HomeMy WebLinkAboutPermit Mechanical 1988-1-14
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I INSPECTION LINE
726-3769
Job Address
legal Description
Address
DESIGN TEAt1
Primary
Structural,
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbing
E1 ectr; ~,~ 1
~1echanical
NO.
Each single fixture
.
.
-1
CITY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
1!J~.-./JtA ~/ ./ ~~~~GY SOURCES:
- -t/ '-j, I~ater Heater
Range ___
---
ValuE of Work:
~h20
(name)
Phone
(address)
Owner diiv; ~,
Address ':3(" ';201 ~f?'" CUh Phone'72b
h .lILUu~ e.a..v ~ /2.L--J,c7 aM / (j/ N
-constructiJ,n LenJ'e~ I
f: -~~ ~
~~/ ~~
~ . 0
(name)
(address)
PLUIlB I NG
F" rHARr,E Nn
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(] bat.h 1
Duplex (1 bath) each
Additional bath
Wa ter serv; ce
Sewer
Storm Sewer
Temporary Construction
Change in existing
rp'i i dy.nrp
Imultifamily, camm. or
Indllc;triill
10f amps.1
ICOW1./INO. FEEDERS
IInstall/alter/relocate I
rl;~tr;h fpprlpr~
IOf amps.
I
I
I
SERVICES
I
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INF0R11ATION LINE
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Pep.
-Fence Demo Change/Use
Other- -
Of)
tx:l
8
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BuiltiinQ Permit Info: Describe Work(i~e.t Build Single
Familv nesidence With Attached Garaae1
Jb~abn /)/j di2~f}
/J .,- () h.t d#.. ,..---..
IWW C.V:", :;:;1-
(1ics.no.1
(exnires1
(Dhonf~ no..
0, 4 .\":"
1
3'3'1'3
/1<>)
(1 ir:fO. no.1
(pxoirpfO)
(ahonp nn,)
q rfC/- ;)t./f? /
ELECTRICAL
MECHANICAL
~rr r~~ NO_
rrr fl:iARG.E.
SQ. FT.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall I
<;.,,,,,.,,,, h""",t-""... :Inri l/...nt" :
Appliance vent
seoaro'tt.p
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hnod o'tnd du('t
Wood stove/heater
ISSUANCE OF PF.RltlT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l~ REQUIRES that the Electr;cal work be done by an"Electrical Contractor, the electrical portion of this permit
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 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 OCCUPAUCY 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 ~"n~J :m'(PlO::;~~~O /:~Ji~:mOliance with ORS 701.055 Win ~:A used~n_ t:s jOject.
IlAl-1E(please print) '1/,1", .L/~=-H,4,.lr.J SIGNATURE tJ"'-vr iJ-J~ DATE I-rtf-it
FOR OF.FICE USE miL Y Y
Sq. Ftg. r1ain x
Sq. Ftg. Access x
Sq. Ftg. Other x
Zone
Fi re Zone
Flood Plain
BUILDING PERfllT
Charges anc
Surcharges
PLU'~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI\IT
Charges and , I
Surcharges i
11ECHANICAL PERMIT
Charges and \ _
Surcharges 'P
Type/Canst.
Bedrooms
Units
Occy Load
Occy Group
Stories
Plan Ck. Comm/lnd
65~/8lrln Ppr r......
------------ Plan n. Res
30%/Blda Per F..
I Fence
------------
I Demo
____.!.S o'Zl ISidewalk
,75 I AlC Paving
15- ~ I Curb Cut
--------.75-1
Value
Value
Value
TOTAL VALUATION
Systems Development
CharQe tl.5~) .
I
I
I
I
I
J
Irotal Comb. Permit
I
I TOTAL
3/.50
/
.
.
~
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
11 03 43
2. example- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilino!or forced air qas
2. exalllPle- waterheater/electrlCa(/or ~
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examyle- if new project. check-new - if addition,
check add, etc.
F. Building pennit information:
1. examole - construct single family house with an
attached garllge
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 infannation 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
I. 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
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.
/tJ'tt??
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V. FOR OFFICE USE ONLY
Permit Cl erk
(JJJ 0/
PROJECT CONOITIONS 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