HomeMy WebLinkAboutPermit Mechanical 1988-3-18
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CITY Ut SPRINGFIECD
COMBINATION APPUCATION/PERMIT
EtlERGY SOURCES:
Heat
Hater Heater
/ Range
{)/ j // / J?'t~~A> ValuE of Hork:
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- .. I Phone BUllGlnQ Pernnt Info: Descnbe Work(1.e., Build Single
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INFORltATION liNt
726-3753
Sq. Ftg. I'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
-Fence Demo Change/Use
Other- -
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I INSPECTION CINE
726-3769
Job Address
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legal De5cription
r-'
Owner'~
Address '/O? Q
Construction lender
Address
OtSIGN TEAl1
(name)
Phone
(address)
(l ire;;. no.)
,
(exoires) (oh0n~ "0;)
Primary
"*
1''/''")', ~"i/I
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(;uirlrpss)
(1 ;l"'c:., no.)
(pxo;rpc;,) fohonp no. )
c'pnpr.:l.l
Plumbina
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Electrical
~1echanical
PCUllB I NG
ECECTRICAC
MECHANICAC
NO.1
I FEF I rHI\RGF ~n I
I ':.EL 1....c.HAR.G..E. ~m I
I ~~~ 1..c..l::IAR.G.E
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
IS,F. Residence
(] bath 1
louplex (1 bath) each
IAdditional bath
1~later service
Sewer
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl ~pnt
Storm Sewer
Of
amps.
Appliance vent
SPOijr.:l.tp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
h~atinq or A.C
Mechanical exhaust
hood ilnd dud_
Temporary Construction
Change in existing
rpc;j1eflrp
multifamily, comm. or
Tnrlllfi.t_r;al
COMM./IND, FEEDERS
Install/alter/relocate
r1;c:.tdh_ fpprlprc;,
Wood stove/heater
Of
amps.!
ISSUANCE OF PFRllIT
TOTAC CHARGES TOTAC CHARGES TOTAC CHARGES
WHERE STATE C,'l~ REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pernit
shall not be vali~ 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 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 OCCUPArKY 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 ba is for exemption is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 7n1.055 will ~e~~ this~~ect.
NAIIE(please printtJ):j/;~ J: E;leJlfL.",.,/ ~Ir,II^TU~~V~. V'f~hATE 3-1fS'-.f"5T
~~ OFFICE USE OHLY v , .
Sa. Ftg. Ilain x Va~ue
Sq. Ftg. Access x Value
SQ. Ftg. Other x Value
Zone
Fire Zone
Tvpe/Const.
Bedrooms
Units
Flood Plain
Stories
Occy Coad
Occy Group
TOTAC VACUATION
BUICDING PERmT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%!Blda Pj'r Fpp
PI an Ck. Res
30%/Blda Per Fee
Fence
Systems Development
Charqe (!.5~)
PCU'1BING PERMIT
Charges and
Surcharges
DtJ:mo
I
I
I
ECECTRICAC PERr1IT
Charges and
Surcharges
MECHANICAC PERMIT
Charges and 5
Surcharges
'Sidewalk
r
AIC Paving
-, (5 ,00 I Curb Cut
.u_ u.-75-1
ITotal Comb. Permit
~
I.
I'OTAC
(s ? S--
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100. Lane County Map Reference
Jl 03 43
2. examp]e- Lot I. Block 3, 2nd Addition to
Sprlngt;eld Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrica(/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 w if addition,
check add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - 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 AND
CHARGES ON THE SCHEDULES
O. 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.
) ( (11
3-({,~t
V, FOR OFFICE USE ONLY
Permit Clerk ~~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date