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HomeMy WebLinkAboutPermit Electrical 1982-2-2 ] IhsPECTION LINE 726- 37 69 , Job Address 0 J 7 UJ. Legal Description SAM L .... CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT · ENERGY SOURCES: Heat Hater Heater .''" - INFORI1ATION liNt 726-3753 " Sq. Ftg. r'1a in Sq. Ftg. Access. Sq. Ftg. Other Net'! Add Alter Rep. -Fence Demo Change/Use -Other- - 0<J f"0 C) o b, ~ 1 ~EJ.J1t.AJAJ(A L- Range ValuE. of I-/ork: Phone BuilGinq Permit Info: Descr,be Work(i,e.. Build Single Family Residence With Attached Garaqe) I P-I-Ld v 1-'6 d- -7;)';}' 7 f?.LE C, tuoR.ct:- (~~) rj / j Construction Lender , Address DESIGN TEAt4 " (name) Phone (address) (1 i cs. no.) (expires) J" Cphone no.) Primary " r~- - J stn.lctl!ra 1 r---'-- J Elt:ci:ri cal ! ,--- i t1ertlanical fcON'i'RAC10Rs ' i - -_. -'1'; ~(na~e 1__,_ (address) 1---- ---'r'.--' , (l'ics. no.) - (~xpiYes)-=- --'-(bhone-'nn,L - ii -'-=-~-=- -~-=~-'-- Iii ~l__ Ii f' ,0 --- ji I I' General Plumbing , Electrical r~g~r~lli~2L_--;~-:~;;~~-~,,~c=,-==,-- -~---,- ,==,=, -_r~-:I~C~Ri C~:~_O~'~'~-- -~, -, -----.'-r"- " '--'~,,-= ,'.. ~~~(~::~~A!~-" r=-- [: (~'NO~';':=;~:'- '=-~"----~--- -~C7Er~1- CHARGE"l'N(;~"T~:~~'~~~:::;' --, ,',< - , ',' ': ,1~'''Fttl8R*~ch~;:f~i;~:e;~~:__~~:I~' ::-~_ _:['1EF~CHAR(iF_~ ::~~~~:':":: ::::' , Ii' - New -:~ r~Uit:~l::. FT .- --~-- ~,:.~. -- :.....aFI110~:v\:e'n0~'" 'W' '-.--- :: (new fix. additional) I ~ or exi:eilsions !. i: i- I SERVICES -J'------- RecessedWall ";.,1 ,__ ,_$Q.~u;.. heater and vel11_ _ _ _1, J ': jTempOrary' Construction --, App1iar.::e ~t- ---,------- -~,; separate ., I IChange in existing Stationary evap. I res i dence coo ') er ~ I Imu1tifamily, comm. or Vent fan with, J Industrial sinole duct I 'I 10f I I Vent system apart from H amps. heating or A.C.; u I ICOMr"./IND. FEEDERS I I Mechanical exhaust . ~,' hood and duct Ii I 1~~~~~~~~a~;:~~~~locate I -' Hood stove/heater ~___ Ij, : ~ ~l IOf ::I~=:=~:,I- __ - ___ __:~= I ,~ I I __ _ _,__--!_, __--' ~ ,I I I ISsUANc.:....O~_~~!~ty _ .=..1 TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES I U WHERE STATE LAH REQUIRES that the E1ect'r;ca1 work be done by an 'Electrical Contractor, the electrical portion of th'is permit' t' shan not be val i-1 until the label has been signed by an Electrical Supervisor and returned to the Building DiViSi1n " ~ I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all information her40n"T;;-iruen, ~ :and correct, and I further certify that any and all work performed shall be done in accordance with the'Ordinanceslof the City ~ 10f Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAJ4CY ~i1l be made ' of any structure without the permission of the Building Division. I further certify that my registratiol. with thelBui1der's Board is in full force and effect as required bY,ORs 701.055, that if exempt the basis for exemption is noted here~n, and that ,only subcontractors and employees who are in comoliance with ORS 701.055 will be used on this project. I COfu.((~.M.'i.- " Fate coloAfTtALt.. ' / NAr-1E(please print) 1A)/: '5 G uJJTE. \-- sIGNATURtv.J. ~~ DATFI,-;J.-8':l. FOr. OFFICE U?E or~~L__ --.-to -----~~~..n--~==""~--, __c_ _~~~_.-=-~:- , - --,----' s.F. Residence (l bath) Duplex (1 bath) each Additiona'l bath ~Jater servi ce Sewer Storm Sewer F'i re Zone Fi,'):Jd Plain Sq. Ftg. Sq. Ftc). Sq. Ftg. Access Other x Value __Value ~ J" -.,-. -~' I. il il I I Zone v _Type/Const. Bedrooms stori e,s Units Occy Load Occy Group ~1a in x___, .value x TOTAL VALUA'nON BUILDING PE:.R~1IT Charges and sUi"charges Plan Ck. 65%/Bldo ------------PTan Ck. 30%/Bldq Fence CommlInd Per Fee Res Per Fee Systems, Development Cha rqe ('1 :5%) PLur1B ING PERMIT Cha rges and Surcharges DlJmo _ ___ _ LQ,-OJj I Sidewalk . tJ() I A/C Paving ___________-' Curb Cut I ~ I J ELE.CTRICfl,L PERrm Cha rges and Surcharges ITotal Comb. Permit I TOT" ~;.~ II ',~ MECHANICAL PERMIT Charges and Surcharges . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant'to furnish A. Job Address B. Legal Description 1. examp 1 e-' Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinqjor forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq, foot garage 2. ' example- if new project, checknew - 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. Abbreviat~d 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 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. 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. 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. Lhd </70 III. IV. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 6-79Lff IO,.,()O ~ 16 10, '-10 "-_-::'~ . ~ Permit appl i cant exempt from regi strati on with the Buil der I s Board because: _ Additi ona 1 Project Infonnati on,: '"'''' PLANS REVIEWED BY: name signature (JA_~ - date