HomeMy WebLinkAboutPermit Mechanical 1990-7-30
I EC 0 I E ~ CITY Uf SPRINGfIELD
~~~~371~ N L N ,.., COMBINATION APPLICATION/PERMlr
Job Address !~~7 f!2n eeV f4-ehtt1 /'f' '/ ' '" ~~~~GY SOURCES:
Legal Description 171J3ZA~2:~ nt/KO, Ilater Heater
Range
ValuE of Hork:
!lLIA
Bul1ciinQ Pennit Info: Oeser be Work(i.eo. Build Single
Familv nesidence With Attached GaraQel
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'1/1(1dpx C,1i)j "f-f'V ,ffi:~
(P U /1/ (-Is i1J.v.).' {,Cl1d er V"Z-f?tJ J
{lies. no. 1 (~xnires\ lbhone no.
.
INfOR/IAllON LINt
726-3753
Sq. Ftq. 11ain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter Rep.
-Fence Oemo Change/Use
Other- -
~
D
o
').)
I-J
,06
I
Owner s7/1I{ V~ 'S M(LIIl(l~/fVlhr+ r 4J "
Address j 303 t; fJ fAI (' j) VVJ elP/oone ~1~;
fud/a.hd. 0(2. C[,7223
Construction Lender
Address
OlSIGN llAM
(narnel
Phone
{address'
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
{namel
(address'
(lies. no.'
(exn; res l
(ohane no. l
Genera 1
Electrical
(lJ;1M mevC-'7 fJ ~ tel-r;bztfT>ivJ
S'l')O All' G-l'
PLUI1BING W-\\ev.-.a> p , en>I"J
FEE CH1IlGL Nn
.'" ~S::l11
""/'11
";).~'-I {,(.J4J
Plumbino
M~~hani~~l
ELECTRICAL
MECHAN I CAL
NO.
<FF rH~~,
F F "- LJJAIlliE-
SQ. FT.
furnace/burner to
BTU's
Each Single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~cp ~p~tpr ~nrl vp~t
Storm Sewer
Of
amps.
Appliance vent
s...eo~r:at~
Stationary evap.
r;noler
Vent fan wi th
sin91e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ~ nd due t
Sewer
Temporary Construction
Change in existing
re5- i ~Jlce.
multifamily. camm. or
Industrial
Water service
COMM./IND. FEEDERS
Install/alter/relocate
~i~trib. feeders
Hood stove/heater
Of
amps.
{" ~ pvp<;s"r-
~,
'o",! 4.J
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I SSUANCF OF PFRllI T
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES .1
HHERE STATE UII REQUIRES that the Electrical work be done by an, Electrical Contractor. the electrical rortion of this remit
shall not be vali~ 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, 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 ons 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 701.055 will be used on this project.
IlPJolE(please print~ /l-/i;r.T M/) .,L/7r{ SIr,NATURE~~%
FOP. OFFICE USE miL v /
v
Sq, Ftg. liain
Sq, Ft9. Access
Sq. Ftg. Other
OATE 7 j, a0/)
/
,
Zone
Fire Zone
Flood Plain
Type/Const.
Bed rooms
Stories
Units
Occy Load
Dccy Group
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILOING PER~lIT
Charges anC:
Surcharges
Plan Ck. Comm/Ind
65t/Bldo Ppr Fpp
- - -- - -- -- - - - PTan Ck. Res
30%'BldQ Per Fee
Fence
Syste~s Development
Charoe (1. 5~ '
PLUt1BING PERMIT
Charges and
Surcharges
OtilllO
ELECTRICAL PERIHT 'Sidewalk
Charges and ------------
Surcharges A/C Paving
Total Comb. Permit
l
MECHANICAL PERMIT
Charges and
Surcharges
__~Ie~OQ.___ Curb Cut
\.~O
TOTAL
~l.~()
J
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Oescription
I, example- Tax lot 100, lane County Map Reference
1/ OJ 43
2, example- lot 1. Block 3. 2nd Addition to
>prlngtield Estates
C. ' Name. etc. of owner and construction lender
O. Energy Sources
1. examEle- heat/electrical ceilinQ!or forced air Qas
2. ,.examDle- waterheater/electrlcal/or solar
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. examyle - 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 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 Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. I f the item( s) to be ins ta 11 ed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BOIlDING DIVISION STAFF WILL FIll OOT 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. -
I I 1. Appl icant 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.
~c;a , d..
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V, FOR OFFICE USE DNlY
Permit' Cl erk
g~
.
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
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