HomeMy WebLinkAboutPermit Mechanical 1989-12-6
Bui16inQ Permit Info: Describe Work(i~e., Build Single
Family ~esidence Hith ,A,ttached Garaael
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I IrISPECTION L1IIE \ C() <::: !)" ,.C<!~ r CITY OF SPRINGFIEI.D
726-3769 l\)'~./ ~Q)H8IIIATION APPLICATION/PERMIT
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u-t't:>NL:::E'1e cr ""Z/I-eyNO Heat( -1\~
Hater Heater
Range
Valut of Hork:
Job Address
legal De5cription
Owner'
Is LlttJ d CoAl.rfRUc..J~~1!,)
900 N, TZlIt4.h4wk VI? Phonea.}3.'//II
Sv'it"E /S'V
Po /J ~I Awl at? "1'7,;1.( 7
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Address
Construction lender
Address
DESIGN TEAr.1
(name)
Phone
(address)
Primary
Structura 1
Electrical
11echanical
CONTRACTORS
{name}
(address)
Genera 1
Plumbina
Electrical
~1echani ca 1
~V~ qj. Pl<,ocE ~,.
;).0/5" tJU66erWA.-y, iEJ65J6.0( 77 to-,'-~7) 7I1-H(,;J,/
Pl.UI1B lNG
EI.ECTRICAI.
NO.1
-----lEach single fixture
IRelocated building
(new fix. additional)
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
FEE I rHARr.F No...... or>
Residence of
SQ. FT.
INew circu~ts alts.
or extenslons
ISERVICES
I
ITempOrary Construction
IChange in existing
resJ cj~.nce
I multifami ly, COI1111. or
Tndust.ri;11
IOf amps.1
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
rlic:;trih fpprfprc:;
Of amps. I
\>/ater service
Sewer
Storm Sewer
INFORl1ATION LINE
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
Fence_Demo _Change/Use
Other
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TOTAL CHARGES
WHERE STATE I.~W REQUIRES
shall not be valid until the
ISSUANCF OF PFRIIIT
TOTAl. CHARGES I TOTAl. CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
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 Spri ngfi e 1 d and the laws of the Sta te of Oregon pe rtai n i ng to the work descri bed herei n, and that UO 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 and employees who are in compliance with ORS 7n1.055 w~~e ~sed on this~roject. ~
SI/M~ D.i"o.e 5ClSEIl/ (=olt. CIf:7 ? --'0"'''' ":' fI7'-
IWIE(please print) 1+14-le,.l1t=y <1- o:k,"cE~. SIGIIATURE ~ '!' (/J~ Zd. DATE I ;1.~b -tel
Fon OFFICE USE Oill. Y (/
Sn. Ftg. IIain
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Fi re Zone
Flood Plain
Tyoe/Cons t.
Bedrooms
Stories
Units
Occy load
Occ'y Group
BUII.DING PERIIIT
Charges and
Surcharges
Plan Ck.
____________ ~/Blda
Plan Ck.
30%/Bldo
I Fence
I'oemo
I Sidewalk
I A/C Pavi ng
COllIn/! nd
Ppr Fpe.
Res
Per Fee
PI.UtIBING PERMIT
Charges and
Surcha rges
EI.ECTRICAI. PERIHT
Cha rges and
Surcharges
, -5
11ECHANICAl. PERMIT I"
~~~~~:~g:~d ,~Y'n - -~ ~ ~---
Curb Cut
MECHANICAl.
r"ABGI ,.1lQ..J
.~(rni~,s
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Appliance vent
s.eoariit.p
S.tationary evap.
cooler
Vent fan with
sinole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood and dlJrt
I \-lood stove/heater
I
1M\\:)~
I
x
Value
Value
Val ue
x
x
TOTAl. VAI.UATlON
Systems Development
Charoe (1.5~)
Total Comb. Permit
TOTAL
~
\ 6 :' ~ f
.
I-
COMBINATION APPlICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample~ Tax Lot 100, Lane County Map Reference
11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examyle- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. 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. example - construct single family house with an
attached garage
2. example - 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. 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 SCHEOULES
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
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PERMIT VALIDATION
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Permit
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED RY'
SignaO
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