HomeMy WebLinkAboutPermit Mechanical 1989-6-15
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Job Address
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legal omription Vi n ~ ~ (S' 7J \ (Y\Q...OU
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.... CITY Uf SPRINGFIELD
,. CDr1BIIIATlDN APPLICATiON/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
,.
NFORI1ATlON
726-3753
Sq, Ftg, 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter P.ep.
--Fence Demo Change/Use
-Other- -
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1 INSPECTlDll UN,C
726-37t-9" .
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Address /&;5-/ ,,>;?"#nv ~7", _;.l/lOne'7/~
7, ,..;,;,
.59"'(2} p/5',
Construction Lender
Range
ValuE of l'lark:
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Buil(;ino"Permit Info:
Fflmil y nes i dcnce IH th
~ <,fY:;>
Oeser be Work(i.e.. Build Single
Mtached r.araqe\
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Addrc5S
DESIGN rEM
{namel
Phone
(addressl
(1 ics. no.)
(exnires)
([)hone no. I
I.
*
Primary
Structural
Electrical
f1echanical
CONTRACTORS
(namel
Cilddress1 l1ies. no. \
(exnirpc;)
(ohone no. \
Genera 1
Plumbinq
Electrical
~lechani~aIIU~rE~.IY ffi-..!"""~-1'7/c.$
PLUIIB I NG
ELECTRICAL
MECHAN I CAl
NO.
FEF CHARGE Nn
FFF rHARr.F NO.
I FTF CHARGF
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Res i dence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(I hathl
Duplex (1 bath) each
Additional bath
SERVICES
Reces sed wa 11
~n~r~ hp~tpr ?nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatiOCl or A.C.
Mechanical exhaust
hood ;lnd due t
l Hood stove/heater
lr - -I I
"" CA'~"."./>~ ~ '9"........ .
I
I
Sewer
Temporary Construction
Change in existing
r~c;.id,,:ncf?
multifamily, conm. or
Indllc;trial
Water service
COI1l-I./lNO. FEEDERS
Install/alter/relocate
dic;trih. fppdpr"
Of
amps.
ISSUANcr nF PFRtuT
TOTAL CHARGES TOT^l CHARGES
WHERE STATE L\l1 REQUIRES that the Electrical work be done by an Electrical
shall not be vali~ until the label has been signed by an Electrical Supervisor
TOTAL CHARGES ~.t".
Contractor. the electrical rortion of
and returned to the Building Division
r5.-
this penait
I HAVE CAREFUllY EXNlINED the completed application for permit. <lnd do hereby certify that all information hereon is true
and correct, and I further certify that any <lnd all work oerformed shall be done in accordance with the Ordinances of the City
of Spri n9 fi e 1 d and the Laws of the S ta te of OrelJon rerta 1 n i ng to the work descri bed here in, and tha t IW OCCUPArKY wi 11 be made
of any structure without the permission of the Ouilding Division. I further certify that my registration with the Ouilder's
Ooard 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 comoliance with OP.S 701.~~~~~t~
IlAIIE(please print)'0tl~ 9').J? (j;o h fLY,.,...,) SIGII^TUR~ _:YCdf~OATEJ,,'~ IS-kl
FOr. OrFICE IISE DrilY /./
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories'
Uni ts
Occy load
Occy Group
51"!. Hfl. l1aio
Sq. Ft~. Access
S~. Ftg. Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
Plan Ck. Carom/Ind
65%/Bldo Per Fee
------------ Plan Ck. Res
30%/Bl d~ Per Fee
Fence
Systems Development
Char~e (1.5%)
PLU'~BJNG PERMIT
Charges and
Surcharges
O~mo
ELECTRICAL PERIIIT
Charges and
Surcharges
Sidewalk
11ECHANICAL PERMIT
Charges and
Surcharges
!~~
7'
------------
.75"
A/C Paving
I Curb Cut
I
Total Comb. rermit
TOTAL
I :):7~
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I COMBINATION APPLICATION/PERMIT (CAP)
1. Appl icant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
17 oj 43
2, example- Lot 1, Block 3, 2nd Addition to
. 'Sprlngtjeld Estates' . '
C. Name. etc. of owner and construction lender
O. . Energy Sources ~, .
1. example- heat/electrical ceil in~q/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1, examole- 1250 sq. foot house. 500 sq. foot garage
2. exarnple- if new project. check-new - if addition,
check add. etc. .
F. Building permit information:
1. examele - construct single family house with an
attached 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 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 DIVISION 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 ~ 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'permi't is issued.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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PERMIT VALIDATION
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