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Home My WebLink AboutPermit Mechanical 1984-8-14 , ." I INSPECTION LINE 726-3769 Job ~ddress -.!:340TIlJL twnJX(l ) Legal Description \,(,)2?f'flJr) tll \ \ . . -m. L ')\1:' }hOne t J~ "4\~c) CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater Range_ __~_ ValuE of Hork:~ fA . ~ BuilriinQ Permit Info: Describe Work(i.e., Build yiiV t;ti1.i:h hmaoe1 ~ I NFORllATlON Ll Nt 726-3753 Sq. Ftg. Main .... ~q. Ftg. Access. ~ Sq. Ftg. Oth Ilew Ad lter Rep. --Fenc- emo Change/Use -0 r- -- Single ~ o ~ Address Ut~lliN ftAr" (name) Phone (address) (lies. no,) ~ (exni'res) {ohane no, I Primary Structural Electrical Mechanical CONTRACTORS {namel (address) (1 i('~, "0.) (pxnirp",) (onnnp nn ) Genera 1 Plumbino Electrical Mechanical Gt\ rimn ~\<:\. <\ ~.\.X.. PLUIIBING \,) ~ f'O (~ri('{\{JD: f'l~. ELECTRICAL ~44-r04 'X L MECHANICAL NO. FFF I...QjARGF NO "-EL ..cHARG.E I NO H~ r~ARG.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 S.F. Residence (] bathl Duplex (1 bath) each Addit i ona I ba th SERVICES } Recessed wall ~rp'rj:> hj:>;lt-o.. ;Inri \1I"'nt- I~~ ~- Of amps. Appliance vent s.eo!'lratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from [ heatino or A.C. I Mechanical exhaust hnnd ~nd nurt I \-Iood stove/heater I I irrn~ ~~'-i;rOC I I ~Jater service Temporary Construction IChange in existing rps i qp':nrp [multifamily, COJm1. or Tnrllldrinl 10f amps. [CO~~./IND. FEEOERS I Install/alter/relocate rli~trih fpprlpr~ Sewer Storm Sewer TOTAL CHARGES TOTAL CHARGES WHERE STATE UI~ REQUIRES that the Electrical work be done by an shall not be vali1 until the label has been signed by an Electrical I SSUANCf OF PFRlll T TOTAL CHARGES ~" If) .u:-: Electrical Contractor, the electrical rortion of this permit Surervisor and returned to the Building Division I HAVE CAREFULLY EXA~1INED the completed aprlication 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 Spri ngfi e 1 d and the laws of the Sta te of Oregon perta; ni ng to the work descri bed herei n, and tha t fW OCCUPAIKY wi 11 be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by O~S 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project. G~RI"EAY SIGIM~.J.6P'LDATE 14 Auf"i:5,'1 FOr. OfFICE USE miL Y . \1 Units Sq. Ftg. t1ainx Value Occy load Sq. Ftg. Access x Value Occy Group Sq. Ftg. Other x Value TOTAL VALUATlOtl llAf.lE(please printl"1<Ar p..,,€l Zone Type/Const. Bedrooms Fi re Zone Flood Plain Stories BUILOING PERfIlT Charges and Surcharges . Pl an Ck. Conm/l nd 65%/Rldo Ppr Fpp ------------ Plan Ck. Res 30%/Bldo Per Fee Fence Systems .Development CharQe (1.5~) . PLU!1BING PERMIT Charges and Surcha rges DfIlllO ELECTRICAL PERI~IT Charges and SuX'c:harges Sidewalk I I ~ 11ECHAN I CAL PERMIT Charges and Surcharges Ale Pavi ng _L5_ro___J Curb Cut .(9() I ITotal Comb. Permit I I TOTAL /6.&0 - I., COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax Lot 100, Lane County Map Reference 11 uj 43 2. example- Lot 1. Block 3, 2nd Addition to Sprlngrield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examEle- heat/electrical ce;l;nq/or forced air Qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. exam~le- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, chee k add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examole - 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. OESIGN TEAM ANO 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 ~ivision 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 0, 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 penmit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '" ~ ..... . PERMIT VALIDATION ~~ ~~ V\\~ ~3~~ - Permi t clerkr1t~ . . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date ..I '-" 34ce :I {'V\ "PRO \lED li~J \"'1'-1 r--':'-- J . 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