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HomeMy WebLinkAboutPermit Mechanical 1981-10-23 \ !. '. \ '" "~. ...-'. ' , I , , . " . .~.~G~~~""':'.J'~I,::':~S!.': ~ ":" :~_.l !~~~;~,~,);.. :'~ r..: :: C, ._ f\ -! .~ :C~.,..~",~.".J-~"", .r~.._. "-....ft~!f;~~__ :" ~":"\,,)r.J.... ,,-,'.:~,J.aR:._~:""~f!".t::_:~:-:.~~;~.'~ :..>;~=-.~~ ""'~ ., INSPECTION LINE 72~3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-.3753 legal Description 17-03-35~41. Part of T.L. 5500 ENERGY SOURCES: Heat ~l prt l-ID Water Heater RanQe Valve of Work: Sq. Fig. MClin Sq. Ftg. Accen. Sq. Fig. Other _New_Add_AJter~R.p. _fence_Demo_Change' Use _Other 00 '-' o <.n \0 '-' Job Address lOne:; M::dn 'TY't:U:"t Owner Sorinofield. Utility Board Addreu ?~n N "1111 ,trt:u:.t Phone 746-8451 Building Permit Info: Describe Work {i.e.. Build Single Familv Residence With Attached Garaae\ Construction lender Install heat Dump Hvac System in Existing Building Address Phone DESIGN TEAM {name} (address) (lies. no.) (upires) (phone no.) Primary CONTRACTORS (name) (address) mcs. no.) ,...,..* '"~. .., Structural Electrieol Mechanical General Plumbinq Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL / I NO, FEE . CHARGE NO.' FEE . CHARGE NO. I FEE . CHARGE Residence of furnace/burner to IJTU's Appliance vent separate Stationary evap. cooler Vent fan with sinqle duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Each single fixture Relocated building (new fix. additional) S.F. Residence /1 bath} 09, ft. Hew circuits, alterations or extensions SERVICES Duplex (l bath) each Temporary Construction Additional both Amps. Water service Sewer Wood stove/heater Storm Sewer FEEOERS 1 Heat Puma Air handler to 10.000 CFM Air handler over 10.000 CFM 6.00 Amps. ISSUANCE OF PERMIT 10.00 16.00 TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE lAW REQUIRES that th~ Et.ctrical work be done by the Eledrical Contrador, the electrical portion of Ihis permit shall not be valid until a label has boen signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREfULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and corred, and I further certify that any. and all work performed .hall 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 herin, and that NO OCCUPANCY will be made of any strudure without the permission of the Building Division. 1 further certify that my registration with the Builder'. Board is in full force and effect a s required by ORS 701.055, that if exempt the basi. for exemption is noted heron, and that only subcontractors and employ... who are in compliance with ORS 701.055 will be used on Ihis project. Basis for Builder's Board exemption: NAME(preoSeprint)~. ~~ SIGNATURE FOR OFFICE USE ONLY OATEO 1.~t;" Zone fire Zone flood Plain Typel Canst. A.edrooms x O;:",rj_. Units nccy Load f"Iccy Group existing jOb "", Fig, Main Sq. Fig. Accer. Sq. Ftg. Other Value Value Value TOTAL VALUATION x Mechanical Permit for #810591 BUILDING PERMIT Charges and Surcharges Plan Ck.. Comm/lnd 65%/ Blda Per Fee Plan Ck. Res 30%/ BldQ Per Fee Systems Development Charae 0.5%\ PLUMBING PERMIT Charge. and Surcharges' Fen~ Demo TOlal Comb. Permit ELECTRICAL PERMIT Charges and Surcharge, Sidewalk. AIC PaviM MECHANICAL PERMIT Cl,arges and Surchargo. lIi O(L Curb Cut "A TOTAL I $16.64 \; . , . , " .. ' \ It" ", . ' I . . '. : .' .. , I ., " ' , "", .' ' , ~:,~-;~~':-~~~~.;;.~.!;~.-~~-_;"~,.~~~J~~..~~~.;;~,~,~~~:.'~:~h~. .-,~..!i~~ ~~:'.~;'!-:.';~~~~~1-.~~?~~;,~~)4~~-~j21Jl~Jt~~~~r!i~~~~~P.~.,:~d,,~~~~_~~~~~;~~~.-;:':.~~,~b~,J:~l"J . ...~ -' . I' .--;--. :.' . 4__ - . . ., ~ . . ~ ... '.' .- '.-.. - .. ~ -. .. -. . . 111. Applicant to sign and date Whenever possible, the initial application will be used as worksheet only. Where possible, Building Division Staff "'l-- . prepare a typewritten 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. /.. Signature(;:afi(;L ,4~ .....-.. COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. legal Description L example-tax lot 100, Lane County Map Reference 2. example-Lot L Block 3, 2nd Addition to Springfield C. Name, etc. of owner and construction lender O. Energy Sources 1. example.heat/electrical ceiling/or forced air gas 2', "example-water heater/electrical/or solar E. Square footage or valuation, etc. '., . . 1. exomple-1250 sq. foot house, 500 sq. foot garage 2. example~if new project, check new-if addition, chec add, etc. F. Building permit information: 1. example-construct single family house with an atta 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 TEAM AND CONTRACTORS To ovoid design or construction delays, Building Oivisi Staff must be able to contact appropriate persons rege design information or job site corrections, etc. II. Abbreviated Plumbing, ,Mechanical & Electrical 'Schedules A. Except where blank spaces occur in the description pal l{i of the Mechanical and Electrical Schedules, the applicc need fill-in only the No. Boxes adjacent to the appropl 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 schedule~ have been abbreviated 2. If the item(s) to be installed are not covered on the ated schedules you should consult the full schedule C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A~ CHARGES ON THE SCHEDULES V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ^""""\,, ~' , '1 ~~ .,- i':' \. " J C', " . 1\}.j(/)'7 Y<\\}~D Additional Project Information: PLANS REVIEWED BY: name---1.Jl.rPP Pl pnp\", r \ I CITY' (\ ., Di:DMIT \/AllnATlnN OF SPRINGFIELD (0. City Hall Springfield, Oregan Department of Public Work. OFFICIAL RECEIPT CI 57505(1 (' No. B 19X' j ( Date /0 -,.;13 Rec'd From <;. 1/ e Address,-:?--2'\;A.~r-I:fL /-1' sf', - <:" .--.~-~ 0'''''' -') t, '7 -, <---'I p I ,- I I Received Far: T (I Q)G). {)O </5", . !?O ( Y fan C/vrf 94,-50 .1U1 (1-11- / ~. iJ(j air, 'a/tinct l-i (), ()() S1D'r m ~w.r-fK(ljfln I~J-' ')-JY) m () HI'!. {)() { 47" ,f,/J ( /X:) , I "1 (] {n\ (I (I ( (I ( h,j 17 II7~J '/7''';' Received ,tJa ''7. q'-t (1 A l (Jj~('/A f / (I Amount (I ~.. ..!!-CI AUTHOIUZKD SIONATUIllIE .. C S''':~TON'TU.N'Ul~ ""'NTIUt' . ~Ug~NI, 0" ,',.g. ..,,,., i '" (j Permit CierI- . ;. -:-"; ,:.~-;.:.:~.:. ifri Mc.;'\ ~,'1H:.J dot.... 10-22-81