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Home My WebLink AboutPermit Electrical 1990-1-4 I INSPECTION lINE . . 726-3769 Job Address /,~ ~;/;;, ,d';--# 57 ~ CITY Uf SPRINGfIElO COMBINATION APPlICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater I Ran~e : ValuE of Hork: owner,.V:~.t:447__>~ ,y/K<P/""_c-:r', ~/..-A- k~ ~ 'All / . , Builoinq Pennit Info: Describe Work(Le.. Build Single Address I ~~ W ,,1 ??'--. Phone Family nesidence Hith Attached Garaoel -?~h ;Y-:::j. 7lE~r;?:.- C:~'~/.""r~ ,~..... Construction lender . L~e? A!/~~ .........~~L=__ "'::-~ . INfORlIATION UNt 726-3753 Sq. Ft~. l'lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- - t I~ . legal Description Address UI:.S lliN r I:.Ar"! (name) Phone {address I {l ics. no. 1 (exnires 1 (ohane no.-) Primary Structural Electrical Mechanical CONTRACTORS (name) {address I ,General ~71/.c ~s~.(')9:r-.6~ Plumbino ~EL~ r~ - Electrical ?~,.?.J:>~ . ~1echanical (lir:c;__f'lll.) F'fHtlq~ (oi!ll4; ) I 1 (ohane no.) 7% -.5'?:75 PlUt-IBING ElECTRICAl MECHANICAl ..J!P , FFF rHAR!';F tJ{l I ~j:j: rl-l'lRGf. In n"F rHAR.G..E.. ?5"P ?<>. - SQ. FT. furnace/burner to BTU's cr Each single fixture Residence of Relocated building (new fix. additional) S. F. Res i dence (] hath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~cp hp~tpr ~nrl vpnt ~Jater service ITempOrary Construction IChange in existing rp~j~~ncp Imultifamily, comm. or Indu<:.trial 10f ICOMM./IND. FEEOERS IInstall/alter/relocate I dic:trih. fpprlprc; 10f amps.1 I I aCL:7- Ca-~I ~.c, ~??9/.-1-SE ~ . 4~//::.~ /~,..j., "'7. ISSUANCf OF PFR!lIT ~~ -, TOTAl CHARGES - I TOTAl CHARGES that the Electrical work be done by an. Electrical Contractor, the electrical nortion of this permit label has been signed by an Electrical Sunervisor and returned to the Building Division amps.1 I Appl iance vent seOrirritp I Stationary evap. cooler I Vent fan with sinale duct I Vent system apart from I heatino or A.C. Mechanical exhaust hood rind duct Sewer IStorm Sewer I I I I I I Wood stove/heater TOTAl CHARGES WHERE STATE lAH REQUIRES shall not be valij until the 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 oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of OreC]on pertaining to the work described herein, and that rw OCCUPArKY 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 ORS 701.055 will be used on this project. tjAf'lE(please print)~lJ , \/"" J( F Z./tT SIr,IIATURE_!?/~~~ OATE //4JpP . FOr. OFFICE USE OIll Y , , Zone Type/Canst. Units Sq. Fig. f1ain x Value Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value Flood Plain Stories Occ'y Group Sq. Ftg. Other x Value TOTAl VALUATION BUIlDING PERf1IT Charges and Surcharges <C"T ~6 Plan Ck. COllU11/1nd ____.,..L!!?.='='___..22!/Bldo P.er Fee ~= Plan Ck. Res . 7- z:>./ 30%lBl do Per Fee 26 - Fence ----~-~---- / .So 06mo 'Sidewalk Systems. Develop~ent Cha rqe (1. 5~) . PlU'1BING PERMIT Charges and $urcha rges ElECTRICAl PERIHT Cha rges and Surcha rge~ A/e Paving ___________J Curb Cut I Total Comb. Permit tlECHAN I CAl 'PERMIT Cha rges and Surcharges I TOTAl 510. B"5 . . " J . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane Co~nty Map Reference II U3 43 '. 2. example- Lot 1. Block 3, 2nd Addition to springtiela Estates C. Name. etc. of owner and construction lender . D. . Energy Sources " - 1. examole- heat/electrical ceilinq!or forced air qas 2. examole- waterheater/electr;cal/or solar E. Square footage or valuation. etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examole - 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.nQl authorized to sign the electrical label. III. Applicant to sign and date Whenever possible, the initial application will b~ 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. \, V. FOR OFFICE USE ONLY Permit Clerk I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board Decause: Additional Project Information: PLANS REVIEWED BY: name /.P"/Y5 ;q:~~ signature , ~___.~ ..--'>da.~e /-7~12a ~.A _ _/,' ,.