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Home My WebLink AboutPermit Electrical 1988-9-28 , ~-/'- -- I INSPECTION LINE 726-3769 . ~$ : /1 . Legal Description\ /J r I /J ,,;;' Owner' /~ ~dz / /lrlij/~ Address ~ /~cd- Sf, tTftl Phone 120 ~ 1J2#57 IS/~ CITY OF SPRINGFIE,D ' COMBINATION APP,ICATION/PERMIT EilERGY SOURCES: Heat Hater Heater Range ValuE of Hark: . INFORlIATION "!f.t 726-3753 Sq. Ftq. /.lain ~q. Ftg. Access. Sq. Ftq. Other Ilew Add A Her pep. --Fence Demo Change/Use Other - - ~ ---.i \)J Job Address Address DESIGN TEAl' (name) Phone (address) BUildinq Permit Info: Describe Work(i.e.. Build Single FamilY nesidence With Attached Garaae) ,,-fAA~~ /1/ //;5. ~p~ I Construction Lender (1 ics. no.) (exoires) (ohone no. I Primary El ectr; ca 1 4, ') I /1 n?l .) .I 0 Structural Mechanical CONTRACTORS (name) (addrpss) (lice;. no.) (PXO; fP<;) (ohonp nn.) Genera 1 Electrical j,J o CU P7\- I -ff'? r 7f/u&/./'_ rI\ vV' I Plumbina ~'echan;ca' P,UI1BING E,ECTRICAL MECHANICAL NO. FEF rHARr,F NO_ FFF r~ARr,F NO. FFF rI-lAR(:;F Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent S.F. Residence (1 bath' Duplex (1 bath) each SERVICES Recessed wall Snnr~ heater nod vpot ~Iater servi ce Temporary Construction Change in existing rp<;.; d~.nct" Imultifami1y, comm. or Tnduc;tr;i'll IOf ICOMM./IND. FEEDERS Install/alter/relocate di~trih. fppdpr~ amps.1 I I App1 iance vent SelJafi'lte I Stati onary evap. cooler Vent fan with sinale duct Vent system apart from I heatina or A.C. I Mechanical exhaust hood i'lnd t1uct Additional bath Sewer Storm Sewer Wood stove/heater Of amps. 1.)"1 TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valij until the ISSUANCE OF PF.RllIT I TOTAL CHARGES I 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 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 Oregon pertaining to the work described herein, and that fW OCGUPArKY 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 701.055 will be used on this project. Zone Fi re Zone Flood Plain Tyoe/Canst. Bedrooms Stories LATI MER- SIGN^TUREA~ ~T ,01, FOr. OFFICE USE ONLY Units Sq. Ftg. r~a;n x Occy Load Sq. Ftg. Access x Occy Group Sq. Ftg. Other x DATE C[-z.~-'iIY NAME(please print) ~N~ Value Value Value TOTAL VALUATION BUILDING PERflIT Charges and Surcharges , P1 an Ck. Conm/lnd 65%/Blda Ppr Fee ------------ Plan Ck. lies 30%/Bl do Per Fee Fence 'Systems. Development l Charoe (1.5~) , PLUI~BING PERMIT Charges and.-- Surcharges. D~mo (::; ,(YC) 'Sidewalk ------------ .7<)' AIC Paving Total Comb. Permit ELECTRICAL PERI~IT Charges and \ Surcharges ~ MECHANICAL PERMIT Charges and Surcharges Curb Cut I I TOTAL l5.75 . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100, lane County Map Reference 17 oj 43 2. exam~le- Lot 1. Block 3. 2nd Addition to springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. examole- waterheaterjelectrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. exam~le- 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. examoJe - 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES 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. \~L{3/ q r 2.5( - rr V. FOR OFFICE USE ONLY Permit Clerk c~ 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 .