HomeMy WebLinkAboutPermit Mechanical 1982-10-28 (2)
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Job Address 112/ /' /.~r-,
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legal De<cription ('?'07.7l-.:J. -ex,., 0::7,.t70/
CITY OF SPRlilGFIElD
COIIBHIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
~'Iater Heater
,
INFORIIATION UNt
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
-Fence Demo Change/Use
Other- -
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IIIISPECTIOII LIIIE.
726-3769
Owner 5H?/~F/e.cD /NVC:57/77ch'T ~.
Range
ValuE. of Hark:
Address
Phone
Bul101no Pemlit Info: Describe Work(i.e., Build Single
Familv Residence With Attached Garaae)
Address
DESIGII TtAl1
(name)
Phone
(address)
"-f\\ ~cu))J' 51- \) ~Slf~llt
(chone no.\
(1 ics. no.)
(exoires)
Construction lender
Primary
c< c.---'. '7-~.5 /1. //74YCR'
/~) #4# :5?: 6~6; ciTE
5S1'o-- :37//
Structura 1
Electrical
Hechan; ca 1
CONTRACTORS
(name)
(address)
flie,,_ .no.)
(plmirps)
{ohnnp. nn l
Genera 1
Plumbina
Electrical
~'~c:hanieal
P~Gr/.?G""R :S:4cE7 ~r<::::.
PlUllBlIIG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGF NO
FFF rHARr,F NO.
SQ. FT.
furnace/burner to
BTU's
FFF rHAor.F
,/.
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
So~~P hp~tp.r ~nrl vPot
Storm Sewer
Of
amps.
Appliance vent
seDarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
r€l~idpnc€l
multifamily, comm. or
Industrial
~Ja ter servi ce
amps.
I
I
-'. I ~ I
/TL-TC?j'" ,. ~'.c:::;; r~
.(;bC7we>h4' I
I I
Wood stove/heater
CO~1./IND. FEEDERS
Install/alter/relocate
di,trih. fppdprc;
Of
G<>.o
I SSUANCf OF PFR!lIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an,.Electrical Contractor, the electrical portion of
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED 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 OCCUPAIKY 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 ORS 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 7nl.055 will be used on this project.
/0. C>O
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thi s permit
IIAI-IE(please print)
Zone L:. C
Fire Zone
Flood Plain
Tyoe/Const.~<<, -/,hL;!? -Units
Bedrooms Occy Load
Stories Occy Group
S IGI1ATURf
FO" QFFT~: USE OIll..Y
Sq. Ftg. Ilain
Sq. Ftl]. Access
B- ;> Sq. Ftg. Other
DATE
x
x
x
Value
Value
Value
TOTAL VALUATION
BUILDING PERMIT
Charges anc
Surcharges
Plan Ck.
65t/Bl dn
Plan Ck.
30t/BldQ
____________1 Fence
I Demo
I Sidewalk
------------1 A/C Paving
_n_.L~':~nl Curb Cut
. C. r I
Comrn/Ind
Ppr Fp~
Res
Per Fee
Systems Development
Charoe tl.5r,) .
PlU11BING PERMIT
Cha rges and
Surcha rges
ElECTRICP.l PERI:IT
Cha rges and
Surcharges
IIECHANICAl PERMIT
Charges and
Surcharges
TOTAL
10. ':;:::0/
/b .C;r
Total Comb. Permit
"... -.
~
COMBINATION APPLlCATION/PER.'IlT (CAP)
!
III.
V. FOR OFFICE USE ONLY
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CITY OF SPRINGFIELD
.
(;
City Hall
Sprlngflald. Oregon
Department 01 Public Works ( .
OFFICIAL RECEIPT,
No. B 59909(
(
DateO......r. :::?&. 19 B~
Rec'd From ,4,UE tll L. <j n /-1
"< 7'/ ~ cle'S.5/<-9C. .c::/ h< c. c-
Address ~-z;,I='e::>.Jl?.b ~.
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Received For:
.d'7 cc:../f .
T-~~
/(;', 00
..61
ItS-6'~
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map
17 03 43
2. example- Lot I. Block 3. 2nd Addition (
Sprlngtield Estates
C. Name, etc. of owner and construction lend.
D. Energy Sources
1. examole~ heat/electrical ceilin~/or f. 'd
2. examole- waterheater/electrical/or so
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house. 500 sq.
2. example. if new project. checknew -' adr
check add, etc.
F. Building permit information:
1. example - construct single family hou:
attached garage (
2. examole ~ remodel existing garage intI
3. examole - convert single family residl.
restaurant (change of use)
G. Value of work as defined in Section 303 (; (If
Structural Specialty Code
H. DESIGN TEM1 AND CONTRACTORS
To avoid design or construction delays. BJ
Division Staff must be able to contact apl ~.~i
persons regarding design information or jr
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrica'
A. Except where blank spaces occur in the de: (p.t
portion of the Mechanical and Electrical ~
the applicant need fill-in only the No. Bl
to the appropriate item(s) to be installel
B. Full Plumbing. Mechanical, and Electrical (eo.
are available at the Building Division
1. To conserve space on the permit form :
have been abbreviated
2. If the item(s) to be installed are no' t',
the abbreviated schedules you should f
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL
CHARGES ON THE SCHEDULES ( .
D. As noted on the CAP. the label must be de'
electrical contractor for signature by hi~
supervisor. The general contractor is.n01
to sign the electrical label. - (
Applicant to sign and date '; \
Whenever possible, the initial application wi.... _~ '__n __ .
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.
lV. 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 penmit is issued.
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- ; AUTHORIZEDSIG~TURE"""'- \~....
BRIGGS "RINTIERS/LITHOGRAP'HlI!:RS. lI!:UQlI!:NIE. ORlI!:GON
Amount Received
..~.-..........,..
Pennit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Pennit applicant exempt frDm registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signatured~ ~~~e
. "
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