HomeMy WebLinkAboutPermit Mechanical 1988-10-25
I INSPECTION LINE
726-3769
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INFORlIATION LINt
726-3753
Sq. Ftg. I"ain '
~q. Ftg. Access.
Sq. Ftg, Other
New Add Alter Rep.
Fence _Demo_Change/Use
_Other
~
~.
~
Job Address
,3 c{ q l/
CITY OF SPRtNGFIElD
COMBINATION APPlICATION/PERMIT
tJ..I'. r EIIERGY SOURCES:
v J /'h.. /)/ A' ./ Heat
I \later Heater
legal Description
Owner' r~ /~/
Address ~ 'i q 1 ~ r--r ~
Range
--
ValUE of \lork:
Phone
BU11riinq Permit Info: Descr,be Work(i.e., Build Single
Familv Residence With Attached Garaae)
CfhJ, ~ 8rU //~
'hp'l/.2bc....
I
Construction lender
Address
Ut>JbN TtAI1
(name)
Phone
(address)
(lics.no.)
(exoires)
(ohane no.
Primar,v
Structura 1
.-.....e2
t?Jl-{J.- -J )
Electrical
Mechanical
CONTRACTORS
Genera 1
(name)
/
1"\1/ (/)-
If)t(JAlJI' ~~ r I 'l~
PLUI1BING ELECTRICAL
(addrps"l
(1 ics. nn.)
(pxo;rps'
(ohnnp !'ln, ,
Plumbina
l,f~Y
Electrical
~lechanical
MECHANICAL
-..BQ."
FEE' r.HARGF NO
'IE-..cIlARG.E. Nn
SQ. FT.
furnace/burner to
BTU' 5
rU-I..cIlARG.E.
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
SERVICES
Recessed wall
~n~~p hp~t~r ~nrl v~nt
Storm Sewer
Of
amps.
Appliance vent
s~oaratp
Stationary evap.
cooler
I Vent fan with
sinoh~ duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and du~t
Wood stove/heater
Additional bath
Water service
Temporary Construction
Change in existing
re'S j qenre
multifamily. corrm. or
Tndu<:.trial
Sewer
COMfl./IND. FEEDERS
Install/alter/relocate
di~trih f~~d~r~
~t7J
Of
amps.
ISSUANCE OF PFRlm
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAli REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this pemit
shall not be vali1 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 performed 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 Oregan pertai nj ng to the work descri bed herei n, and that NO OCCUPAUCY will 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 ons 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 be used on this project.
Units
Occy Load
Occy Group
<::::)
SIGNATURE ---^Sdl \
FOP. OFFICE USE miL Y
Sq. Ftg. l1ain
Sq. Ftg. Access
Sq. Ftg. Other
~
DATE ID-'Z<;-~
NAME(please print) ~L~
\\-\ c-,,\ H. L
ZonE"
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
\
>
Value
Value
Value
>
>
TOTAL V ALUA Tl ON
BUILOING PERfIIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Bldo Per Fee
------------ Plan Ck. Res
30%/Bldo Per Fee
syste.ms Development
Cha roe [1. 5~) .
PLUl1BING PERMIT '.' Fence
Charges and.--'" ------------
Surcharges O~o
ELECTRICAL PERfllT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and 6
Surcharges
'Sidewal k
AIC Paving
Total Comb. Permit
. 00
____J.5_,____
.7')
Curb Cut
/~~
TOTAL
ISr7S---
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.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilinq/or forced air qas
2. example- waterheater/eJectrlcal/or ~
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cheCK add. etc.
F. Building permit information:
1. example. construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam~le - 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.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.
( ~~~2---'
I 0 - ;;L 5 - y~
V. FOR OFFICE USE ONLY
Permit Clerk CL-
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