HomeMy WebLinkAboutPermit Mechanical 1989-9-25
I INSPECTION LINE
726,3769
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.. INFORJtATION LINE
'IIlIIl;' 726-3753
Sq. Ftq. 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Pep.
--Fence Demo Change/Use
Other- -
- +- .........
Job Address 726 Rqyne ~ .,
legal Description \, Cy~ =>.~ \ \ ()( i\{)l!)
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOORCES:
Heat
l~ater Heater
Range
Address
Orland Dewitt
/"b Rayner
Phone
Owner
Spfd, or. 97477
Construction Lender
746-9720
Address
OE~IGN TEAH
(name)
Phone
(address)
(lics. no.l
(exo;resl
(ahOM no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(pxoirp~'
(OhMP !'In )
Genera 1
Plumbino
Electrical
Mechanical
Marshall's Oil & Insulation,4131 E st spfd or. 97478 25790 12/23/89
747-7445
PlOl1B I NG
ELECTRICAL
MECHANICAL
NO,
FEF rHARGE Nn
~~F rHAR~F NO
Fn' rl-lARhF
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath]
Duplex (1 bath) each
Additional bath
1 ~Iater service
1 Sewer
SERVICES
Recessed wall
So~rp kp~tpr ~nrl ~pnt
Storm Sewer
Temporary Construction
IChange in existing
, I"P~.iqenrp
Imultifamily, camm. or
Tnrllldr;al
10f amps,
I COMI'!. /lND, FEEDERS
I Install/alter/relocate
rlic.trih fpp(ipl"c:.
I Of amps.
I
Appliance vent
~~O~ ri'l. tp
Stationary evap.
cooler
Vent fan with
sinole duct.
I Vent system apart from
heatinq or A.C.
I Mechanical exhaust
hood and durt
I \'Jood stove/heater
I SSUANCF OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES I S, IS
WHERE STATE L\l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical rortion of this permit
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 aprlication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon oertaining to the work described herein, and that 110 OCCOPAllCY 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 701.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Marshall's Oil & Insualtion SIGIIATURE~_c-&.u~~~_
FOr. OFFICE USE DIlLY
So. Ftg, 11ain
Sq. Ftg. Access
Sq. Ftg. Other
DATE 9/25/89
NN4E(please print)
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
TOTAL VALUATION
x
x
BOIlOING PERflIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________...Q2I/Blda Ppr Fj:Ij:I
Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charqe (1.5~ '
PlUI~BING PERMIT
Charges and......
Surcharges
Demo
ELECTRICAL PERrm
Charges and
Surcharges
I'Side"a 1 k
I AIC Paving
___L~~__: Curb Cut
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
.
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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
II 03 4j
2. exam~le' Lot I, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air cas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. example' 1250 sq. foot house, 500 sq, foot garage
2. examole- if new project. check new - if addition,
chec K add, etc.
F. Building permit information:
1. exam21e - construct single family house with an
attached garage
2. exam~le - 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 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 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. ---
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
signa ture.
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
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I
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PERMIT VALIDATION
.~
q -Zlo,2J1
_~'l4q~
Permit
clerk~i10
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
'.
,-
PLANS REVIEWED BY:
, name
signature
date