HomeMy WebLinkAboutPermit Electrical 1982-5-4
"I~
.
CITY OF SPRINGFIELD
COMBIlIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Ranqe
Va 1 Uf of Harle
.
INFORlIATlON UNt
726-3753
Sq. FtQ. r.lain
~q. Ftg. Access.
Sq, Ftg. Other
New Add Alter Rep,
--Fence Demo Change/Use
Other- -
~
~
~/
~'
'I IrlSi'ECTI0II LIIIE
726-3769
Job Address
/1/7
:)aa r~
A '~./.
legal Description
Owner
N'Ca.i.AI ~~?#,/v4r
1117 -s;,."".". /I' "!5 r..
<;P.&t.'P., &PR. "'77Y7?
~ ~+.;"'"
Phollf-,.-.;'JI?J'
Buildino Permit Info: Oescr.be Work(i.e.. Build Single
Familv nesidence With Attached Garaael
6€.LTRI'::",t. 0tSH77h'O, ;:;;;e::.
~rN :5n?E ~ W6'!>T Ei9z>
#D,;;1/T,Ch.l .
{lies. no.)
(exoires)
(ahoM no..
Address
Construction lender
Address
Ut::illiN TEAH
(namel
Phone
(address)
Primary
Structural
Electrical PReP Wt9J'TKo",:
Mechanical
CONTRACTORS
-;Z~ M~",,__c:Sr. . Eu.::. ~c
,
~.~~:Z<
'.;
(namel
(address 1
(1;cs. no.)
(pxo;rp~l
(ohonp nn,l
General
Plumbina
Electrical Alk-" ~./ /11;41. F'.Le<:77'?/.c/4-N'>
~1echanical
PLUllB I NG
110,
FFF r.HARr,F
ELECTRICAL MECHANICAL .-
Nn t:;:';:' r" 'IllG.E JJQ.... FFF r" 'l.RGL
Residence of furnace/burner to
SQ. FT, BTU's //
New circuits alts. Floor furnace
or.extenSiOrl,S..~ /5".- and vent
Z ..~ ~~
I SERVICES l Recessed wall
Sn~rp hp~tpr ~nrl vpnt
I I
Each single fixture
Relocated building
(new fix, ,additional)
IS,F. Residence
(1 bath)
IDuPlex (I bath) each
Additional bath
Sewer
I
I
I
I I
i~-r
I I
I
I I ISSUANCF OF PFRIIIT
. TOTAL CHARGES .(..r:-""'~ .f. -. TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Temporary Construction
Change in existing
rpo;jrjpnrp
Imultifamily. camm. or
Industrial
10f
ICO~4,/INO, FEEDERS
I Install/alter/relocate
didrih. fpprlpr<;.
-+-t^'
I
amps.1
Appliance vent
~PO~ri\t.p
Stationary evap.
cooler
Vent fan with
sinol~ rluct
I Vent system apart from I
h~atina or A.C.
I Mechanical exhaust
hnorl ~nd dlJct
I Wood stove/heater
I
I
I
f
Water service
Storm Sewer
~"
U"I~~I
'..... ',\
TOTAL CHARGES
, WHERE STATE LAW REQUIRES
shall not be valid 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 Derformed 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 OCCUPAfKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder'~
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 701.0 ill be use~roject,
IW'lE(please print) 1)13")1/11"0/ J AIC, tJ 1'--./ SIGIlA URE AA~MAA./r>^ _ !lATE ph:L
FOP. OFFICE US'( miLy 41
Sq, Ftg, !lain
SQ. Ftg. Access
Sq, Ftg, Other
Zone
/11 -=-'3
Tyoe/Const,
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
Fire Zone
,
Flood Plain
Stories
,
TOTAL VALUATlO~1
BUILDING PERf.lIT
Charges and
Surcharges
I Plan Ck.
65%/Bldo
Plan Ck.
30%lBldq
Fence
Corrm/Ind
Ppr F".".
Res
Per Fee
Systems Development I
CharQe O,5~) . ,
PLU!~BING PERMIT
Charges and
Surcharges
Domo
_n_'-~:'~nIS1dewalk
.. 60 A/C Paving
~___________ Curb Cut
I
I
I
ELECTRICAL PERr~1T
Cha rges and
Surcharges
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surch,"rl1~s
[ TOTAL
$ I,)." 60 '~
.....- . ...._-~---,,-,_.
-- --~_.-...__.."----,.._..-- ..~_........... - ---.._--.~-_..-
.
iI
COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A. Job Address
8. Legal Description
.1. examp.le. Tax Lot 100. Lane County Map Referer
1/ 03 43
2, exa~le- Lot I, Block 3, 2nd Addition to
~prlngt;eld Estates
C. Name. etc. of owner and cons"truction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinqlor forced ai
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I, examole- 1250 sq, foot house, 500 sq, foot ga
2. examDle- if new project. check-new - if add;t
check add. etc.
F. Building pennit information:
1. example - construct single family house with
a ttached garage
2. example - remodel existing garage into family
3. example - convert single family residence int
restaurant (change of use) .
G, Value of work as defined in Section 303 (a) of th
Structural Specialty Code .
H, DESIGN TEM1 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriat
persons regarding design infonmation or job site
corrections, etc..'
II. Abbreviated Plumbing, Mechanical, & Electrical Schedu
A. Except where blank spaces occur in the descriptio
portion of the Mechanical and Electrical Schedule
the applicant need fill-in only the No. Boxes adj.
to the appropriate item{s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedul,
are available at the Building Division
1. To conserve space on the permit fonm the schel
have been abbreviated
2. If the item(s) to be installed are not coverel
the ~bbreviated schedules you should consult.
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANI
CHARGES ON THE SCHEDULES
D. As noted on the CAP. the label must be delivered"
electrical contractor for signature by his electro
supervisor. The general contractor is.~ author"
to sign the electrical label.
III, Applicant to sign and date
Whenever possible, the initial application will be USI
a worksheet only. Where possible, Building Division ~
will prepare a type written copy and return it to the
applicant at the time the actual penmit is issued for
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 penmit is issued.
V, FOR OFFICE USE ONLY
.
,';
, '<
PERMIT VALIDATION
'\
(
-,-
CITY OF SPRINGFIELD
(
(
City Hall
Springfield, Oregon
Department 01 Public Works (
OFFICIAL RECEIPT 6
' , No. B 5898 (
Dste IS"" ~ l\ 1tK~ .
Rec'dFm~\Ur-\( : ,,-r (IJ:)m. (
Address ~D ~03SS .QJ.. b
<rC
~
,
"
(
~m
Received F.or:
e .'i!:.-
x;::) 06100
.(
(
r-\LQ T'-TJ
I~~U
(0'0
(
LfY?-l
c;
(
t
'c
c
\,
(0.
Amount Received I ~. In ()
ct) (/)~ )
; A.UTHORlZEDSlGNAlURE
(0~
(
(.
(
/
.~ :~
(
\.
(
BRIOGS PIIINTlERtlJLlTHOGItAPHlERtI.lEUQlENlE. OlllEOON
"". _ 1_
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
'"'
nilme
sicl"I~t:!lr~
..,l ".:=.
i
date
'."-.:". -