HomeMy WebLinkAboutPermit Mechanical 1981-10-23
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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
'-'
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<.n
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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
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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:
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Additional Project Information:
PLANS REVIEWED BY:
name---1.Jl.rPP Pl pnp\",
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CITY'
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Di:DMIT \/AllnATlnN
OF SPRINGFIELD
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City Hall
Springfield, Oregan
Department of Public Work.
OFFICIAL RECEIPT
CI
57505(1
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No. B
19X' j
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Date /0 -,.;13
Rec'd From <;. 1/ e
Address,-:?--2'\;A.~r-I:fL /-1' sf',
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Received Far:
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10-22-81