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Home My WebLink AboutPermit Mechanical 1985-10-10 . . , ,'....-, .'.. Il~ e~ INFORlIATION LINe 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftq. Other New Add Alter Rep. Fence _Demo_Change/Use _Other I I ~ W ~ i INSPECTION LINE 726-376g Job Address /IJ /J d I CITY UF SPRINGFIELD COMB illATION APPLICATION/PERMIT ,- EIIERGY SOURCES: Heat Hater Heater Ranqe ValuE of Hork: m &:;u legal Oe~cription Owner ~~~l ~~ / fJ h ':2 /J1 ;j.i;,,~ Phone Builriina Permit Info: Describe Work(i.e., Build Single Fami~Z~~f" \~h J;;:: G&~ ~4r-Ji/ ) .L __ -- Address Construction Lender Address Ut~ I tiN rtAr~ (name) Phone (address) (lies. no.) (exnires) (ohone no. Structural * Primary Electrical Mechanical CONTRACTORS (name) (addrpss 1 (lir.e;. no.l (pxoirpc;1 (ohonp nn.l General Plumbina ;/~~ ~"a1'1sl rf- . _L-I !/J? /JAlP .Lf./J fl / Electrical "'echanical PLUIIBING ELECTRICAL MECHANICAL lID. I Each single fixture I FEF I rHARGE .Jj(\ , , <.EL 'J:ilAB.Ii[ NO ' Res idence of furnace/burner to SQ. FT. BTU's I ~~Ll..cHAB.G.E.~ Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent IS.F. Residence 11 bath 1 IDuPlex (1 bath) each IAdditional bath 1~later service I Sewer 1 Storm Sewer ISERVICES I Recessed wall ~o~r.P hp~tpr ~nrl vpnt ITemporary Construction IChange in existing rP'i i dJ'nrp Imu1tifamily, comm. or Tnduc;:trial IOf amps.1 ICOMfI./IND. FEEDERS l'Instal1/alter/relocate I rli~trih fppnprc; IOf amp~1 Appliance vent seoaratp Stationary evap. cooler I Vent fan with sinale duct I'Vent system apart heatina or A.C. IMechanical exhaust hood ann rllJr:t I ~'Iood stove/heater I I .Iff.. I I I I from I I 1/0100 I I I I I I-If) I I I SSUANCE OF PFRI11T TOTAL CHARGES WHERE STATE L~H REQUIRES shall not be valiJ until the TOTAL CHARGES TOTAL CHARGES I D. E/O that the Electrical work be done by an."Electrical Contractor, the ,electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM11NED 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 NO OCCUPAfKY 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 is noted hereon, and that only subcontractors and em 10yees who are in compliance with ORS 7Ql.055 will be used on this project. ",.- SIGIlATURE Fn~ OFFICE USF- DIlL Y Sq. Ftg. Sq. Ftg. Sq. Ftg. :bH(\j ThoMPs'Olll DATE I(J-I {) -r;c;- IlA).IE(please prin p /' ZonE' Fi re Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group t1ain Access Other x x Value Value Value x TOTAL VALUATIOIl BUILDING PERfllT Charges an~ Surcharges Plan Ck. Comm/lnd ___________ 65%/BldCl PM !='pe Plan Ck. Res 30%/Bldo Per Fee I Fence ------------ I Demo I Sidewalk I A/C Payi ng ( D , 00 I Curb Cut - - - - - - - -.tfOl Isyste,ms Development Charo. (1.5%) , PLUt~BING PERMIT Charges and Surcha rges I I I I ELECTRICAL PERI:IT Cha rges and Surcharges Irotal Comb. Permit MECHANICAL PERMIT Charges and Surcharges 1- j'OTAL [0, +0 , ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Applicant to furnish A. Job Address 8. legal Description 1. examole- Tax lot 100. lane County Map Reference IT O'j 43 2. examole- Lot 1. Block 3, 2nd Addition to ~prln9tield Estates C. Name. etc. of owner and construction lender O. Energy Sources . 1. exam~le- heat/electrical ceilinq/or forced air QdS 2. example. waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. examyle- if new project, check new - if addition, check: add. etc. F. .Building permit information: 1. examole. construct single 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. DESIGN TEAM 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO 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 .is issued. -w G r;;s 4# rpn \ \) \'D-(orp- V. FOR OFFICE USE ONLY Permit Clerk CC---/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: / Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: I name signature date . I ~