HomeMy WebLinkAboutPermit Mechanical 1989-5-8
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'726-3769 .
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Job Address t~A LoCl (,0 m 0 8f) \1 m ~~ . ~~~~r,y SOURCES:
l.e9.1 Omription \ 'lO:\;:{ 8. \ a n~ncx) -, I/.ter lIeatcr
RanrJe___
_fl (\ I.... ~,.... J ValuE" of
Owner \.,,\Q \-X'?\ \\l.. 0 rtu::'-n fJ yff\ ~
::2.."::2..1 ,.............. /A"- -, fr~ - OuiltiinQ Pe lit Info: Descrlbe Hork(1.e., Build Single
Address \._J'--J\..O\.. ) ~~l. (Y19- ...-::::\r"\. TI rY'!lonc rc1r.lilv r.esidence Uith "ttached l'iaraae)
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Add re s 5 Phone
UDllir/ltJ\/1 {name) (address)
LIlY ul SI'RlIIGf IELU
CO/1BII/ATlON APPLICATION/PERMIT
tlfORlIAT: .:1 Lt..:.
726-3753
So. Ftq. '-lain
~q. rtl). Access.
SQ. Flq. Other
Ife'" Add JI.1ter ~~eo.
-Fence Demo Change/Use
Other -- --
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(I ics. no.)
lexolres I
lohone no. I
Primary
Structural
Electrical
!1echanical
CONTRACTORS
Plumbino
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(-lCU'\ \)(\ q. c\\\<:l\\-\-:U\0.\? 4iL('n L:)'~~,'\t\J Po 11,' l{l\4,-lJ9 ~ ~-M~\ I
PLurmlllG \J (J ELECTRICAL q MECHANICAL I
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Res idence of
(nome)
(addrpss)
(I ics. no. 1
(plmirpc;,\
(ohnnp fin.)
General
Electricdl
~lf?chaniCcll
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-----lEach sinqle fixture
-----jRelocated building ---/--
(new fix. additional)
IS.F. P.esidence
(1 bathl
-----louPlex (I b.th) e.ch
IAdditional bath
sq. FT.
f),OC'
New circuits alts.
or extensions
?50
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ISERVICES
1-'
Hater servlce
jTemporary Construction
IChanqe in existing
rp~ldrnr:~
Imultifamily, (OOr.!. or
Indu<;trial
Sewer
I Storm SC\'lcr
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3/1l!'>s.1
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IC01~'1./INO. FEEDERS
losla 11 fa 1 ter/re locate
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r IIAVE CAl~UULLY EXN1JrI[[) t~le completed apfllication for ~ermit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of OreC)on pertaining to the work described herein. and that UD OCCUPAIlev \~ill be made
of any structure without the nermission of the Ouilding Division. I further certify that my re~istration with the Ouilder's
Bo.rd is In full forc~~ effect as re~uired by Or.S 701.055, th.t if exe:;~e b.sis for exemotion is noted hereon. .nd th.t
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FOr. orF I C~ USE OIIL Y " I
Zone
Fire lone
Flood Plain
Tyoe/Cons t.
Oed rooms
Stories
Uni~s
Occy load
IJcc:v Group
Sf!. rtn.
SQ. Ftg.
Sq. FIg.
f1ain
Access
Other
x
Value
Value-
Value
x
TOTAL VALUATIOII
BUILOIUG PERtHT
Charges anc
Surcharges
Conm/l nd
Ppr Fpe
R-es
Per Fee
Syster.Js Development
Char"e (I. 5')
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& ,c9-~
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Plan Ck.
65t/Bldn
PI.n Ck.
'30%/Bldn
PLUI'OING PERMiT
C~Jrgcs Jnd
Surcha rges
Fence
I Of-mo
\ "5 .OU I Sidewalk
-----~75 IA/CP.vin"
-j<::l-:SD__' Curb Cut
,0. Il I
ITotal (amb. rp.rmit
1_,
Ill.'Tf\l
. [LECTRIUL rERr~iT
CharQcs and
Surcha rlJes
I1ECtlAlll CAL PErH I T
Charges and
Surchilrl'JeS
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
1/ OJ 4J
2. examnle- lot 1. Olock J. llld Addition to
Springfield (states
.C~ Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ccillnq/or forced air qas
2. example- watet'heater/clectnccl~/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. exampJe- if new project. check-new _ if addition,
check add. etc.
F. Building permit infor/MUon:
1. examole - construct sinyle family house with an
attached garage
2. examoJe. r~nodel existing garage 1nto family room
3. examole - convert single family residence into
res taurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structu~al SpeCialty Code
H. DES I GN TENI AND COIITRACTORS
To avoid deSign or conSlr'uction delays, Building
Division Staff ~ust be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Nechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fil1.in only the Ho. Boxes adjacent
to the appropriate item(s) to be installed
8. 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
Z. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu I es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AIIO
CHARGES 011 TIlE SCHEOULES
O. As noted on the CAP, the label must be del1vered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not author'ized
to sign the electrical label.
Ill, 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 pJans ,,,,ill be processed unUJ these
fees are paid. All other fees and charges are due and
payable when the permit is issued,
V. FOR OFF! CE USE OIlL Y
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
QL
\'5flfl 9
8-8 ~81
f
PermitClerk dt/Ja ~
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Permit applicant exempt from registration with .the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
~
date
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