Garaoel fJ./;"'.1 I); I ~ - - i 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 (pxoirp",l .23;2.0 OR'kLU/M ~fle ~M ~ . 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 I ~. .- ~.7!r1.),:;:n,N,.. b I I I 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 Of amps. 00 ~ N N o 31/-1/5/ ,g 3 (ohnnp M.. '" 3L/t.1518.? ~~~ r~~ I I 13. ...... I [ I ' I~.-I I I /<P.... c /5":-- 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..~_~_ ,~ IS:~~ . ~;. I . '. ___.F. , 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. \ .. '. . .) . '. :. . , .. , PERMIT VALIDATION , - V. FOR OFFICE USE ONLY Permit .PROJECT CONDITIONS TO BE SATISFIEO BEFORE OCCUPANCY: \ - \ '1-15~ loOd 7:5 , Cl"'C:4-ffi ) . , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name~7J~ ~~J;Y'signature~~ .~...:..o..;,.:_. ........~_.-..........,...._. , da te /-/ 'I-'f!i'.:s J