HomeMy WebLinkAboutPermit Mechanical 1991-11-25
I INSPECTION LINE
726-3769
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EllERGY SOURCES:
Hea t V--
l~a ter Hea ter
Range
ValuE of ~Jork:
T:,CX,J.) M-
Bul1riinQ Permit Info: Describe Work(i~e..
Family nesidence With Attached Garaael
.
INFORlIATlON LINt
726-3753
Sq. Ftg. "lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Poep.
-Fence Demo Change/Use
-Other - -
Phone
Bui ld Single
~
~
o I~""p;c...
p~c:l, O? qll.j7~
/ ?-do~~5e>-.s-c=>_ 6/~~
Owner EI'\'\ eC-ct \~\' \-h, cl rC:U-l \;c...!
Address 3Lf78 Ol"~MOlc...
/
Job Address
32yc:>
oS
legal Description
Construction Lender
Address
Ut, I oN I tAI1
(name)
Phone
(address)
(lies. no.)
(exoires1
(ohane no. ')
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
f1 ;ce;. nn. l
(pxoirpc:)
(ohnflP nn. \
General
Plumbina
FfF
rHARr.F
~I'{O \~I'l..) IG.I
E, c!;-\-. S p.fd, c:t2~L/~
~HANICA;:' )
NO.
ma. (oS ~ \\j
P~G
I
-"7 Lf/-1V~-
0:1 + 1, ~.s" ~at.'~ /" Lf/3/
EL~L
Electrical
~'echanical
Nn
H<
r"MJiE. J!O.....
<<<
r"~
Each Single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Recessed wa 11 I ~ Jr? ""...
"2 Sl"r~ ~"'fJ'r 'lnrl \P~t Ie,. ,..c.
~~ t~~ ~.:::;I
App 1 i ance vent - ~
c;,eoar<ltp
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart from
heatinq or A.C.
I Mechanical exhaust
hood <lnd durt
l'I~sta~l/alter/relocate I I Wood stove/heater
dlc;,trlh. fppdprc;.
IOf amps. ~ _ tl.. rp,!.J~:~'..\k~"~
V Ow 'Ae.{ S '</J,I,' I')~ - _It 0,"" "" oS ~"ot;"':t'~
I I IT 1 ' I '.L 1'>-00' Cl> "'f'~: . fife
~ n~4. ~":-j-l.t(\I'~ ~, tlltoJ D'~fW-^Il
I . r' ISSUANCf 'OF PFRlm /D. aro
TOTAL CHARGES TOTAL CHARGES /b~-o;,
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
SERVICES
~Ia ter servi ce
ITemporary Construction
IChange in existing
rpc;.idpn('p
Imultifamily, comm. or
lnduc;,trial
10f
ICOMH,IlND. FEEDERS
amps.
Sewer
Storm Sewer
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
I HAVE CAREFULLY EXAHINED 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 Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that 110 OCCUPAllCY 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 employees who are in compliance with ORS 701.055 will be used on this project.
Md{.1h.a\\~ n:, "\- n . A.ln:.I>-#'
IlAf.lE(please print) ~ n...{... \,,-f r""," SIGtlATURE 11I1A.L/jI,"IV 114.II.)A,}..
FOr. OFFICE USE OIILY-
Sq, Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
DATElI-1..S _c:q
Zone
Type/Const.
Bedrooms
Stories
Units
Occy-load
Occ.y Group
x
Value
Value
Value
Fire Zone
,
Flood Plain
,
TOTAL VALUATION
BUILDIIIG PERflIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65~/BldQ P~r ~pp
Plan Ck, Res
30tlBldo Per Fee
Fence
Systems Development
Charoe (1.5~)
PLU'1BING PERMIT
Charges and
Surcha rges
D~mo
ELECTRICAL PERI~IT Sidewalk
Charges and -----------_
Surcharges /~ v.. '-I/~T /6_.... A/C Paving
11ECHANICAL PERMIT Ib,d> Curb Cut
Charges and ______....e_____
Surcharges ,. ~f?
Total Comb. Permit
TOTAL
?6-$c::>
.
COMBINATION APPLICATION/PERMIT (CAP)
"
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot lOa, Lane County Map Reference
17 03 43
2, exa~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinqjor forced air qdS
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, SOD sq. foot garage
2. example- 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 WjLL FILL OUT ALL FEES AND
, CHARGES ON. T.HE 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
~
PERMIT VALIDATION
"
.., '.
;ljc,-o/# ~6 "3/~ /
/1-7S-9 r
Permit Clerk ~~ .
r ':'7
.
Permit applicant exempt from registration with the Builder's Board because:
I
Additional Project Information:
PLANS REVIEWED BY:
name
signature
da'te