HomeMy WebLinkAboutPermit Mechanical 1981-8-5
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INSPECTION LINE
726-3169
CITY OF SPRINGfielD
COMBINA IICN APPLlCAflON I PERMIT
~C<5"-n.t Si. 5P/',-nc.{;-~/d
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l.gaIO",do,'on J7-o~ -;2~-41 I/.... 5000
ENERGY SOURCES:
Heat
Wal~r Healer
Ronqe -
Value of Work:
Job Add,e"
j 1; It.
0_1'111'
,T""'",, J) C", /t'c-.,
,
/" / (.. F/""",..-:.:o_ M it 5t- _ phon. 70- ? 0,' \-
5"'r;"YC.;~,{J. O/"::c."~ :9'>,,::> ')
INFOIZMATION LINE
nb-J7SJ
. Sq. FIg. Main
Sq. fig. Aceon.
Sq. ftg. Other
_New _Add _Altef _Rep.
... _F.rlce_Demo_Chonge; U ~lI
_Olh.,
OQ.
.......1
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Building Permit Info: De"ribe Work ii.e.. Build Single
family 'R"!,idenct!' Wif:. Alloched Goroqel
WtHttJ~
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Addre"
Con,Uuclion lender
Add,eu
Phone
DESIGN TEAM
(oddraul
(Iin. no.)
(namei
Primary
Structural
Electrical
Mechanicol
CONT~ACTORS
(nome\
(address)
Oics. no.)
Gt'neroi
Plumbinq
fleClrical
j.\e~hanical
?LUMBING
ELECTRICAL
NO.
f::=
CHARGE j NO. I
FEE
CHARGE I NO.
Residence of
Eacn ,inq[e f;.o;lure
R",localed building
(ne..... till. additionall
S.f. iI:.es.d.n~.
(l both)
SQ: ft.
New circuits. allllrol;olls
or elittensians
SERVICES
Ouolell: !1 balhl each
Temporory Construction
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Additional bOTh
Amps.
Watl'r ,er...ice
Sew.r
Slor.m Sewer
fEEOERS
Ames.
TOTAL CHARGES
I TOTAL CHARGES
(elitpires)
(phone no.)
(upires)
f)hone no.)
MECHANICAL
FEE
! CHARGF~
furnaCD/ burner to
IlTU's
Applianc. ....nt
seporate
Stalionar;' ....op.
cooler
Vent fOil with
sing I. duct
Vent system aport from
heotj~g or A.C.
Ml'chanical oxhoust
hood and duct
Wood stove/healor
s~
Heat Puma
Air handler to
10.0i'0 CF M
Air hondl., o....r
10,000 CFM
ISSUANCE OF PERMIT
10 Co
I~~
TOTAL CHARGES
WHERE STAlE lAW REQUIRES Ihllll th. Electrical work b. don. by the Ele..trical Contractor, the ./ectrical porrion of this p.rmit shall nol b. valid until a
10b.I hos bun ,i']nod by an Electrical Contractor and attach.d to tho el.ctrir:ol pan.l.
I HAVE C~EFULlY EXAMINEO the complefed application for permit, and do hereby certify that 011 information hereon is tru. and correct, and I fu,tj,(/r
ce,tify that ony and all work performed sholl be done in accordance with the Ordinanc.es of Ihe City of Springfi.ld and the lows of Ih. StalG of Oregon
Pllrlaining to the .....ark c!llICrioec.i herin~ and Inot NO OCCUPANCY will b. mod. of any structure without the p.rminion of the Building Oi'li,ion. I furthcr
certify that my regiSl'Totion wiln the Builder's Boord h in fuJl force and effect as required by ORS 701.055, that if" exempt the basis for exemption is nol.d
h.ron, and that only submnrroctors and .mployees who ore in compliance with ORS 701.05.5 .....iII b. u~ on this project.
Bo,is for Builder's Boord elitemption-
NAME (pl.o,. printl
ililGNATURE
3L.
I~'
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DATE
g-~--'iJ1
FOR OFfiCE USE ONLY
Zone
Fire Zone
Flood Plain
Type/ Canst.
~droom'
Sq. Fig. M;:(in
Sq. Ftg. Access
Sq. Fig. Olh.r
~foriel
Units
""'ccy load
'Jeey Group
BUILOING PERMIT
Chorgo, and
Surcharges
Plan Ck. Comm/lnd
65<::.1 Bide Per Fee
Plan Ck. Res
30~:'1 BId,.. Per Fee
PLUMBING PERMIT
Chorges and
Surcnarges
Fence
I Tala/ Comb. P~rmit
Dcma
ElECTRICAL PERMIT
Chlllrge' and
Surchor9u
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I TOTAL
Sidewalk
IttI("P,.,vi"o
MECHANICAL PERMIT
Choroe, and
Surch.arges
_____L$.I!IO Cu,b Cu'
,("CJ
Value
Value
Voluo
TOTAL Y AlUA TlON
.
Systems Oe"'lI!lopmllnt
Charae (1.5%)
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COMBINATION APPlICATlONtRMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Descri ption
1. examole.tax lot 1 DO, lane County Map Reference 17 03 43
2. example-lot 1. Block 3, 2nd Addition to Springfield Estates
.C. Name, elc. of owner and construction lender
D.. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. exam ole-water heater/electrical/or ~
E. Square footage or valuation, etc.
1. example-I 250 sq. foot house, 500 sq. foot go rag. r-
2. example.if new project. check new-if addition. ch ',~.
add. etc.
F. Building permit information:
L examole-construct single family house with an at. \p
garage
2. example.remodel existing garogb into family roo
J. exompie.convert single family residence into
restaurant (change of use)
G_ Value of work os defined in Section 303 (a) of the
Structural Specialty Cede
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divi!
Staff must be able to contact appropriate persons re~ /.'_
design jnf~rmation or job site corrections, et~.
II. Abbreviated Plumbing, Mechanical & Electrical Schedule
A~ Except where.blank spaces occur in the description pc fl.
of the Mechanical and Electrical Schedules, the applic ~.
need fill-in only the No. Boxes adjacent to the appro,
item(s) to be installed .
B. full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To cons.e'rve space on the permit form the sched'vle
hove been abbreviated .
2. If the item(s) to be installed ore not covered on the (1-
ated schedules you should consult the full schedul.
C. BUilDING DIVISION STAff Will fill OUT All fEES AI
CHARGES ON THE SCHEDULES (
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PERMIT VALIDATION
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
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No.
B 57021(
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Date j( - <;' 19h- 1
Rec'd From .~,.,/~ U~
Address ';tJ/(; ea.. :'Y7:.-xL Lf, /1
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Received Far:
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III. Applicant to sign and dote
Whenever possible, the initial application will be used as
worksheet only. Where possible, Building Division Staff y
prepare a typewritten copy and return it to the applicant
the time the actual permit is issued for his signatur€..
IV. Fees and Charges
Plan check fees are due and payable at the time of the 01
and no plans will be processed until these fees are paid. .
other fees and charges ore due and payable when the pe
is issued.
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Amount Received
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4UTliORIZIID SIGN..TUIllr;
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'HUTO"'TUIU..ULL ""'''T'U'' . luO.'U 0" .7.0,
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
';'00,"" A ~
"'ate %' -~-x-/
PLANS REVIEWED BY,
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