HomeMy WebLinkAboutPermit Mechanical 1986-2-14
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Job Address
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CITY Ur SPRINGFIElD
COMBINATION APPlICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work:
-
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I INSPECTION liNE
726-3769
I
INFDRlIATJON L1Nl l
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
-Other- -
legal Description
BuildinQ Permit Info: Describe Work{i.e.,
Familv nesidence With Attached Garaoe)
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Build Sin91e
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00
Address \ 0 \0 """L
(V ...b~0.1 r,WJJvU'.--.~
~~ ~. Phone
Owner'
Construction lender
Address
UlSIGN TEAH
(name)
Phone
(address)
(lies. no.)
(exoirfl's)
(ohone no. \
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~r
...
Primary
Structural
Electrical
Mechanical
CONTRACTORS
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(name)
g 21 2.1 \"".lJ)O\(fu..,
(addres~ 1
11~~rn~1
(exoirp~l
(ohonp. no_)
Genera 1
Plumbino
Electrical
~1echanieal
PlUlIBI NG
ELECTRICAl
ITLI~'~
MECHANICAL
NO.1
Each single fixture
FEE I CHARGE .1Jn
>>.
r"1lRIiE.
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated buildin9
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
<;O~r:P np.:ltpr ilnri VPr'lt ,
Storm Sewer
LL~.;:h,,-, ~
( o.OD
Temporary Construction
Change in existing
rp<;.j1eflC":p
multifamily, comm. or
tnfiuo;trial
Of amps.1
ICOW~./IND. FEEDERS
[Install/alter/relocate
fii<;.trih. fppfier<;.
[Of amp..[
Appliance vent
<:;poarate
Stationary evap.
C'ooler
Vent fan with
..inole duct
Vent system apart from I
hea t; no or A. C.
Mechanical exhaust
hood nnd fiur.t.
I
I
I
I
li<;,OC'
[
I
Wa ter serv; ce
Sewer
Wood stove/heater
(-'oJ r, L , -t:.,. :Jtc~
ISSUANCE OF PFR!iIT
TOTAL CHARGES /0.00 TOTAL CHARGES TOTAL CHARGES i ), 0 0
WHERE STATE L'H REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this perr.lit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon ;s 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 OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s
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 employees who are in compliance with ORS 7Ql.055 will b~ used on this project.
SIGNATURE W.4n it,) Ma.--L
FOn OFFICE USE DilLY /./
Sq. Ftg. ilain x
Sq. Ftg. Access x
Sq. Ftg. Other x
2
OAT~
NN~E(please print)
~}~ (.)
/3rl/t....EY
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bed rooms
Stories
Units
Occy Load
Occ'y Group
Value
Value
Value
TOTAL V AlUA TI ON
BUilDING PERHIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________~/Bldo Pp!" Fep
Plan Ck. Res
30%/Bldo Per Fee
[ Fence
I DfjRlo
I'sidewalk
I A/C Pavin9
i Curb Cut
I
Systems Development
Charoe (1.5%) "
PLUt~BING PERMIT
Charges and
Surcharges
iO .00
------------
.l.(O
ElECTRICAl PERiHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Total Comb. Permit
__L~:.Q.9_____
, Co 0
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot 100, Lane County Map Reference
1/ OJ 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceili~Q/or forced air Qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new.- if addition.
check add, etc.
F. Building pennit information: ",
1. example - construct single family house with an
. attached garage
2. exam21e - remodel existing garage into family room
3. examyle - 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
fu 11 schedu 1 es
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. -
Ill. 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
PERMIT VALIDATION
,
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(11
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Ir)
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$~
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V
Pennit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
.
.,'. -~~
date