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Home My WebLink AboutPermit Electrical 1982-5-4 (2) /",..... 1 INSP~CTIO~ CUIE 726-,769 ' Job Address .~a" 7'N- ///7 Legal Description . . CIIY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat t~ater Heater INFORllATlON UNt I 726-3753 Sq, Ftg, 1,lain ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Rep. --Fence Demo Change/Use Other -- -- A'<1': ~ ~ N, g, Ranqe~ Value. of Nork: NICOLAI ~?~<r' '1117 s.,,", ;; '~r. <) PF(.P" ePJiI? 9'/ '1'77 ~~-h",-- I~~T I I I I I ISSUANCF OF PFRlllT r--oca - -r= TOTAL CHARGES I TOTAL CHARGES /,). ~ oJ . I TOTAL CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be va1i1 until the label has been signed by an Electrical Supervisor and returned to the Building Division Owner Address Construction Lender Address Ut.~ H:iN TE.At1 lnameJ Primary Structural Electrical PRsp WA/ rK'oP Mechani ca 1 CONTRACTORS (name) General Plumbina Electrical A/~~/ /h/t.L /llechanical PLUI1B I NG NO, FEE r.HARr:F Each sing1e fixture Relocated building (new fix. additional) -' S.F. Residence (] bath! I Duplex (I bath) IAdditional bath I Water service I Sewer I Storm Sewer I I I I I I each , I I I I Buildino Permit Info: Describe Work(i.e., Build Single Familv Residence With Attached Garaoel 6/tF'T7?/~A(' Ut$HT/;<rc;., /6~ ~rH :5dJ€ 'f' W6"!>T Ei?lz> I'fPP/T/~h,r ' (lies. no.) Pho"i2~~1 Phone (address) (exoires) (ohone no.') -;Z~ /V!",,.;i?o€ 57: , E~ ~c I q8.r.~"?<.z (address 1 (1 ir:s, no.) (pxniresl (ohonp no.) C L -=C7H/c:J~.#" / ELFCTRICAL NO Residence of SQ, FL New"circuits alts. 2 or'extensioO?-..ce- ~R~ SERVICES Recessed wall So~rp hp~tpr ~nrl vpnt MECHANICAL /' I ("l-Il1Q~~ rI-lAQr::~ NO >>> >>> furnace/burner to BTU's / / Floor furnace and vent /S.- ITemporary Construction IChange in existing rp$ i q~.nce jmultifamily. camm. or Induc;triill [Of ICOMM,/IND, FEEDERS I Install/alter/relocate rli~trih. fpprlpr~ ~< I App 1 i ance vent seoaratp I Stationary evap. cooler 1 Vent fan with sino 1 educt I Vent system apart from I hea t i nq or A. C. I Mechanical exhaust hood and duct I ~lood stove/heater I amps. ~#"o;;- "'''"~I I ! '- I HAVE CAREFULLY EXJ\tlINED 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 rw OCCUPAIKY 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 OP.S 7nl.O ill be used 0 1S roject. NPJ.1E(please print) 1Jt::JI-/\/ D~Jl.Jc, () "I SIf,iI~ URE . FOR OFFICE USE o~Ly Zone fi1 ="3 Type/ConsL Units So, Ftg, f1ain Fire Zone Bedrooms Occy Load Sq, Ftg. Access Flood Plain Stories Occy Group Sq, Ft9, Other om .J/t;hz. . 1 /MA -dJnA _ x x Value Value Value x TOTAL VALUATION BUILDING PER~\IT Charges anG Surcharges I Plan Ck. CammlInd 65%/Rldo Ppr Fpe --------------p;-an Ck. R'es 30%/Bl dq Pp.r Fee Fence PLU'1BING PERMIT Charges and Surcharges ELECTRICAL PERr~1T Charges and Surcharges ____I s". 00 , ,60 /lECHANICAL PERMIT Charges and Surcharges ISyste~s ,Development Charqe (1.5%) , Demo I-Sidewalk A/C Paving Total Comb. Permit Curb Cut ;1 /<:6::>\ ./<./' ~- ", "n, V",_ I I TOTAL . . ,. :.-. f' ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100. Lane County Map Reference II 03 43 2. example- lot 1. Block 3, 2nd Addition to ~pr'~gtie'd Estates '". C. Name. etc. of owner and cons'truction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Q35 2. exaTl!Ple- waterheater/electrlca l/or. solar. E. Square footage or valuation. etc. 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, check add, etc. F. Building permit information: .1. example - construct single family house with an attached garage . 2. examole - remodel existing garage into family room 3. examjle - 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 deslgn 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 ~bbreviated schedules you should consult the full schedules C, BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOU~ES 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. --- III. 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 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 PROJECT CONDITIONS TO BE 'SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date . ..