HomeMy WebLinkAboutPermit Electrical 1983-12-20
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I ItlSPECTlOll LIflE . CITY UF SPRlflGfIELD
726-3769 C0/1BIlIATION APPLICATION/PERMIT
1 " EflERGY SOURC~
Job Address !,..t;Il~. <!''''Je~ ~ fPftIJ:- Heat ~ fiI21,
Legal Omription \1l)'6?:>S::S8 (ma) ilater Heater
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Address
Owner ~ PK/J,/!..A!3J)
lIr/l..I1Y lSa4I?D
-'741'71341;' / Phone
Construction lender
Address
UESIGN HAr.1
Primary
DlE6/b/J 15~M-:'
(name)
Structura 1
Electrical
11echanical
CONTRACTORS
General
Plumbina
(name)
n:....d6/J ~-(J11';Mtt,
INF0R11ATION LHtt
726-3753
Sq. FIg. f.lain
~q. ~tg. Access.
5q. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other - -
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N
W
"-
ur
Ranqe
vff4.~~rb
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BuilGina Pernlit Info: Describe Work(i.e.,
Familv nesidence With Attached Garaae)
Build Single
f? t.~ Wt:r w,{)~ 1V ~1t.THv'AL
IZ So R' (p J..,J7(;:, A1J1)? Ufitt);o GKJrr d~
Phone
(address)
lli"cs. no.)
(exoi res)
{phone no.
P-e.aPll ~ 4- 35
P.flb 17X' C:n4t7~ M!73t? y~
(address' (lir:c;. no. \ (exoirps) (ohnne no.)
tp(!J /3~ ~J; q/b t'R "74C>~ t ZqUJ!ioR.)
~lechanical
(.dY tlJet/ J!3-Lf!L:rI<?!t:
IU?~ ~AJI'-=>.
HAl?ilXJ'l<'{).
~7 /'2'12
74-1 P.t'P z..
, Electrical
PLUIIBING
NO.1
lEaCh single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
(j bath)
louPlex (1 bath) each
IAdditional bath
1~later service
Sewer
Storm Sewer
FfF
rHARr,F
ELECTRICAL
MECHANICAL
Nn ~ ~~~
I Res i dence of
5Q. FT.
~1'New circu~ts alts.
O~::J~l~~ ("J';'"
I SERV I CE5
I
ITempOrary Construction
IChange in existing
rp~id~nce
Imultifamily, COIJJll. or
Tnnll<:.triil1
10f amps.1
ICOMH./IND. FEEDER5 .
I Install/alter/relocate
rlic::t.rih. fppdprs
10f amps.1
I
I
I
nHI.Rt::F ~m_
FFF rHAP(:;F
furnace/burner to
BTli's
:~>
/4),- .
Floor furnace
and vent
Recessed wall
~nil~p hpiltpr ilnd vpnt
Appliance vent
seoa ra tp
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood nnd dud
I \'/ood stDve/h_eater I I
0/ l,f~~ J..,Z!::$~ lI~
I . '1 I
I I I
~A!Er ... -c:r:_
TOTAL CHARGES TOTAL CHARGES /C/.- TOTAL CHARGES /~ -
. WHERE STATE L.'H REQUIRES that tile Electrical work be done by an.'Electrical Contractor, the electrical portion 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 EXM11NED 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 performed 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 OCCUPAUCY 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 7Ql.055 will be used on this project.
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rWIE(please prin(, aHel~ A
Zone
Fire Zone
Flood Plain
BU I LO IflG PERf.1IT
Charges an~
Surcharges
PLUt1BING PERMIT
Charges and
Surcha rges
ELECTRIC~.L PERI~lT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
s m.rrn
Type/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
SIGtlATURE
FOr! OrFICE llSE OW.Y
Sq. Ftg.
Sq. Ftg.
5q. Ftg.
Of&
DATE
1'21"'P~1
x
x
Value
Value
Value
Hain
Access
Other
x
TOTAL V ALUA TI ON
Systems Development
Charoe O.5~) .
Plan Ck. Comm/lnd
65%/Rldo Per Fpp
------------ Plan Ck. R-es
30%/Bldo Per Fee
Fence
_____j~, CO Sidewalk
. yo AIC Paving
/0, AO Curb Cut
------------
.~O
Demo
Total Comb. rermit
TOTAL
;;;:t:). 80
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COMBINATION APPLICATION/PERMIT (CAP)
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CI~OF SP'RINGFIELD
City Hall
Sprfngflald, Oregon
Department 01 Public Worl<a
OFFICIAL RECEIPT
No. B 62149
Date p~ 20/19..$"5
Rec'd Frome'"" ,#;Ii'/S /1. ~M/ rA" .
Address '"Ro,75<11>x ':6 '1.3"5 -'~~... ,:'"'
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Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Refere
II OJ 43
2. examole- lot 1. Block 3, 2nd Addition ~o
Sprlogfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinQ/or forced a ~
2. examOle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot 9
2. .example- if new project, check-nfw - if addi f'
check add. etc.
F. Building permit information:
1. example - construct single/family house w;th
attached gar~ge (
2. examole - remodel existing garage into famil '".
3. example - convert single family residence in
restaurant (change of use) .
G. Value of work as defined in Section 303 (a) of t (
Structural Specialty Code
H. DESIGN TEM4 ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropria (
persons regarding design information or job site
corrections. etc.
Abbrev)ated Plumbing, Mechanical. & Electrical Sched
A. Except where blank spaces occur in the descripti ('.
portion of the Mechanical and Electrical Schedul
the applicant need fill-in only the No. Boxes ad
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical. and Electrical Schedu (
are available at the Building Division
1. To conserve space on the permit form the sch
have been abbreviated
2. If the item(s) to be installed are not cover
the abbreviated schedules you should consult
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered
electrical contractor for signature by his elect
supervisor. The general contractor is .not authorized -
to sign the electrical label. ---
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 actua1 permit is issued for his
signature.
Fees and Charges
Plan check fees are due and payable at the time of the
application. and no p1ans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
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Received FO~~,
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7?~.;~ pEF<
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Amount Received A-C!-/
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v __ AUTHORIZEDSIGNAl\J$lE '" \......
.,11100S ..RINTERS/LlTHOORA..HER_. EUGaNE. OREOON
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FOR OFFICE USE ONLY
Pennit
Clerk4.P ,n.~~!
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PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
PLANS REVIEWED BY:
name Le>7?N~ ~~~~ Signatur~"""""""'~- ~ date /2-~-8:S:-