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HomeMy WebLinkAboutPermit Electrical 1990-2-20 r Job Address EilERGY SOURCES: Heat -. -tL.. D:JIJ~I' Hater Heater Ranl'Je INFORHATlON lIN' 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use QtilE<7/onl Other- - l3uil(linq" Permit Info: Describe Work(i..e.. Build Single Fa.ll1ilv nesidence Hith JI..ttached Garaqe) fLljVLDdU.- 01 $i-/-6.tJnD ,~ . 1 INSPECTION LINE 726-3769 . -ZSO .N. AS,. Legal Description /7 - fJ6~:;;3 t;; :3 'J. CITY OF SPRINGFIE~D CDrlBlljATlON APPLICATION/PERMIT Construction lender fut!, OJ;(; (P Address S"R2-<.""\ &F IU]~ 2S\) N, A Chit ,--r'Y ~,,^10a !'!J(' Phone Owner Address DESIGN IlAI-\ {name} Phone (address) (1 ics. no.) (exnires) ~! 00;" ~'. (phone n'o. t Primary Sc", , Nh. ~ -r GAuAs NI.!t I (name) J.A4,,<<-vJ '2-1E.. O;yv..,MfJZJ:A..M.-- Q.-~ A:5<; 0 0A-rY'-5 IN(..., UJi:> S. ~(C-L.. 72(. -07~ Structura 1 Electrical Zau ::>,;-'\( l.oL- $YeMA> 7 2-(, -07f'~ Mechanical CONTRACTORS (address' (l ire:::. no.) (pxni ff>S) (ohone nn. ) J<f'1,7/<13 , Genera 1 8c.s- W. 2ND E:oCrfAJL OR--. Plumbincr Electrical ~~,.j ~CT/A.c.... 2::,135" ~.sofA.JU,T '1r'-I' f":JJ~97'-frrr... 2o'S:~G IP-(-C,x) ~lechanical PLUI1BING ELECTRICA~ MECHANICA~ NO. FEF CHARGE Nn ~FF rHARr.FI Nn_ FFF rHARr.F SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) ----I New circu~ts alts. or extenslons ~ &>A f776/'3"&'- ISERVICES I .ITempOrary Construction Change in existing rp~ i np,nrp multifamily, comm. or lnrluc;t.rial <<'~ Floor furnace and vent S. F. Res i dence (j bath) IDuplex (1 bath) each IAdditional bath I~Jater service I Sewer Istorm Sewer Recessed wall Sb~CP hp~tpr ~nrl vpnt Of amps. Appl iance vent seoil ra tp Stationary evap. r:nnler I Vent fan with sinale duct I Vent system apart from I heatinq or A.C. I Mechanical exhaust I hood and duct ~ I ~Jood stove/heater I I I I I I I Of amps.1 COI-\I-\./IND. FEEDERS Install/alter/relocate rlic;trih_ feedprc; TOTA~ CHARGES TOTAL CHARGES WHERE STATE L.\\~ REQUIRES that tlie Electrical work be done by an shall not be valii until the label has been signed by an Electrical ISSUANCF OF PFR!llT .:;;r.;.>-SC> TOTA~ CHARGES Electrical Contractor. the electrical portion of this per~it Supervisor and returned to the Building Division r HAVE~CAREFULLY EXN1INEO the completed apnlication_for ~ermit. a~d do he~eby cert.ifY_ tha~Jl in(o_rmat;~n_h~r~on is ~rue and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of th~ City of Springfield and the Laws of the State of Oreryon pertaining to the work described herein, and that rlO OCCUPAHCY \'ii11 be made of any structure without the permission of the Ouilding 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 ex p the basis for exemption is noted hereon, and tha~ ~~YV\~K(\C?{m~~nl~nce w OP.S 701.05 ,.'-,-' ~e ~on~i;;io;;ct. HAI.IE(please print) LA.rJMY ~(r Vr... ~'~...-vI_/ DATE Z -20- 10 CJ ~ sC']. ftg. f1ain x Value Sq. FtQ. Access x Value Sq. Ftg. 'lfher.4'..7.C",,/.....A ~lue 'YS;-~ -rV';W ~~li1 TOTA~ VA~UATlOrl /7 ,. I.q ~a) I Systems Development I ,E /..L1 ( U'. ~-..1 Charqe (1.5%) /Y,,/ '-. ------ Zone cc Tyoe/~st. ~-/~~ Units Bedrooms Occy Load Stories -;/ Occy Group _"'B-:::::< Fi re Zone Flood Plain BUI~DIHG PER~IIT Charges an~ Surcharges , ~lanCk. ___~~~.q_ 65%/Bldo Plan Ck. /3.':::>3 30%/BldQ I Fence I Demo ____~.:_s.::~J Sidewalk CommlInd Ppr Fpp Res Per Fee PLUI1BING PERMIT Charges and Surcha rges E~[CTRICP.~ PERI~IT Charges and Surcharges / -/3 AIC Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTA~ ';? <9 7/t;; . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address 8. legal Description 1. example- Tax Lot 100, lane County Map Reference II oj 43 2. example- Lot 1. Block 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1.' example- heat/electrical ceilinqfor forced air qas 2: examole- waterheater/electrlcal!or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. fOQt 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. example - remodel existing garage into family room 3. example - 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 .0. 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . " PERMIT VALIDATION : -,'. ....., " t ,- f) q-q() it ( 0'L2f3 v ., ',- Permit Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . name~-1?"fuE' ;z::z.c~ ~)"") signature ./7 /',~ /~__~/~date --r., '/.P' 7-7'- "'5"0